Presentation on theme: "ICD-10-CM An Introduction 2013"— Presentation transcript:
1 ICD-10-CM An Introduction 2013 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.Bobbi Buell, MBAonPoint Oncology LLC
2 Main Objective Inspire panic---this is not that far away. Create an awareness of ICD-10-CM.Start to consider the impact the conversion to ICD-10 will have on your operations.Start to understand what it means and does not mean in Oncology.
3 Latest Update This is happening 10/1/2014 CMS intimated that the deadline would not be postponed.The AMA still vehemently opposes this deadline.Hospitals have spent millions on it.You be the judge.
4 Implications of the Transition – Who? ProvidersHospitalsPhysiciansOutpatient facilitiesPost-acute providers (home health agencies, skilled nursing facilities, etc.)Health Plans or PayersThird party administratorsEmployers
5 Implications of the Transition – Who? OthersLaboratoriesFree standing ancillariesResearchersPublic health agencies et alData collection agencies/organizations (tumor registries)VendorsClearinghousesBusiness associates and partnersPatients
7 Why is ICD-9 Being Replaced? ICD-9-CM is out of date and running out of space for new codes on the procedural side.Lacks specificity and detailNo longer reflects current medical practiceICD-10 is the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
8 Reimbursement Issues With ICD-9? Example: Fracture of WristSkateboarder fractures right wristA month later, fractures left wristICD-9 would require additional documentation to find out which wrist was fracturedICD-10-CM describes in fracture codesLeft versus rightInitial or subsequent encounterRoutine healing , delayed healing, nonunion or malunion
9 There Are Benefits of ICD-10 Reflects more emerging technologies, particularly PCSCaptures the details of EMRsMight reduce ADRs from payers due to more specificityStatistical outcomes will be more measurable and specificMay support better epidemiological trending
10 What is ICD-10-CM?CM = Clinical modification to ICD-10 used around the worldConsultation withPhysician groupsClinical codersOther users of ICD-9-CM
11 Who Runs The Show?National Center for Health Statistics (NCHS) is the federal agency that is responsible for maintaining the diagnostic coding systems in the U.S.CMS partners with them to oversee publicly available coding systemsWHO oversees ICD-10 without the –CMThe American Health Information Management Association (AHIMA) oversees education and training
12 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
13 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
14 Character Changes ICD-9-CM ICD-9-CM Chapter ICD-10-CM Chapter 1Infectious or Parasitic DiseaseA0-B99NeoplasmsC00-D49Chapter 6Diseases of the Nervous SystemG00-G99Chapter 7Diseases of the Eye and AdnexaH00-H59Chapter 8Diseases of the Ear and MastoidH60-H95
15 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
16 ICD-9-CM Structure – Format Numeric or Alpha(E or V)NumericVXE541X4X.XX.CategoryEtiology, AnatomicSite, Manifestation3 – 5 Characters
17 ICD-10-CM Structure – Format Alpha(Except U)2 - 7 Numeric or AlphaAdditional Characters..XMAS3X2XX1XXAXCategoryEtiology, AnatomicSite, SeverityAdded code extensions (7th character) for obstetrics, injuries, and external causes of injury3 – 7 Characters
18 Characteristics of ICD-10-CM ICD-10-CM far exceeds its predecessors in the number of concepts and codes providedThe disease classification has been greatly expanded to include health-related conditions and to provide greater specificity at the sixth digit level and with the seventh digit extensionBy the way, the 6th and 7th digit extensions ARE NOT optional for the codes where they are present
19 Arrangement of Volumes of ICD-10 Volume 1: Main classificationsVolume 2: Instruction/ Guidance to usersVolume 3: Alphabetical IndexICD-10 has 21 chapters against 17 Chapters in ICD-9
20 Chapters of ICD-10Chapters I to XVII: Diseases and other morbid conditionsChapter XVIII: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified.Chapter XIX: Injuries, poisoning and certain other consequences of external causes.Chapter XX: External causes of morbidity and mortality,Chapter XXI: Factors influencing health status and contact with health services.
21 What You Should Worry About The codes you most frequently useCan you run a report from your PM or EMR system that shows you all ICD-9’s that you have billed more than times over the past 2-3 years? Your limits will depend upon your size.These are the codes you need to know and translate.You do not need to know 69,000 codesBut, physicians need to access to non-cancer codes to use when they are evaluating and/or managing patients
23 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 Other Major Differences With ICD-10 Use additional codesSequelaeCombination codesDifferences in anemiaMandatory 6th and 7th digits
29 Cancer Differences Laterality Mandatory’ use additional’ codes—look at lung cancer6th digits (check out skin and breast cancers)Much more detail and confusion surrounding lymphomaMore detail in myeloid leukemiaHelp with CUP
32 ICD-10 Implementation Plan Checklist:Year2011201220132014Phase 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
34 Diagnostic Codes are Ubiquitous Diagnostic codes are everywhere – used by every person, every process, every system….SuperbillsPayments/EOBs/ERAsReferralsContractsEMRsBut, again, this is limited to codes you actually use
35 Solo Practitioner Or Small Group (2-10) Practice Implementation Planning Organize Implementation EffortEstablish Communication PlanConduct Impact AnalysisContact System VendorsEstimate BudgetImplementation PlanningDevelop Training PlanAnalyze Business ProcessesEducation and TrainingPolicy Change DevelopmentDeployment of CodeImplementation ComplianceSource: AAPC
37 Organize Implementation Effort Enlist staff person (coder, biller, manager) to oversee effort who will be key point personPrepare information to share with other providers and staffIdentify work and scope for implementationShould be a team effort involving all medical practice staff and the staff needs to believe that this will actually happen.If everyone is not signed on to this, your effort will not work long term
38 Organize Implementation Effort Examine the level of coding you have in your practice—who is certified? Who has experienced a change before, e.g. E/M, admin codes? Who is equipped to deal with this?Look at all areas that will impact practice and identify each one that will be affectedList of codesPractice management systemElectronic Medical Record (EMR), if applicableSuperbillsClinical areas and pharmacySchedule regular meetings to share information with physicians and discuss progress and barriers of implementation.
39 Establish Communication Plan How will point person communicate with all staff?Most practices communicate via meetings or memosNo need to change method of communicationsDevelop regular schedule for ICD-10 progress effortsMonthly until 6 months prior to implementationBi-weekly thereafterInclude information, publications, and articlesDocument all meetings and what was discussed herein and make sure you are tracking with your plan.
40 Conduct Impact Analysis Take this step prior to development of budgetIn depth look at resources required for implementationMaybe check for a little process improvementHelps determine what costs might be involved as well as work processes
42 Potential Areas that will be Impacted! For those that can’t read the small print…Clinical AreaPatient CoverageSuperbillsABN’sPhysiciansDocumentationCode SpecificityProblem listsNursesFormsDocumentationPrior AuthorizationManagersPolicies & ProceduresVendor/Payer ContractsBudgetsTraining PlanSource: AAPC 2012
43 Potential Areas that will be Impacted! LabDocumentationReportingBillingPolicies & ProceduresTrainingPharmacyInfusion RoomCodingCode SetClinical KnowledgeConcurrent UseFront DeskReferrals/ History codesSystemsSource: AAPC 2012
44 List Every Area That Uses Codes GeographicalTechnologicalProcessesVendorsPayersPaperEtc
46 Conduct Impact Analysis Develop reasonable timeline that can be accomplished in your practiceMap out a project plan on a simple Excel spreadsheet with benchmarks and status of completionManagers and/or coders should get physician approval for the project plan and its impact on the practice. Make sure you show and tell them the level of work it will take.
47 From Impact Analysis Develop a plan for Then, go to the next step… ProcessesDepartmentsTrainingThen, go to the next step…
50 Contact System Vendors Will they be able to accommodate the need to move to ICD-10? Really? Were they ready for 5010?What plans do they have in place for implementation?Will they have new tools in place to help you with ICD-10? Will these have a cost? Will they create savings? How long will they run parallel coding?When will they have software available for testing?Will we need new hardware or is current hardware sufficient?What is the cost?
51 Estimate Budget Budget considerations should include Hardware costsSoftware costs and licensingTrainingParallel codingPhysician QueryProductivity lossesJeopardy to cash flowSome notable budget estimates follow this slide…
52 Develop Budget Cost Breakdown Example TOTAL $84,000 Education $ 2,500 Process Analysis $ 7,000Changes to Super bills $ 3,000IT Costs $ 7,500Increased Documentation $44,000Cash Flow Disruption $20,000TOTAL $84,000Cash flow disruption due to errors, delays in processing, etc.Important that vendor can demonstrate successful test files before deadlineConducted in 2008
53 ICD-10 Implementation $: AMA (c) onPoint Oncology LLC
57 Implementation Planning Break down planning into stages that fit your size and structure…Training for a very small practice does not need to begin until 6 months prior to implementationReview superbills or chargemaster or order entry charges and remove rarely used codesCrosswalk common codes from ICD-9-CM to ICD-10-CMLook up codes in ICD-10-CM book and use GEMs, if necessary, but this is a very general and not necessarily accurate way of coding.Some vendors now have side-by-side coding, which facilitates the learning process.You should parallel codes for some period
58 Develop Training Plan Who needs training? PhysiciansCodersBilling staffAdministrative staffNurses, MAs, PharmacyRequired number of hours depends on their role and coding interfaceWhat resources are available in your area?
59 Develop Training PlanMany organizations will have several mechanisms for trainingDistance learningWorkshopsConferencesAudio ConferencesWebinarsBooksEstablish training schedule or just “Train the Trainer”, but this must be a trusted coding person who also can communicate necessary information to clinicians.Having systems that facilitate clinicians and coders to be around the codes in 2014 are helpful.
60 Develop Training PlanDetermine if temporary staff or overtime will be necessary during training periodWhat materials will the office need for ongoing support after training?BooksSoftware (code look up programs)Other
61 Analyze Payer Processes Identify all payer systems and processes that currently use ICD-9-CMReview existing medical policies related to ICD-9-CMWhich contracts tied to reimbursement are tied to a particular diagnosis? Which payers have policies for cancer drugs that are tied to ICD-9? How will this be impacted?Modify any contract agreements with health plansAscertain their timelines for testing ICD-10 acceptance
62 Policy Change/ Payment Impact After health plans complete and change medical policy for procedures and services a specialty providesReview new payment policiesIdentify opportunities to improve coding processesCommunicate policy changes to applicable staffFind out the policy switch-over date (might not be 10/1/2014)How long will they accept ICD-9-CM claims?Good news: many payers have ICD-10 right on their sites right now!!! Check it out!!!
63 Education and Training Formal education should begin approximately months prior to implementationLarge practices may need to begin earlier to accommodate all staff who need trainingUse various methods of training: on-line, distance, “Boot Camps”Training time depends on their rolePhysicians and coders/billers will need more training time than administrative staff
64 Deployment of CodeShould receive all updated software no later than 7/31/2014 for implementation of your charge documents. And, that is cutting it mighty close…Vendor delivers software update with ICD-10-CM, but you should also know how long ICD-9 will be on- line.Vendors shouldTest systemIntegrate software into your systemsMake internal customizationsTest systems with clearinghouses, payers, electronic claims transmission (end to end)Ensure that the vendor will maintain updates to code during transition period
65 Testing of Code Does your PM system transmit ICD-10 codes? What does your clearinghouse do?Is your coding translated to incentive programs, PQRS? EHR?Does the process from documentation to billing work?Where are the snafus?
66 Implementation Compliance Compliance date for implementation – October 1, 2014Ensure you are staffed for the change.Make sure lines of credit are in place.Monitor compliance activities to identify any problems.QA chart to billing coding and do this until it looks clean.Pursue vendor and payer problems as necessary.
67 Other ConsiderationsConsider use of electronic tools to facilitate coding processCould reduce costs and claims rejectionsCould increase productivity and coding accuracyDon’t convert superbills/charge documents too earlyThings can change and you don’t want to up your costsAssign ICD-10-CM codes directly, not by applying ICD-9- CM to ICD-10-CM map—it’s good practice’!!67
68 ResourcesICD-10-CM Online GEMs Mapping Files ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2011/ Preparation Check List CMS ICD-10 Information https://www.cms.gov/ICD10/
69 Basic Education Sites NCHS – Basic ICD-10-CM Information tmCMS – ICD-10-PCS InformationAHIMA - ICD-10 EducationWEDI – ICD-10 ImplementationWe have included some web sites that contain basic information on what ICD-10 is, how coding should be done, and some of the key implementation steps and issues. We urge you to monitor these web sites for continued information. Both local and national organizations are looking at this topic, and may have resources for you to take advantage of.
70 CDC’s Web Resources General ICD-10 information ICD-10-CM files, information, and General Equivalence Mappings (GEM) between ICD-10-CM and ICD-9-CM
71 AHA’s Resources Regulatory member advisories Presentations and articlesICD-10 audio seminar seriesCentral Office on ICD-9-CMAHA Central Office ICD-10 Resource Center
72 In Summary… The time to start is YESTERDAY The first thing you need to do is determine where change needs to happen and how much it will cost. Physicians may have no idea that this will be a line item.Hospitals are way ahead of practices. They are doing dual coding right now! So, do not count on delays!Physicians need to be trained---do not let them off the hook--- documentation is very different under ICD-10-CM.Check out your payer polcies---some are already translated!What did you learn from 5010 that will help you with this?Marshall the resources that are available at no charge and there are a lot.
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