Presentation on theme: "ICD-10-CM Everything You Need to Know … For Now"— Presentation transcript:
1 ICD-10-CM Everything You Need to Know … For Now 2009 CodesThe single most significant coding change in 30 years is before us – the conversion from ICD-9 to ICD-10The change will impact virtually all facets of your clinical practice and research. Major changes will have to occur to our business processes and our information systems. Countless hours will need to be spent education our faculty and the vast majority of our staff.
2 Main Objective Create an awareness of ICD-10-CM. Start to consider the impact the conversion to ICD-10 will have on your operations.Participants can help spread the “word” throughout the University.
4 What is ICD and ICD-10?ICD is the World Health Organization's International Classification of Diseases and Related Health Problems and is the international standard diagnostic classification system.ICD-10 is the abbreviated term used to refer to the 10th revision of the ICD.From which ICD-9 and ICD-10 are derivedICD-10 was endorsed by the World Health Assemble in May 1990 and came into use in WHO Member States in 1994
5 What is ICD-10-CM and ICD-10-PCS? The U.S. clinical modification (CM) of the WHO’s ICD-10, maintained by the NCHS.Includes diagnoses which will be used by all providers in every health care setting.ICD-10-PCS:The procedural coding system developed under contract by the CMS.Includes procedure codes which will only by used for hospitals claims for inpatient hospital procedures.
6 Implementation Date – October 1, 2013 On January 16, 2009, the Department of Health and Human Services published a Final Rule for the adoption of ICD-10-CM and ICD-10-PCS code sets.All HIPAA covered entities must be ICD-10 compliant on October 1, 2013.The compliance date is firm and not subject to change:There will be no delay.There will be no grace period for implementation.There will be no impact on CPT and HCPCS codes.Coding class 1993 – WHO adopting ICD-10 in 1994ICD-9-CM codes will not be accepted for services provided on or after October 1, 2013."Unfortunately, I believe some speakers in the industry talk about maybe this being delayed or postponed or double coding, but let me make very, very clear to you that the HIPAA final rule states that this is a firm implementation date of Oct. 1, 2013." - Pat Brooks, RHIA - Senior technical adviser, Center for Medicare Management, CMS
8 Why is ICD-9 Being Replaced? ICD-9-CM is out of date and running out of space for new codes.Lacks specificity and detailNo longer reflects current medical practiceICD-10 is the international standard to report and monitor diseases and mortality, making it important for the U.S. to adopt ICD-10 based classifications for reporting and surveillance.ICD codes are the core elements of HIT systems, conversion to ICD-10 is necessary to fully realize benefits of HIT adoption.1) ICD-9-CM is not sufficiently robust to serve health care needs of the future.2) The US is the only developed country that has not yet implemented ICD-103) limited structural design cannot accommodate advances in medicine and medical technology and the growing need for quality data
9 Coding Process Remains the Same ICD-10-CM code book retains the same traditional formatIndexTabularProcess of coding is similarLook up a condition in the IndexConfirm the code in the Tabular
10 Major Differences Between ICD-9-CM and ICD-10-CM 13,600 codes69,000 codesCode book contains 17 chaptersCode book contains 21 chaptersConsists of 3 to 5 charactersConsists of 3 to 7 characters1st character is alpha or numeric1st character is alphaOnly utilizes letters E and VUtilizes all letters (except U)Second, third, fourth, and fifthcharacters are always numericSecond characteris always numericThird, fourth, fifth, sixth, and seventhcharacters can be alpha or numericShorter code descriptions becauseof lack of specificity andabbreviated code titlesLonger code descriptions because of greater clinical detail and specificityand full code titles5x more codes in ICD-10, than ICD-9ICD-10 code book contains more chaptersSplit some I-9 chapters in to two – nervous and sense organsv and e codes were supplementary chapters in I-9, now own chapters3) I-9 3 to 5, I4)10 key pad, much easier to make errors reading letters1st digit is alpha – letters A-Z, except UV codes are now Z codesCodes #s will be different
11 Comparison of ICD-9-CM and ICD-10-CM ICD-9-CM CodeIcd-10-CM codeA - Category of codeB - Etiology, anatomical site, and manifestationA - Category of codeB - Etiology, anatomical site, and/or severityC - Extension7th character for obstetrics, injuries, and external causes of injuryABABC
12 Comparison of ICD-9-CM and ICD-10-CM ICD-9-CM CodesICD-10-CM CodesPressure ulcer codes9 codes–125 codesL89.0-L89.94Codes:707.0 Pressure ulcerunspecified siteelbowupper backlower backhipbuttockankleheelother siteCode Examples:L – Pressure ulcer of right lower back, stage IL – Pressure ulcer of right lower back, stage IIL – Pressure ulcer of right lower back, stage IIIL – Pressure ulcer of right lower back, stage IVL – Pressure ulcer of right lower back,unspecified stageL – Pressure ulcer of left lower back, stage IL – Pressure ulcer of left lower back, stage IIL – Pressure ulcer of left lower back, stage IIIL – Pressure ulcer of left lower back, stage IVL – Pressure ulcer of left lower back,L – Pressure ulcer of sacral region, stage IL – Pressure ulcer of sacral region, stage II…L89.90 – Pressure ulcer of unspecified site, unspecified stageThe codes on the right are only a small set of the 125 potential pressure ulcer codes offered in ICD-10Pressure ulcer stages 707.2x separate codes (6 codes) , difficult to match up if more than one pressure ulcer
13 New Features of ICD-10-CM Combination codes for conditions and common symptoms or manifestationsCombination codes for poisonings and external causesAdded lateralityExpanded codes: injury, diabetes, alcohol/substance abuse, postoperative complications
14 New Features of ICD-10-CM Added extensions for episode of careInclusion of trimester in obstetrics codes and elimination of fifth digits for episode of careExpanded detail relevant to ambulatory and managed care encountersInclusion of clinical concepts that do not exist in ICD-9-CMChanges in timeframes specified in certain codes1)A Initial encounter for closed fractureB Initial encounter for open fractureD Subsequent encounter for fracture with routine healingG Subsequent encounter for fracture with delayed healingK Subsequent encounter for fracture with nonunionP Subsequent encounter for fracture with malunionS Sequelae2) Delivered, Antepartum or Postpartum is replaced with the trimester3) No info4) Underdosing5) Acute MI is 8 weeks in ICD-9, 4 weeks in ICD-10
15 Examples – ICD-10-CM Codes I10, Essential (primary) hypertensionA69.21, Meningitis due to Lyme DiseaseO9A.311, Physical abuse complicating pregnancy, first trimesterS52.131A, Displaced fracture of neck of right radius, initial encounter for closed fracture
16 Examples - Combination Codes Combination codes for conditions and common associated symptoms and manifestationsI25.110, Arteriosclerotic heart disease of native coronary artery with unstable angina pectorisK50.013, Crohn’s disease of small intestine with fistulaCombination codes for poisonings and their associated external causeT42.3X2S, Poisoning by barbiturates, intentional self –harm, sequelaIn ICD-9 these codes would require multiple code assignmentsICD-10 has combo codes for ASHD with angina. When using one of these combo codes it is not necessary to use an additional code for the angina pectoris. A casual relationship can be assumed in a pt with both atherosclerosis and angina pectoris unless the documentation indicates the angina is due to something other than atheroslerosis.ICD-10 provides combo codes for complications commonly associated with Crohn’s dz.
17 Examples – Combination Codes Diabetes Codes in ICD-9Diabetes Codes in ICD-10Secondary diabetes mellitus with peripheral circulatory disorders, not stated as uncontrolledDiabetic gangreneDiabetic peripheral angiopathyE Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangreneDiabetes with other coma, type I, not stated as uncontrolledE Type 1 diabetes mellitus with ketoacidosis with comaDiabetes with neurological manifestations, type II or unspecified, not stated as uncontrolledMononeuritis of unspecified siteE Type 2 diabetes mellitus with diabetic mononeuropathySecondary diabetes mellitus with renal manifestations , not stated as uncontrolledChronic kidney disease, unspecifiedE Diabetes mellitus due to an underlying condition with diabetic chronic kidney diseaseICD-10 diabetes mellitus codes are combination codes that include:the type of diabetes mellitusThe body system affectedThe complication affecting that body systemICD-10 DM is no longer classified as controlled and uncontrolled
18 Examples – Added Laterality C50.212, Malignant neoplasm of upper-inner quadrant of left female breastH16.013, Central corneal ulcer, bilateralL89.213, Pressure ulcer of right hip, stage IIIH61.20, Impacted cerumen, unspecified, earH61.21, Impacted cerumen, right earH61.22, Impacted cerumen, left earH61.23, Impacted cerumen, bilateralReduction in claim denials
19 Examples – Obstetrics and New Clinical Concepts Obstetric codes identify trimester instead of episode of careO26.02, Excessive weight gain in pregnancy, second trimesterInclusion of clinical concepts that do not exist in ICD-9-CMT45.526D, Underdosing of antithrombotic drugs, subsequent encounterZ67.40, Type O blood, Rh positive
20 New Official Guidelines and Coding Clinic The AHA Central Office serves as the clearinghouse for issues related to the use of ICD-9-CM.With the transfer to ICD-10, a new office will be developed called AHA Central Office on ICD-10-CMCreation of new official guidelinesDevelopment of the AHA Coding Clinic for ICD-10 (similar to the Coding Clinic for ICD-9 but will require a major overhaul)Maintains integrity of the classification systemRecommends revisions and modifications to current and future revisions of ICDDevelops education material and programs on I-9Answers questions from providers related to I-9Publishes AHA Coding Clinic
22 What are GEMs? “GEMs” stands for General Equivalence Mappings The CMS and the CDC created GEMs to ensure consistent national data when the U.S. adopts ICD-10.The GEMs will act as a translation dictionary to bridge the “language gap” between the two code sets and can be used to map an ICD-9 code to an ICD-10 code and vice versa.Mappings between ICD-9-CM and ICD-10-CM will play a critical role in the successful transition to ICD-10. The CMS and the CDC created the GEMs to ensure consistent national data when the US makes the transition.
23 Purpose of GEMsDesigned to give all sectors of the healthcare industry that use coded data the tools to:Convert large databases and test system applicationsLink data in long-term clinical studiesDevelop application-specific mappingsAnalyze data collected before and after the transition to ICD-10-CMThey are public domain, general purpose reference mappings designed to give all sectors of the healthcare industry that use coded data the tools to:
24 Not a Substitute for Coding The GEMs should not be used as a substitute for learning how to use the ICD-10-CM code sets.“GEMs are not a substitute for learning ICD-10-PCS and ICD-10-CM coding. They’ll help you convert large data sets.”Mapping simply links concepts in the two code sets, without consideration of context of specific patient information, whereas coding involves assigning the most appropriate code based on documentation and applicable coding guidelines.They were created to serve a specific, limited, short-term need – primarily for translation purposes.Compare GEMs to a Spanish to English dictionary, where both languages can be found and speakers can go back and for the to translate from one to the other.Pat Brooks, senior technical advisor, CMS stresses that the GEMs are not substitute for learning ICD-10. A GEM should NEVER be used as a way to code in ICD-10. GEMs were not developed act as a substitution for learning to code in ICD-10.
25 Why a GEM Won’t Always Work A clear one-to-one correspondence between an ICD-9 or ICD-10 code is the exception rather than the rule.ICD-9 codes: Coronary atherosclerosis of native coronary artery and Intermediate coronary syndrome (unstable angina)ICD-10 code :I Atherosclerotic heart disease of native coronary artery with unstable anginaThere are situations when a code in the target system does not existT503x6A Underdosing of electrolytic, caloric and water-balance agents, initial encounterNot all ICD-9 codes are used in ICD-10, Not all ICD-10 codes have comparative codes in ICD-9
26 Forward and Backward Mapping Forward MappingICD-9 CodeDescription(Source)820.8Fracture of unspecified part of neck of femur, closedICD-10 CodeDescription(Target)S72.009AFracture of unspecified part of neck of femur, initial encounter for closed fractureBackward MappingICD-9 CodeDescription(Target)820.8Fracture of unspecified part of neck of femur, closedICD-10 CodeDescription(Source)S72.001AS72.002AS72.009AFracture of unspecified part of neck of right femur, initial encounter for closed fractureFracture of unspecified part of neck of left femur, initial encounter for closed fractureFracture of unspecified part of neck of femur, initial encounter for closed fractureIn the backwards mapping example, all three ICD-10 codes would map onto Even though the ICD-10 codes are specific to a side of the body, the ICD-9 codes does not contain any specificity – so all three codes correlate with In the forward mapping example, the same does not apply. Because you are taking a code with no specificity regarding side, it maps onto S72.009A – which is an ICD-10 code that is more generic. The codes S72.001A and S72.002A would not appear as options because they specifiy “left femur” and “right femur.”
28 ICD-10 Implementation Plan Checklist:Year2009/ 2010201120122013Phase IAwareness andImpact AssessmentPhase IIPreparing for ImplementationWe encourage that you start now to get ready for ICD-10 implementation.The phases of an Implementation plan are included here. AHIMA’s ICD-10 Preparation Checklist includes greater details for each phase, and this document is a great resource to get you started.Phase 1 – Impact AssessmentPhase 2 – Preparing for ImplementationIs the next step and this also includes making the change to 5010 as wellPhase 3 – Go Live PreparationThis phase will be focused on testing and training – a very busy time period.Post-implementationAnd of course we won’t be done on the first of October 2013, careful data review and analysis and impact assessment will start all over again.Phase IIIGo Live PreparationPhase IVPost –Implementation
29 ICD-10-CM Preparation Create awareness among faculty and staff. Identify your current systems and work processes, whether electronic or manual, in which you use ICD-9.Identify potential changes to existing practice workflow and business processes.Although the implementation date is years away, it is not too early to begin planning for the transition, and even putting some of those plans in motion.Among the systems and work processes you shouldreview for possible modification or upgrade:Billing processEncounter Forms/Fee TicketsCodingCharge EntryElectronic Health RecordDatabasesDepartment specific software applicationsClinical documentationContracts (payer)2. Inventory of all systems that require modification to support ICD-10. Consider hardware and software needs.
30 ICD-10-CM PreparationAssess status of business associates and vendors ICD-10 readiness.Budget for implementation costs.Conduct a detailed assessment of education needs.4. Are our products and vendors ICD-10 ready? Can the vendor prove it?5. Hardware and Software costs6.
31 Assessment of Educational Needs Identify who will require education:Coding professionalsProvidersBilling personnelClinical personnelAdministrative staff and ManagementResearchersDetermine what type and level of education they will need.Assess the current level of coder education and experience.Assess the level of knowledge necessary per person/role based on job responsibilities.Determine the best method of education.The bulks of the costs of implementing ICD-10 will be the training of personnel
32 Coder Training and Education Build awareness to understand the impact of the code set change and the differences between the code setsDevelop pre-requisite skills where needed, for example, in the biomedical sciencesEducate on the foundational concepts on the structure and organization of the code setsRole-based application “just in time”3 – 9 months prior to implementationAHIMA has developedAHA/AHIMA recommends 6 - 9
33 Coder Training and Education The DHHS recommends inpatient/hospital coders receive 50 hours of training and outpatient coders receive 10 hours of training.AHA/AHIMA anticipates that a maximum of 16 hours of training may be sufficient for experienced coding professionals on ICD-10-CM only.6 hours learning the fundamentals (structure, coding conventions, guidelines and how ICD-10 is different)6 hours in more intensive training applying the conventions and guidelines4 hours practicing applying codes to typical encountersPresumes that coding professionals already possess the required knowledge in biomedical sciences.However, based on feedback from a field testing project sponsored by AHIMA and the American Hospital Association, it is anticipated that one to two days of training will be necessary for coders only needing to learn ICD-10- CM and not ICD-10-PCS. Since ICD-10-CM has the same hierarchical structure, the same basic organization, and many of the same conventions as ICD-9-CM, experienced coding professionals will not require the level of extensive training that would be necessary for an entirely new coding system. They will primarily need education on the changes and in the classification itself as well as guidelines and definitions.
34 Education Requirements - AHIMA AHIMA Certified Professionals are required to participate in a predetermined number of mandatory baseline educational experiences specific to ICD-10-CM.RHIT – 6 CEUsRHIA – 6 CEUsCCS-P – 12 CEUsCCS – 18 CEUsCCA – 18 CEUs
35 Proficiency Test - AAPC AAPC members holding a credential will have two years to pass a proficiency test:You will be given two (2) years to pass the exam, beginning October 1, 2012 (one year before implementation of ICD-10) and ending September 30, 2014 (one year after implementation)The test will consist of 75 questionsThe test will be open-book, online and un-proctoredCoders will be allowed two (2) attempts to pass for the $60 administration fee
36 Clinical Documentation The increased specificity of the ICD-10 codes requires more detailed clinical documentation in order to code some diagnoses to the highest level of specificity.There are “unspecified” codes in ICD-10-CM for those instances when medical record documentation is not available to support more specific codes.The benefits of ICD-10 can not be realized if non-specific codes are used rather than taking advantage of the specificity ICD-10 offers.1) The test results found that ICD-10-CM codes can be applied to today’s medical records in a variety of health care settings without having to change documentation practices, although improved documentation would result in higher coding specificity and, therefore higher data quality in some cases.2) Field study only about 12% of the codes assigned were unspecified even though no changes to documentation were made as part of the study.
37 Improving Documentation Conduct medical record documentation assessmentsEvaluate records to determine adequacy of documentation to support the required level of detail in new coding systemsImplement a documentation improvement program to address deficiencies identified during the review processEducate providers about documentation requirements for the new coding system through specific examplesEmphasize the value of more concise data capture for optimal results and better data qualityAsthma –Mild IntermittentMild PersistentModerate PersistentSevere Persistent
38 Physician TrainingDHHS agrees that some physicians will want intensive training on ICD-10 but some will seek “awareness training”.Nolan study estimates 8 hours of intensive physician trainingNachimson Advisors, LLC study predicts 12 hours of physician training in both the code set and documentation procedures.AHIMA believes most physicians would want no more than 4 hours of training.11 medical organizations (MGMA, AAD, AAPC, AANS, AAOS, AMA among others) retained Nachimson (knockamosin) advisors to assess the cost impact on the ICD-10 mandate.
39 Fee TicketsAHIMA/AHA study found the process of converting fee tickets to ICD-10-CM is not difficult, time consuming, or expensive. Most can be converted to ICD-10 in just a few hours and they are no longer in length than existing fee tickets.Making the “fee ticket” more manageable:Electronic fee ticketHybrid codingContext-specific fee ticketsLimit specificity/code optionsList 7th character separate
40 Coder ProficiencyAHA/AHIMA field test demonstrated that people with previous ICD-9-CM experience can learn ICD-10-CM easily.Proficiency in use of the system will be dependent on a number of factors, including level of coder education and experience.It is anticipated that most coders will have a high level of proficiency within 6 months of use.In the AHA/AHIMA ICD-10-CM Field Testing Project , 76% of the participants stated that ICD-10-CM is an improvement over ICD-9A 2003 field testing study conducted by AHIMA and the AHA demonstrated that people with previous ICD-9-CM experience can learn ICD-10-CM easily. For someone familiar with ICD-9, ICD-10-CM is not difficult to learn.
41 ICD-10 Web Resources2010 versions of ICD-10-CM, GEMs and the Official Guidelines are all available on-line.CMS, AHA, AHIMA and NCHS/CDC all have ICD-10 resource centers.AHIMA has a free monthly ICD-10 Newsletter
42 ConclusionWhile it is too early to start learning how to code utilizing the ICD-10-CM code set, it is never to early to start planning/preparing for the transition.