Presentation is loading. Please wait.

Presentation is loading. Please wait.

ICD-10 International Classification of Diseases – CM “Time to Plan for Transition” March 28, 2014 11:00 am – 12:00 pm.

Similar presentations


Presentation on theme: "ICD-10 International Classification of Diseases – CM “Time to Plan for Transition” March 28, 2014 11:00 am – 12:00 pm."— Presentation transcript:

1

2 ICD-10 International Classification of Diseases – CM “Time to Plan for Transition” March 28, :00 am – 12:00 pm

3 PRESENTED BY Rhonda Anderson, RHIA, President (mobile) Anderson Health Info. Systems, Inc. 940 W. 17 th Street, Suite B Santa Ana, CA Tel Fax Complimentary of AHIS, Inc. 2

4 OBJECTIVES Participants will identify: –Dates for New ICD-10 –Documentation support –Some general coding guidelines –YOUR Work plan Complimentary of AHIS, Inc. 3

5 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. 4

6 HIPAA Assigning ICD-10 diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA) Complimentary of AHIS, Inc. 5

7 FINAL REGULATION January 15, 2009 Final Regulation Released EXCHANGE 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, 2011 Complimentary of AHIS, Inc. 6

8 WHAT 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 codes Complimentary of AHIS, Inc. 7

9 WHO IS AFFECTED?? Freestanding providers Ancillary services – “that means all of us really” who provide services and bill for them under Medicare, Medi-Cal and private insurances Complimentary of AHIS, Inc. 8

10 WHO IS AFFECTED?? -2 Developed 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 emphasis Complimentary of AHIS, Inc. 9

11 WHO IS AFFECTED?? -3 More specific in documentation to support the ICD-10 diagnostic code convention, general and specific coding guidelines Complimentary of AHIS, Inc. 10

12 REVIEW OF FEW DETAILS No you will NOT code! You will need –To provide your Board of Directors with some information about the importance –To know your resources –Identify your own champions –Obtain assurance from the computer system –To know that coding is correct Complimentary of AHIS, Inc. 11

13 WHY ICD-10 IS HAPPENING? Increased level of detailICD-10 CM/PCS – Increased level of detail –Required for medicine advancements in technology –$$, improved data quality for clinical and financial decision making –To support value based purchasing and facilitate quality reporting Complimentary of AHIS, Inc. 12

14 WHY ICD-10 IS HAPPENING? -2 ICD-9 codes have limited data about resident’s medical condition & hospital inpatient procedures ICD-9 is 30 years old Has outdate and obsolete terms Inconsistent with current medical practices Complimentary of AHIS, Inc. 13

15 STATE MEDICAID PROG. NEED TO TRANSITION TO ICD-10 Like everyone else covered by HIPAA, state Medicaid programs must comply with ICD-10 Complimentary of AHIS, Inc. 14

16 CODES CHANGE EVERY YEAR ICD-10 codes will be updated every year Complimentary of AHIS, Inc. 15

17 ICD-10 DIFFERENCES Organization – Two volumes Structure – Alphanumeric categories rather than numeric categories.(has “includes and excludes notes: –Categories are three digits –Chapters – re-arranged –Titles have Changed – examples on following slides Complimentary of AHIS, Inc. 16

18 ICD-10 DIFFERENCES -2 CHAPTERICD-9-CMICD-10-CM 1Infectious and Parasitic Diseases Certain Infectious and Parasitic Diseases 2NeoplasmsMalignant Neoplasms 6Diseases of the Nervous System and Sense Organs Diseases of the Nervous System 7Disease of the Circulatory System Diseases of the Eye and Adnexa Complimentary of AHIS, Inc. 17

19 ICD-10 DIFFERENCES -3 CHAPTERICD-9-CMICD-10-CM 8Diseases of the Respiratory System Diseases of the Ear and Mastoid Process 9Diseases of the Digestive System Diseases of the Circulatory System 10Diseases of the Genitourinary System Diseases of the Respiratory System Complimentary of AHIS, Inc. 18

20 ICD-10 DIFFERENCES -4 CHAPTERICD-9-CMICD-10-CM 13Diseases of the Musculoskeletal System and Connective Tissue 14Congenital Anomalies Disease of the Genitourinary System Complimentary of AHIS, Inc. 19

21 ICD-9 DIFFERENCES Lacks detail Lacks laterality Difficult to analyze dated due to non-specific and do not adequately define diagnoses needed for medical research Does not support interoperability because it is not used in other countries Complimentary of AHIS, Inc. 20

22 ICD-10 Code composition – increased specificity Level of detail May consist of up to 7 digits with the seventh digit extensions representing visit encounter or sequelae as stated above Includes full code titles and no reference back to common 4 th and 5 th digits) V and E codes are no longer supplemental Complimentary of AHIS, Inc. 21

23 ICD-9-CM DIAGNOSIS CODES – FORMAT & STRUCTURE 3-5 characters in length Approximately 14,000 codes First digit may be alpha (E or V) or numeric Digits 2-5 are numeric Always at least three digits, Decimal placed after the first three characters Limited space for new codes Complimentary of AHIS, Inc. 22

24 ICD-10-CM DIAGNOSIS CODES – FORMAT & STRUCTURE 3-7 characters in length Approximately 68,000 codes Digit 1 is alpha, digit 2 and 3 are numeric; digit 4-7 are alpha or numeric Decimal placed after the first 3 characters, All letters used except “U” Flexible for adding new codes Very specific Has laterality Complimentary of AHIS, Inc. 23

25 CODE FORMAT ICD-9-CM Code FormatICD-10-CM Code Format Complimentary of AHIS, Inc. 24

26 FIVE-SIX CHARACTER SUBDIVISION Way too much detail…but it looks like this!! –J10.8 – Influenza due to other influenza virus with other manifestations –J10.81 – Influenza gastroenteritis –J10.89 – Influenza with other manifestations: Influenzal encephalopathy Influenzal myocarditis Complimentary of AHIS, Inc. 25

27 FIVE-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 arm Complimentary of AHIS, Inc. 26

28 ICD-10 STRUCTURE Index and Tabular list similar to ICD-9 ICD-10 index larger, categories, subcategories and codes are contacted in the tabular list Z =codes and in Chapter 21. Factors Influencing Health Status and Contact with Health Services (NEW)…Former V=codes are now Z =codes and in Chapter 21. Factors Influencing Health Status and Contact with Health Services (NEW)… Complimentary of AHIS, Inc. 27

29 ICD-10-CM DIAGNOSIS CODES Specificity improves coding accuracy and depth of data for analysis Detail improves the accuracy of data used in medical research Supports interoperability and the exchange of health care data between other countries and the U.S. Complimentary of AHIS, Inc. 28

30 MAPPING TOOLS Mapping from ICD-9 to 10 tools are available, General Equivalence Mappings (GEMS) – translation dictionary for diagnoses Called “GEMS” – general equivalence mappings CM – GEMS available PCS – GEMS just available last of September (acute hospital mostly) Complimentary of AHIS, Inc. 29

31 GEM FILES Do not despair…you vendor should prepare as much of a crosswalk as possible NOTE: will require some conversion for long term resident’s diagnoses by the effective date of ICD-10 TRAININGLater TRAINING and how to use them…Key to early review!!! Complimentary of AHIS, Inc. 30

32 THE WORKPLAN TRANSITION TO ICD-10 Complimentary of AHIS, Inc. 31

33 IMPLEMENTATING ICD-10 Notification to Board –Click here for HO #1 (ICD-10 for Governing Body)Click here for HO #1 (ICD-10 for Governing Body) Timeline –Click for HO #2 (ICD-10-CM Expanded Implementation Plan (Part 2))Click for HO #2 (ICD-10-CM Expanded Implementation Plan (Part 2)) Complimentary of AHIS, Inc. 32

34 IMPROVE 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 record Complimentary of AHIS, Inc. 33

35 ICD-10 CODES REQUIRE Clear focus to better documentation Absolutely critical to the success of ICD- 10 Good resident care: –Affect so many facets of health care downstream –Quality measures to analytics, research, payment and surveillance –Must be as accurate as possible Complimentary of AHIS, Inc. 34

36 ICD-10 CODES REQUIRE -2 Good resident care (cont.) –Accurate coding require physician’s efforts to provide good documentation as well as nursing –No reason to delay implementation of good documentation practices –Information that is required to code according to ICD-10 is information necessary to resident and is already documented in the medical record Complimentary of AHIS, Inc. 35

37 ICD-10 CODES REQUIRE -3 Good resident care (cont.) –What are you documenting today? –Ways more appropriately document? –Failure to fully properly document has medical, financial, and even regulatory ramifications Complimentary of AHIS, Inc. 36

38 DEVELOP 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 accuracy Who codes need to understand basic anatomy and pathophysiology increase in questions from coders Complimentary of AHIS, Inc. 37

39 STRATEGIES FOR TRAINING Leadership those individuals who are responsible for moving things through the organization: –Understand what the impact of ICD-10 will be –What challenges anticipated Complimentary of AHIS, Inc. 38

40 STRATEGIES FOR TRAINING -2 Training Medical Record, MDS/PPS, DON, Medical Director: –Have training –Parallel coding taking the same cases and coding them accurate to ICD-9 and ICD-10 –Parallel training and testing –Start in early 2014 Complimentary of AHIS, Inc. 39

41 STRATEGIES FOR TRAINING -3 Leadership should understand enough about the coding changes to understand the implications: –Documentation –Business practices –MDS / Medicare PPS –$$ impact for training, implementation and billing Complimentary of AHIS, Inc. 40

42 RESOURCES HIM Consultant – Be sure ICD-10 Certified or Specialized Training Centers for Medicare & Medicaid Services (CMS) Includes official codes and guidelines Complimentary of AHIS, Inc. 41

43 ICD-10 CODE SETS Complimentary of AHIS, Inc. 42

44 WHY PREPARE NOW? Major understanding for providers, payers and vendors Will drive business and systems changes, hospital, SNF, Physicians, Outpatient, et’l, from large national health plans to small provider offices, laboratories, medical testing centers Staff time – start looking who affects now and what they need to know Financial resources Also option for ICD-10 transition Complimentary of AHIS, Inc. 43

45 TYPES OF TRAINING – PROVIDERS / STAFF Six months before the compliance deadline Projected to take 16 hours for coders to 50 hours ICD-10 resources and training materials available: –Through CMS –Professional associations, societies, software/system vendors, HIM Consultants Complimentary of AHIS, Inc. 44

46 ICD-10 PROJECT PLAN Develop and complete an ICD-10 project plan: –Identify each task, deadline and who is responsible –Develop plan for communicating with staff and business parts about ICD-10 –Estimate and secure budget Complimentary of AHIS, Inc. 45

47 ICD-10 PROJECT PLAN -2 Check with: –HIM Consultants, –Payers, –Software/systems vendors –Clearinghouses –Billing services –Labs –Physicians Complimentary of AHIS, Inc. 46

48 ICD-10 PROJECT PLAN -3 Check out: –Systems changes –A timeline –Costs –Testing plans Complimentary of AHIS, Inc. 47

49 ICD-10 PROJECT PLAN -4 Evaluate current documentation Identify most commonly used diagnoses by checking out: –Reports – past coding Medicare coverage issues “ADR” –Documentation to support those diagnoses –Medical staff / Medical Director support –Clinical documentation improvements Complimentary of AHIS, Inc. 48

50 SPECIFIC INFO. NEEDED TO ACCURATELY CODE Diabetes Mellitus –Type of diabetes –Body system affected –Complication or manifestation –If type 2 diabetes, long-term insulin use Complimentary of AHIS, Inc. 49

51 SPECIFIC INFO. NEEDED TO ACCURATELY CODE -2 Fractures –Site –Laterality –Type –Location Complimentary of AHIS, Inc. 50

52 REVIEW CHANGES IN DOC. REQUIREMENTS Injuries –External cause – cause of the injury, more applicable to op –Place of occurrence – home, at work, in the car, etc. More related to op we will have some references –Activity code –External code status – indicate if the injury was related to military, work, or other Complimentary of AHIS, Inc. 51

53 LOOK AT SAMPLES IN BACK OF POWERPOINT Complimentary of AHIS, Inc. 52

54 TRANSITION & TESTING March 2014 to September 2014 March 1, 2013 – December 31, 2013 –Conduct high level training on ICD-10 for clinicians –Codes to prepare for testing –Clinical documentation Complimentary of AHIS, Inc. 53

55 TRANSITION & TESTING -2 April 1, 2014 –ICD-10 codes for diagnoses –Test data and reports for accuracy January 1, 2014 – April 1, 2014 –Review, coder and clinical preparation –Begin detailed ICD-10 coding training (6-9 months) –Work with Consultants and vendors to complete transition to production – ready ICD-10 systems Complimentary of AHIS, Inc. 54

56 COMPLETE TRANSITION / FULL COMPLIANCE October 1, 2014 Complete ICD-10 transition for full compliance –ICD-9 codes continue to be used for services provided before October 1, 2014 –ICD-10 diagnosis and inpatient procedure codes required for services provided on or after October 1, 2014 –Monitor systems correct errors if needed Complimentary of AHIS, Inc. 55

57 PRINCIPAL DIAGNOSIS Circumstances 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. 56

58 PRINCIPAL DIAGNOSIS -2 The references and correct coding guidelines HAVE BEEN USED IN THE PAST – NOW THERE ARE NEW CODING GUIDELINES – TAKE PRECEDENCE IN ICD-10 Complimentary of AHIS, Inc. 57

59 PRINCIPAL DIAGNOSIS -3 WE WILL TEACH THE NEW GUIDELINES!!!WE 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!!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. 58

60 HIPAA Assigning ICD-10 diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA) Complimentary of AHIS, Inc. 59

61 HIPAA -2 Not part of this presentation – HIPAA Changes –Privacy Notice –Business Associate –Minimum Necessary –Rights to restrict use/disclosure –Right to Access electronic and manual Protected Health Information –HITECH Changes for Breach and Fines –Impermissible Use Complimentary of AHIS, Inc. 60

62 QUESTIONS & ANSWERS Complimentary of AHIS, Inc. 61

63 SOME EXAMPLES Reference ONLY Slides from here to end of ppt. on coding – sample references Complimentary of AHIS, Inc. 62

64 ICD-10 NEW FEATURES Combination Codes for Condition s and Common Symptom or ManifestationsCombination 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 pectoris Complimentary of AHIS, Inc. 63

65 ICD-10 NEW FEATURES -2 Added Laterality – EXAMPLES –C Malignant neoplasm of upper-inner quadrant of left female breast superficial vessels of right lower extremity –I80.01, Phlebitis and thrombophlebitis of superficial vessels of right lower extremity right hip, Stage III –L80.213, Pressure Ulcer of right hip, Stage III Complimentary of AHIS, Inc. 64

66 A FEW CODES YOU WILL LEARN Added examples of specificity:Added examples of specificity: –A41.9 Sepsis without cause organism –A41.9 Sepsis without cause organism – Sepsis, unspecified –Severe Sepsis – A41.9 Sepsis unspecified for the infection. Additional code for organ must be identified –UROSEPSIS is not allowed as a dx Complimentary of AHIS, Inc. 65

67 A FEW CODES YOU WILL LEARN -2 Septic Shock – EXAMPLE OF SPECIFICITY R65.21 Severe sepsis with septic shock. Add additional codes for other acute organ dysfunction. –Circulatory 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 Sepsis Must be clear if it is present on admission Complimentary of AHIS, Inc. 66

68 ICD-10 NEW FEATURES -3 Expanded CodesExpanded Codes (injury, diabetes alcohol/substance abuse, postoperative complications) Diabetes –E08.22 Diabetes due to underlying condition with diabetic chronic kidney disease Complimentary of AHIS, Inc. 67

69 CHAPTER 4 – E00-E89 Endocrine, nutritional and metabolic diseases –Diabetes Mellitus Combination codesCombination codes Includes the body system affected and complications affecting the body system Many codes particular category as are necessary to describe all of the complications of the disease may be used Sequenced base on the reason for a particular encounter Complimentary of AHIS, Inc. 68

70 CHAPTER 4 – ENDOCRINE, NUTRITIONAL…(E00-E89) Endocrine, nutritional and metabolic diseases – SPECIFICITY –Secondary Diabetes Mellitus: Category E08 due to underlying condition Category E09 for drug/chemical induced Use code Z79.4 for residents who routinely use insulin; also assigned for long-term (current) use Complimentary of AHIS, Inc. 69

71 CHAPTER 9 – DISEASES OF CIRCULATORY SYS. (I00-I99) Hypertension with Heart Disease –Heart 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 I50 Complimentary of AHIS, Inc. 70

72 CHAPTER 10 – DISEASES OF RESPIRATORY SYS. (J00-J99) Chronic Obstructive Pulmonary Disease (COPD) and Asthma –Acute exacerbation of chronic obstructive bronchitis and asthma –J44 and J45 distinguish between uncomplicated cases and those in acute exacerbation Acute Respiratory Failure –Principle diagnosis when it is the condition established after study to be chiefly responsible Complimentary of AHIS, Inc. 71

73 CHAPTER 13 – DISEASE OF MUSCULOSKELETAL (M00-M99) Site and laterality:Site and laterality: –Designations –Represents the bone, joint or the muscle –Where 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 sites –Bone vs. Joint – Certain conditions where the bone may be affected at the upper & lower end; site designation will be the bone, not the joint Complimentary of AHIS, Inc. 72

74 LET’S SEE SOME CODES Sequencing of codes is determined by the reason for admission/encounter - Hypertensive RetinopathySequencing of codes is determined by the reason for admission/encounter - Hypertensive Retinopathy –H35.03 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. 73

75 ICD-10 NEW FEATURES An example S42.321A Displaced transverse fracture of shaft of humerus, right arm, initial encounter for closed fracture This means more specific documentation from the physician (the initial encounter may not have been in your setting) Complimentary of AHIS, Inc. 74

76 REPEATED FALLS Code R29.6 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 assigned Complimentary of AHIS, Inc. 75

77 CODING OF TRAUMATIC FRACTURES Fractures of specified sites are coded individually by siteFractures of specified sites are coded individually by site S-codes…need to pay attention to level of detail furnished by medical record content Fracture not indicated as open or closed, displaced, initial vs. subsequent encounter for fractures. (use 7 th character extension for initial encounter (A.B.C) There are specific instructions related to this area (#18) Complimentary of AHIS, Inc. 76

78 AFTERCARE Aftercare 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 disease Z code should not be used if treatment is directed at a current acute disease Complimentary of AHIS, Inc. 77

79 REMINDER MAKE YOUR LIST OF DUTIES YOU SEE IMPORTANT WHEN YOU RETURN TO YOUR FACILITYMAKE YOUR LIST OF DUTIES YOU SEE IMPORTANT WHEN YOU RETURN TO YOUR FACILITY Complimentary of AHIS, Inc. 78

80 THANKS FOR ATTENDING Rhonda Anderson, RHIA, President (mobile) Anderson Health Information Systems, Inc. 940 W. 17 th Street, Suite B Santa Ana, CA Complimentary of AHIS, Inc. 79


Download ppt "ICD-10 International Classification of Diseases – CM “Time to Plan for Transition” March 28, 2014 11:00 am – 12:00 pm."

Similar presentations


Ads by Google