Presentation on theme: "Anderson Health Information Systems, Inc."— Presentation transcript:
1Anderson Health Information Systems, Inc. ICD-10 International Classification of Diseases – CM “Time to Plan for Transition”March 28, 201411:00 am – 12:00 pm2014 ICD-10 Time to Plan for Transition 1 Hr (02/16/14)
2Anderson Health Information Systems, Inc. PRESENTED BYRhonda Anderson, RHIA, President(mobile)Anderson Health Info. Systems, Inc.940 W. 17th Street, Suite BSanta Ana, CA 92706Tel FaxComplimentary of AHIS, Inc.2014 ICD-10 Time to Plan for Transition 1 Hr (02/16/14)
3Complimentary of AHIS, Inc. OBJECTIVESParticipants will identify:Dates for New ICD-10Documentation supportSome general coding guidelinesYOUR Work planComplimentary of AHIS, Inc.
4Complimentary of AHIS, Inc. ICD—10 “HAS TWO PARTS”ICD-10 CM – Clinical Modification – Skilled Nursing will use “CM”ICD-10 PCS – Procedural Code System (used for procedures, operations within the hospital inpatient setting)Complimentary of AHIS, Inc.
5Complimentary of AHIS, Inc. HIPAAAssigning ICD-10 diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA)Complimentary of AHIS, Inc.
6Complimentary of AHIS, Inc. FINAL REGULATIONJanuary 15, 2009 Final Regulation ReleasedEXCHANGE the ICD-9 for the ICD-10 by October 1 (originally 2013, changed to 2014)ICD-10 for billing purposes as far as ability to accept the code known as “5010” was required by October, 2011Complimentary of AHIS, Inc.
7WHAT DOES ICD-10 COMPLIANCE MEANS? ICD-10 compliance means that everyone covered by HIPAA is able to successfully conduct health care transactions using ICD-10 codesComplimentary of AHIS, Inc.
8Complimentary of AHIS, Inc. WHO IS AFFECTED??Freestanding providersAncillary services – “that means all of us really” who provide services and bill for them under Medicare, Medi-Cal and private insurancesComplimentary of AHIS, Inc.
9Complimentary of AHIS, Inc. WHO IS AFFECTED?? -2Developed for the provider and the coder….(person who may review the documentation and determine if code is accurate)Consistent, complete documentation in the medical record is a major emphasisComplimentary of AHIS, Inc.
10Complimentary of AHIS, Inc. WHO IS AFFECTED?? -3More specific in documentation to support the ICD-10 diagnostic code convention, general and specific coding guidelinesComplimentary of AHIS, Inc.
11Complimentary of AHIS, Inc. REVIEW OF FEW DETAILSNo you will NOT code!You will needTo provide your Board of Directors with some information about the importanceTo know your resourcesIdentify your own championsObtain assurance from the computer systemTo know that coding is correctComplimentary of AHIS, Inc.
12Complimentary of AHIS, Inc. WHY ICD-10 IS HAPPENING?ICD-10 CM/PCS – Increased level of detailRequired for medicine advancements in technology$$, improved data quality for clinical and financial decision makingTo support value based purchasing and facilitate quality reportingComplimentary of AHIS, Inc.
13Complimentary of AHIS, Inc. WHY ICD-10 IS HAPPENING? -2ICD-9 codes have limited data about resident’s medical condition & hospital inpatient proceduresICD-9 is 30 years oldHas outdate and obsolete termsInconsistent with current medical practicesComplimentary of AHIS, Inc.
14STATE MEDICAID PROG. NEED TO TRANSITION TO ICD-10 Like everyone else covered by HIPAA, state Medicaid programs must comply with ICD-10Complimentary of AHIS, Inc.
15CODES CHANGE EVERY YEAR ICD-10 codes will be updated every yearComplimentary of AHIS, Inc.
16Complimentary of AHIS, Inc. ICD-10 DIFFERENCESOrganization – Two volumesStructure – Alphanumeric categories rather than numeric categories.(has “includes and excludes notes:Categories are three digitsChapters – re-arrangedTitles have Changed – examples on following slidesComplimentary of AHIS, Inc.
17Diseases of the Eye and Adnexa ICD-10 DIFFERENCES -2CHAPTERICD-9-CMICD-10-CM1Infectious and Parasitic DiseasesCertain Infectious and Parasitic Diseases2NeoplasmsMalignant Neoplasms6Diseases of the Nervous System and Sense OrgansDiseases of the Nervous System7Disease of the Circulatory SystemDiseases of the Eye and AdnexaComplimentary of AHIS, Inc.
18Diseases of the Ear and Mastoid Process ICD-10 DIFFERENCES -3CHAPTERICD-9-CMICD-10-CM8Diseases of the Respiratory SystemDiseases of the Ear and Mastoid Process9Diseases of the Digestive SystemDiseases of the Circulatory System10Diseases of the Genitourinary SystemComplimentary of AHIS, Inc.
19ICD-10 DIFFERENCES -4 CHAPTER ICD-9-CM ICD-10-CM 13 Diseases of the Musculoskeletal System and Connective Tissue14Congenital AnomaliesDisease of the Genitourinary SystemComplimentary of AHIS, Inc.
20Complimentary of AHIS, Inc. ICD-9 DIFFERENCESLacks detailLacks laterality Difficult to analyze dated due to non-specific and do not adequately define diagnoses needed for medical researchDoes not support interoperability because it is not used in other countriesComplimentary of AHIS, Inc.
21Complimentary of AHIS, Inc. ICD-10Code composition – increased specificityLevel of detailMay consist of up to 7 digits with the seventh digit extensions representing visit encounter or sequelae as stated aboveIncludes full code titles and no reference back to common 4th and 5th digits)V and E codes are no longer supplementalComplimentary of AHIS, Inc.
22ICD-9-CM DIAGNOSIS CODES – FORMAT & STRUCTURE 3-5 characters in lengthApproximately 14,000 codesFirst digit may be alpha (E or V) or numericDigits 2-5 are numericAlways at least three digits,Decimal placed after the first three charactersLimited space for new codesComplimentary of AHIS, Inc.
23ICD-10-CM DIAGNOSIS CODES – FORMAT & STRUCTURE 3-7 characters in lengthApproximately 68,000 codesDigit 1 is alpha, digit 2 and 3 are numeric; digit 4-7 are alpha or numericDecimal placed after the first 3 characters,All letters used except “U”Flexible for adding new codesVery specificHas lateralityComplimentary of AHIS, Inc.
24Complimentary of AHIS, Inc. CODE FORMATICD-9-CM Code FormatICD-10-CM Code FormatComplimentary of AHIS, Inc.
25FIVE-SIX CHARACTER SUBDIVISION Way too much detail…but it looks like this!!J10.8 – Influenza due to other influenza virus with other manifestationsJ10.81 – Influenza gastroenteritisJ10.89 – Influenza with other manifestations:Influenzal encephalopathyInfluenzal myocarditisComplimentary of AHIS, Inc.
26FIVE-SIX CHARACTER SUBDIVISION -2 Way too much detail…but it looks like this!!ANOTHER EXAMPLE – WITH SPECIFICITY AND LATERALITY:S Laceration of ulnar artery at forearm level, right armComplimentary of AHIS, Inc.
27Complimentary of AHIS, Inc. ICD-10 STRUCTUREIndex and Tabular list similar to ICD-9ICD-10 index larger, categories, subcategories and codes are contacted in the tabular listFormer V=codes are now Z =codes and in Chapter 21. Factors Influencing Health Status and Contact with Health Services (NEW)…Complimentary of AHIS, Inc.
28ICD-10-CM DIAGNOSIS CODES Specificity improves coding accuracy and depth of data for analysisDetail improves the accuracy of data used in medical researchSupports interoperability and the exchange of health care data between other countries and the U.S.Complimentary of AHIS, Inc.
29Complimentary of AHIS, Inc. MAPPING TOOLSMapping from ICD-9 to 10 tools are available, General Equivalence Mappings (GEMS) – translation dictionary for diagnosesCalled “GEMS” – general equivalence mappingsCM – GEMS availablePCS – GEMS just available last of September (acute hospital mostly)Complimentary of AHIS, Inc.
30Complimentary of AHIS, Inc. GEM FILESDo not despair…you vendor should prepare as much of a crosswalk as possibleNOTE: will require some conversion for long term resident’s diagnoses by the effective date of ICD-10Later TRAINING and how to use them…Key to early review!!!Complimentary of AHIS, Inc.
31THE WORKPLAN TRANSITION TO ICD-10 Complimentary of AHIS, Inc.
32Complimentary of AHIS, Inc. IMPLEMENTATING ICD-10Notification to BoardClick here for HO #1 (ICD-10 for Governing Body)TimelineClick for HO #2 (ICD-10-CM Expanded Implementation Plan (Part 2))Complimentary of AHIS, Inc.
33IMPROVE DOCUMENTATION NOW All of the information that is required to code according to ICD-10 is information that is necessary to an individual’s care and is already documented in the medical recordComplimentary of AHIS, Inc.
34Complimentary of AHIS, Inc. ICD-10 CODES REQUIREClear focus to better documentationAbsolutely critical to the success of ICD-10Good resident care:Affect so many facets of health care downstreamQuality measures to analytics, research, payment and surveillanceMust be as accurate as possibleComplimentary of AHIS, Inc.
35Complimentary of AHIS, Inc. ICD-10 CODES REQUIRE -2Good resident care (cont.)Accurate coding require physician’s efforts to provide good documentation as well as nursingNo reason to delay implementation of good documentation practicesInformation that is required to code according to ICD-10 is information necessary to resident and is already documented in the medical recordComplimentary of AHIS, Inc.
36Complimentary of AHIS, Inc. ICD-10 CODES REQUIRE -3Good resident care (cont.)What are you documenting today?Ways more appropriately document?Failure to fully properly document has medical, financial, and even regulatory ramificationsComplimentary of AHIS, Inc.
37DEVELOP THE RELATIONSHIP BETWEEN CLINICIANS Clinicians (DON) do not need to understand all of the intricacies of coding, and coders do not need to understand all of medicine – but the 2 must work together to ensure optimal accuracyWho codes need to understand basic anatomy and pathophysiology increase in questions from codersComplimentary of AHIS, Inc.
38STRATEGIES FOR TRAINING Leadership those individuals who are responsible for moving things through the organization:Understand what the impact of ICD-10 will beWhat challenges anticipatedComplimentary of AHIS, Inc.
39STRATEGIES FOR TRAINING -2 Training Medical Record, MDS/PPS, DON, Medical Director:Have trainingParallel coding taking the same cases and coding them accurate to ICD-9 and ICD-10Parallel training and testingStart in early 2014Complimentary of AHIS, Inc.
40STRATEGIES FOR TRAINING -3 Leadership should understand enough about the coding changes to understand the implications:DocumentationBusiness practicesMDS / Medicare PPS$$ impact for training, implementation and billingComplimentary of AHIS, Inc.
41Complimentary of AHIS, Inc. RESOURCESHIM Consultant – Be sure ICD-10 Certified or Specialized TrainingCenters for Medicare & Medicaid Services (CMS)Includes official codes and guidelinesComplimentary of AHIS, Inc.
42Complimentary of AHIS, Inc. ICD-10 CODE SETSComplimentary of AHIS, Inc.
43Complimentary of AHIS, Inc. WHY PREPARE NOW?Major understanding for providers, payers and vendorsWill drive business and systems changes, hospital, SNF, Physicians, Outpatient, et’l, from large national health plans to small provider offices, laboratories, medical testing centersStaff time – start looking who affects now and what they need to knowFinancial resourcesAlso option for ICD-10 transitionComplimentary of AHIS, Inc.
44TYPES OF TRAINING – PROVIDERS / STAFF Anderson Health Information Systems, Inc.TYPES OF TRAINING – PROVIDERS / STAFFSix months before the compliance deadlineProjected to take 16 hours for coders to 50 hoursICD-10 resources and training materials available:Through CMSProfessional associations, societies, software/system vendors, HIM ConsultantsComplimentary of AHIS, Inc.2014 ICD-10 Time to Plan for Transition 1 Hr (02/16/14)
45Complimentary of AHIS, Inc. ICD-10 PROJECT PLANDevelop and complete an ICD-10 project plan:Identify each task, deadline and who is responsibleDevelop plan for communicating with staff and business parts about ICD-10Estimate and secure budgetComplimentary of AHIS, Inc.
46Complimentary of AHIS, Inc. ICD-10 PROJECT PLAN -2Check with:HIM Consultants,Payers,Software/systems vendorsClearinghousesBilling servicesLabsPhysiciansComplimentary of AHIS, Inc.
47Complimentary of AHIS, Inc. ICD-10 PROJECT PLAN -3Check out:Systems changesA timelineCostsTesting plansComplimentary of AHIS, Inc.
48Complimentary of AHIS, Inc. ICD-10 PROJECT PLAN -4Evaluate current documentationIdentify most commonly used diagnoses by checking out:Reports – past coding Medicare coverage issues “ADR”Documentation to support those diagnosesMedical staff / Medical Director supportClinical documentation improvementsComplimentary of AHIS, Inc.
49SPECIFIC INFO. NEEDED TO ACCURATELY CODE Diabetes MellitusType of diabetesBody system affectedComplication or manifestationIf type 2 diabetes, long-term insulin useComplimentary of AHIS, Inc.
50SPECIFIC INFO. NEEDED TO ACCURATELY CODE -2 FracturesSiteLateralityTypeLocationComplimentary of AHIS, Inc.
51REVIEW CHANGES IN DOC. REQUIREMENTS InjuriesExternal cause – cause of the injury, more applicable to opPlace of occurrence – home, at work, in the car, etc.More related to op we will have some referencesActivity codeExternal code status – indicate if the injury was related to military, work, or otherComplimentary of AHIS, Inc.
52LOOK AT SAMPLES IN BACK OF POWERPOINT Complimentary of AHIS, Inc.
53Complimentary of AHIS, Inc. TRANSITION & TESTINGMarch 2014 to September 2014March 1, 2013 – December 31, 2013Conduct high level training on ICD-10 for cliniciansCodes to prepare for testingClinical documentationComplimentary of AHIS, Inc.
54Complimentary of AHIS, Inc. TRANSITION & TESTING -2April 1, 2014ICD-10 codes for diagnosesTest data and reports for accuracyJanuary 1, 2014 – April 1, 2014Review, coder and clinical preparationBegin detailed ICD-10 coding training (6-9 months)Work with Consultants and vendors to complete transition to production – ready ICD-10 systemsComplimentary of AHIS, Inc.
55COMPLETE TRANSITION / FULL COMPLIANCE October 1, 2014Complete ICD-10 transition for full complianceICD-9 codes continue to be used for services provided before October 1, 2014ICD-10 diagnosis and inpatient procedure codes required for services provided on or after October 1, 2014Monitor systems correct errors if neededComplimentary of AHIS, Inc.
56Complimentary of AHIS, Inc. PRINCIPAL DIAGNOSISCircumstances of inpatient admission always govern the selection of PRINCIPAL DIAGNOSIS:“that condition established after study to be chiefly responsible for occasioning the admission of the resident to the hospital (facility) care”Complimentary of AHIS, Inc.
57Complimentary of AHIS, Inc. PRINCIPAL DIAGNOSIS -2The references and correct coding guidelines HAVE BEEN USED IN THE PAST – NOW THERE ARE NEW CODING GUIDELINES – TAKE PRECEDENCE IN ICD-10Complimentary of AHIS, Inc.
58Anderson Health Information Systems, Inc. PRINCIPAL DIAGNOSIS -3WE WILL TEACH THE NEW GUIDELINES!!!The importance of consistent, complete documentation in the medical record cannot be overemphasized. Without such documentation the application of all coding guidelines is difficult!!Complimentary of AHIS, Inc.2014 ICD-10 Time to Plan for Transition 1 Hr (02/16/14)
59Complimentary of AHIS, Inc. HIPAAAssigning ICD-10 diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA)Complimentary of AHIS, Inc.
60Complimentary of AHIS, Inc. HIPAA -2Not part of this presentation – HIPAA ChangesPrivacy NoticeBusiness AssociateMinimum NecessaryRights to restrict use/disclosureRight to Access electronic and manual Protected Health InformationHITECH Changes for Breach and FinesImpermissible UseComplimentary of AHIS, Inc.
61Complimentary of AHIS, Inc. QUESTIONS & ANSWERSComplimentary of AHIS, Inc.
62Anderson Health Information Systems, Inc. SOME EXAMPLESReference ONLY Slides from here to end of ppt. on coding – sample referencesComplimentary of AHIS, Inc.2014 ICD-10 Time to Plan for Transition 1 Hr (02/16/14)
63Complimentary of AHIS, Inc. ICD-10 NEW FEATURESCombination Codes for Condition s and Common Symptom or Manifestations – specify…This example reflects specificity down to the type of artery – and would related to post follow up care but the Dx. Given at the hospital would carry, too.I – Arteriosclerotic heart disease of native coronary artery with unstable angina pectorisComplimentary of AHIS, Inc.
64Complimentary of AHIS, Inc. ICD-10 NEW FEATURES -2Added Laterality – EXAMPLESC Malignant neoplasm of upper-inner quadrant of left female breastI80.01, Phlebitis and thrombophlebitis of superficial vessels of right lower extremityL80.213, Pressure Ulcer of right hip, Stage IIIComplimentary of AHIS, Inc.
65A FEW CODES YOU WILL LEARN Added examples of specificity:A41.9 Sepsis without cause organism –Sepsis, unspecifiedSevere Sepsis – A41.9 Sepsis unspecified for the infection. Additional code for organ must be identifiedUROSEPSIS is not allowed as a dxComplimentary of AHIS, Inc.
66A FEW CODES YOU WILL LEARN -2 Anderson Health Information Systems, Inc.November 2011A FEW CODES YOU WILL LEARN -2Septic Shock – EXAMPLE OF SPECIFICITYCirculatory failure associated with severe sepsis; represents a type of acute organ dysfunction. Underlying infection sequenced first, followed by code R65.21 Severe sepsis with septic shock. Add additional codes for other acute organ dysfunction.New guidelines for sequencing Severe SepsisMust be clear if it is present on admissionComplimentary of AHIS, Inc.2014 ICD-10 Time to Plan for Transition 1 Hr (02/16/14)
67Complimentary of AHIS, Inc. ICD-10 NEW FEATURES -3Expanded Codes (injury, diabetes alcohol/substance abuse, postoperative complications)E08.22 Diabetes due to underlying condition with diabetic chronic kidney diseaseComplimentary of AHIS, Inc.
68Complimentary of AHIS, Inc. CHAPTER 4 – E00-E89Endocrine, nutritional and metabolic diseasesDiabetes MellitusCombination codesIncludes the body system affected and complications affecting the body systemMany codes particular category as are necessary to describe all of the complications of the disease may be usedSequenced base on the reason for a particular encounterComplimentary of AHIS, Inc.
69CHAPTER 4 – ENDOCRINE, NUTRITIONAL…(E00-E89) Endocrine, nutritional and metabolic diseases – SPECIFICITYSecondary Diabetes Mellitus:Category E08 due to underlying conditionCategory E09 for drug/chemical inducedUse code Z79.4 for residents who routinely use insulin; also assigned for long-term (current) useComplimentary of AHIS, Inc.
70CHAPTER 9 – DISEASES OF CIRCULATORY SYS. (I00-I99) Hypertension with Heart DiseaseHeart conditions classified to I50 or I51.4-I51.9 are assigned to, a code from category I11 when a causal relationship is stated (due to hypertension) or implied (hypertensive)Use an additional code from category I50Complimentary of AHIS, Inc.
71CHAPTER 10 – DISEASES OF RESPIRATORY SYS. (J00-J99) Chronic Obstructive Pulmonary Disease (COPD) and AsthmaAcute exacerbation of chronic obstructive bronchitis and asthmaJ44 and J45 distinguish between uncomplicated cases and those in acute exacerbationAcute Respiratory FailurePrinciple diagnosis when it is the condition established after study to be chiefly responsibleComplimentary of AHIS, Inc.
72CHAPTER 13 – DISEASE OF MUSCULOSKELETAL (M00-M99) Site and laterality:DesignationsRepresents the bone, joint or the muscleWhere more than one bone, joint or muscle is involved, such as osteoarthritis, use the assigned “multiple sites” code; if not available, use multiple codes to indicate the sitesBone vs. Joint – Certain conditions where the bone may be affected at the upper & lower end; site designation will be the bone, not the jointComplimentary of AHIS, Inc.
73Complimentary of AHIS, Inc. LET’S SEE SOME CODESSequencing of codes is determined by the reason for admission/encounter - Hypertensive RetinopathyH35.03 Hypertensive Retinopathy,031 – Right eye, 032, left eye, 033, bilateral,039 – Unspecified (and this would be a ?? For billing most likely)!!I10 – Essential Primary Hypertension.Complimentary of AHIS, Inc.
74Complimentary of AHIS, Inc. ICD-10 NEW FEATURESAn example S42.321A Displaced transverse fracture of shaft of humerus, right arm, initial encounter for closed fractureThis means more specific documentation from the physician (the initial encounter may not have been in your setting)Complimentary of AHIS, Inc.
75Complimentary of AHIS, Inc. REPEATED FALLSCode R29.6 Repeated falls for use for encounters when a resident has recently fallen and the reason for the fall is being investigated. Code Z91.81, History of falling, is for use when a resident has fallen in the past is at risk for future falls. Both codes may be assignedComplimentary of AHIS, Inc.
76CODING OF TRAUMATIC FRACTURES Fractures of specified sites are coded individually by siteS-codes…need to pay attention to level of detail furnished by medical record contentFracture not indicated as open or closed, displaced, initial vs. subsequent encounter for fractures. (use 7th character extension for initial encounter (A.B.C) There are specific instructions related to this area (#18)Complimentary of AHIS, Inc.
77Anderson Health Information Systems, Inc. AFTERCAREAftercare codes cover situations when the initial treatment of a disease has been performed and the resident requires continued care during the healing or recovery phase or the long term consequences of the diseaseZ code should not be used if treatment is directed at a current acute diseaseComplimentary of AHIS, Inc.2014 ICD-10 Time to Plan for Transition 1 Hr (02/16/14)
78Anderson Health Information Systems, Inc. REMINDERMAKE YOUR LIST OF DUTIES YOU SEE IMPORTANT WHEN YOU RETURN TO YOUR FACILITYComplimentary of AHIS, Inc.2014 ICD-10 Time to Plan for Transition 1 Hr (02/16/14)
79Anderson Health Information Systems, Inc. THANKS FOR ATTENDINGRhonda Anderson, RHIA, President (mobile) Anderson Health Information Systems, Inc. 940 W. 17th Street, Suite B Santa Ana, CAComplimentary of AHIS, Inc.2014 ICD-10 Time to Plan for Transition 1 Hr (02/16/14)