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ICD-10 Diagnosis Coding In use by majority of developed nations for years Goes into effect in 12 months (Oct. 1, 2014) Will require considerable adjustment.

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Presentation on theme: "ICD-10 Diagnosis Coding In use by majority of developed nations for years Goes into effect in 12 months (Oct. 1, 2014) Will require considerable adjustment."— Presentation transcript:

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2 ICD-10 Diagnosis Coding In use by majority of developed nations for years Goes into effect in 12 months (Oct. 1, 2014) Will require considerable adjustment in coding Need to start preparation & begin testing

3 ICD-10 Diagnosis Coding ICD-10 better provides for improvements in… Quality Measurements –healthcare successes on specific diagnoses Public Health – worldwide sharing of diagnostic data Research – analysis using more precise diagnoses Reimbursement – refined “pay for performance” Cost containment – lower insurance premiums

4 ICD-10 Diagnosis Coding ICD-10 captures documentation that ICD-9 omits, such as: Initial vs. Subsequent Encounter vs. Sequelae Acute or Chronic Condition Right or Left (1/3 of ICD-10 code descriptions are identical except for indicating laterality) Normal Healing, Delayed Healing

5 ICD-10 Diagnosis Coding CMS: No Clear Mapping Between ICD-9-CM and ICD-10-CM Code Sets. There are one-to-one correspondences, one-to-many, many-to-one, many-to-many, or no correspondence at all.

6 ICD-10 Diagnosis Coding CMS: GEMs (General Equivalency Mapping)GEMs (General Equivalency Mapping The GEMs are to assist with converting large ICD-9 databases to ICD-10 The GEMs are not a substitute for learning how to use ICD-10-CM Providers’ coding staff should assign individual codes from the ICD-10 code books

7 Senile Cataract ICD-9 Source

8 ICD-10 Senile Cataract

9 ICD-9 Source Senile Cataract

10 ICD-9 ICD-10 Source Pseudoexfoliation of the lens w/o GLC does not exist in ICD-10 Senile Cataract

11 ICD-10 Source Pseudoexfoliation of lens capsule convert to ICD-10convert to ICD-10 Senile Cataract Pseudoexfoliation of the lens w/o GLC does not exist in ICD-10

12 ICD-9 Currently must file two lines of code for GLC patient Glaucoma

13 You only file one code, but you have to chose one of 20 codes ICD-10Glaucoma

14 ICD-10 Diagnosis Coding CMS: No Clear Mapping Between ICD-9-CM and ICD-10-CM Code Sets. There are one-to-one correspondences, one-to-many, many-to-one, many-to-many, or no correspondence at all.

15 ICD-10 Diagnosis Coding Doctors and staff will be faced with learning curve Learning curves slow down production Learning “on-the-fly” will be disastrous Outline a plan, step by step, your practice intends to follow

16 ICD-10 Diagnosis Coding To Help Staff Understand the Complexities of the Switch to ICD-10… Make a table of the top 20+ diagnoses currently used by your office Using ICD-10*, make a table of these same diagnoses, but with the ICD-10 coding Using ICD-10 * ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2014/ ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2014/

17 ICD-10 Diagnosis Coding Establishing a transition plan All current use ICD-9 will be affected by the transition. Thus, identify everywhere that your practice uses ICD-9. Decide who needs training, what type of training they need, and when they need it. Schedule staff training on a regular basis for questions and feedback

18 ICD-10 Diagnosis Coding Establishing a transition plan Share your plan with your EHR vendors and billing services. Set up time for software vendors to train your staff on computer system changes (whether using EHR or non-EHR software systems). Coordinate carefully with Billing Service and Clearinghouse vendors

19 ICD-10 Diagnosis Coding Establish a training plan Anyone who will test ICD-10 systems before the transition will need training way in advance Others who use ICD codes can be trained 6 to 9 months before the October 1, 2014, transition Doctors and staff should become well versed in the multiple changes in diagnosis coding

20 ICD-10 Diagnosis Coding Other suggestions from CMS Communicate with your peers, especially those using the same software, clearinghouses, etc. Set aside a contingency fund for preparation costs and for possible unforeseen implementation hang-ups.

21 ICD-10 Diagnosis Coding In Summary, Educate All Personnel Prepare for Changes Communicate with Vendors Test


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