Presentation on theme: "Update to ICD 10 CM Diagnostic Code Set. Agenda Why ICD 10 CM? Highlights of ICD 10 CM & ICD 10 PCS Is it a big change? Timeline Make your Plans We want."— Presentation transcript:
Update to ICD 10 CM Diagnostic Code Set
Agenda Why ICD 10 CM? Highlights of ICD 10 CM & ICD 10 PCS Is it a big change? Timeline Make your Plans We want your Feed back.
ICD 10 For Mortality coding 14,000 to 16,000 codes What are the Diagnostic Code Sets? ICD 9 CM For Mortality & Morbidity coding 13,000 codes ICD 10 CM For Morbidity & Mortality coding 68,000 codes ICD 10 AM For Morbidity & Mortality coding 15,000 codes
Because Abu Dhabi continues to use version ICD-9, it has difficulty comparing its health service utilization to other countries. 4
5 ICD-9-CM Limitations Space limitations – Codes have already been assigned to inappropriate sections – Leads to challenges for coders Workarounds – Use of ‘overflow’ chapters compromise the structure of ICD-9-CM Emerging technology – Not expandable nor detailed enough to capture future healthcare information
6 Why ICD-10-CM?? Significant improvement in coding primary care encounters, external causes of injury, mental disorders, neoplasms, and preventative health Recognition of advances in medicine and technology More detail Addition of laterality (where the procedure or disease is located) Expanded distinctions for ambulatory and managed care encounters
7 Highlights In the US as of 2014 ICD-10-CM (Diagnosis) Will affect inpatient and outpatient ICD-10-PCS ( Procedures) Will only affect inpatient in the U.S. NOT UAE -We have CPT for outpatient reimbursement ICD-10-CM/PCS: Incorporates much greater specificity and clinical information, which results in: Improved ability to measure health care services; Increased sensitivity when refining grouping and reimbursement methodologies; Enhanced ability to conduct public health surveillance; and Decreased need to include supporting documentation with claims; Includes updated medical terminology and classification of diseases;
8 Highlights In the US as of 2014 All software will be ICD 10 based All certified coders will be ICD 10 based All RVU’s will be ICD 10 based ICD 9 CM will no longer be updated after 2012 ICD-10-CM/PCS: Provides codes to allow comparison of mortality and morbidity data; and Provides better data for: Measuring care furnished to patients; Designing payment systems; Processing claims; Providers making clinical decisions; Tracking public health; Identifying fraud and abuse; and Conducting research.
A revised classification system that: – permits international exchange of data for disease prevention & advanced healthcare research; – increases value of current clinical terminologies and permits greater use of health information technology to improve our health knowledge and decision support while lowering the cost of healthcare. – gives more specificity to Payers to reduce denials due to lack of information Why Upgrade to ICD 10 CM?
Upgrade to ICD 10 CM DSP 184 CCSC 092 Amend decision to: Implement ICD 10 CM one year after Implementat ion in the USA Implement ICD 10 CM as the Code Set for Diagnostic coding one year after implementation the USA (which presently means as of Encounter.Start >=1 Oct 2015), contingent on availability of DRG grouper for pricing minimum 12 months prior to the implementation date. Request DRG panel to confirm the timeframe. Daman: to establish and negotiate prices Payers and Providers will need at least on year after the DRG grouper is available for pricing (not for testing)
11 Is it a big change? Comparison ICD-9-CM Mechanical complication of other vascular device, implant and graft 1 code (996.1) ICD-10-CM Mechanical complication of other vascular grafts 156 codes, including T – Breakdown (mechanical) of aortic (bifurcation) graft (replacement) T – Breakdown (mechanical) of carotid arterial graft (bypass) T – Breakdown (mechanical) of femoral arterial graft (bypass) T – Breakdown (mechanical) of other vascular grafts T – Breakdown (mechanical) of unspecified vascular grafts T – Displacement of aortic (bifurcation) graft (replacement) T – Displacement of carotid arterial graft (bypass) T – Displacement of femoral arterial graft (bypass) T – Displacement of other vascular grafts
X X X X X X X X X X X X X X X X X X X X X X X X categoryetiology, anatomic site, manifestation categoryetiology, anatomic site, severity extension ICD-9 Code Format ICD-10 Code Format ICD-9-CM 14,025 ICD-10-CM 68,069 Diagnosis Codes Comparisons
Extensions A = initial encounter D = subsequent encounter S = sequela (late effect)
Patient is discharged with principal diagnosis of nontraumatic subarachnoid hemorrhage, commonly known as a stroke. Patient Case Scenario 1: Subarachnoid Hemorrhage In ICD-9-CM there is one code: 430 Subarachnoid hemorrhage In ICD-10-CM - twenty possible codes requiring detail of which artery the hemorrhage came from for accurate code assignment. right and left carotid siphon and bifurcation; right and left middle cerebral; right and left anterior communicating; right and left posterior communicating; basilar; right and left vertebral; and other or unspecified intracranial arteries.
A patient is treated for fracture of the patella to assign an accurate code, sixth and seventh characters are needed in ICD-10-CM. Patient Case Scenario 2: Fracture of the Patella ICD-9-CM Fracture of patella, closed ICD-10-CM S82.021D - Fracture of patella, displaced longitudinal, right patella - subsequent encounter for closed fracture with routine healing
Make Your Plan to ICD 10 CM Phase 1: Implementation plan development and potential impact assessments – Establish interdisciplinary steering committee to develop ICD‐10 implementation strategy – Development of potential impact assessments Phase 2: Implementation preparation – Training/awareness on Codes and Code uses (data etc) – Education on the available GEM and how to use Phase 3: “Go live” preparation – Contracts
Impact assessment. The purpose of this assessment is to anticipate who or what will be affected by the transition to ICD-10-CM while determining the degree of impact. An implementation budget must be created to address the costs associated with upgrading technology and training as well as the potential loss of productivity, which can delay remittance. A systems inventory is necessary to identify systems requiring modifications – All processes and systems that pertain to ICD codes need to be analyzed and modified to accommodate the expanded alpha-numeric code structure of ICD-10. Make Your Plan to ICD 10 CM
Training: More intense training regarding the specifics of the code set will be required for those who use coded data for the purpose of reimbursement, statistics, and/or research. – Ahima estimates the training time for experienced codes to be 16 hours with 10 hours practice) – And we mustn’t forget the Documentation Training required for doctors. Make Your Plan to ICD 10 CM
GEMs and the multiple uses of these GEMs – Maps are created for many purposes, (exchange of data for patient care purposes, access to longitudinal data, reimbursement, public health data reporting, and KEH. Correct mapping requires a complete understanding of how data will be used. – Even though standardized mappings will facilitate the process of translating between the old and new code sets, there will still be challenges connecting data coded under Make Your Plan to ICD 10 CM ICD-9-CM to data coded under ICD-10-CM due to the differences in the code sets. This will impact reports that compile statistical data for trend analysis. ICD-9-CM to data coded under ICD-10-CM due to the differences in the code sets. This will impact reports that compile statistical data for trend analysis. Download GEM from CMS website 10-CM-and-GEMs.html We want your feedback: