2 Agenda Why ICD 10 CM? Highlights of ICD 10 CM & ICD 10 PCS Is it a big change?TimelineMake your PlansWe want your Feed back.
3 What are the Diagnostic Code Sets? ICD 10For Mortality coding14,000 to 16,000 codesICD 9 CMFor Mortality & Morbidity coding13,000 codesICD 10 AMFor Morbidity & Mortality coding15,000 codesICD 10 CMFor Morbidity & Mortality coding68,000 codesDiagnosis codes are located in ICD-10-CM very much the same way as in ICD-9-CM, thereby giving it a familiar look and feel despite the fact there are almost 5 times as many diagnosis codes.
4 Because Abu Dhabi continues to use version ICD-9, it has difficulty comparing its health service utilization to other countries.Difficult to benchmark etc99 countries have adopted ICD-10 for morbidity data reportingAccurate description is critical for research and ultimately will improve the quality of healthcareEstimated that ICD-9-CM procedure code set will run out of codes in 2009
5 ICD-9-CM Limitations Space limitations Workarounds Emerging technology Codes have already been assigned to inappropriate sectionsLeads to challenges for codersWorkaroundsUse of ‘overflow’ chapters compromise the structure of ICD-9-CMEmerging technologyNot expandable nor detailed enough to capture future healthcare informationAccurate description is critical for research and ultimately will improve the quality of healthcareEstimated that ICD-9-CM procedure code set will run out of codes in 2009
6 Why ICD-10-CM??Significant improvement in coding primary care encounters, external causes of injury, mental disorders, neoplasms, and preventative healthRecognition of advances in medicine and technologyMore detailAddition 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) 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; andDecreased need to include supporting documentation with claims;Includes updated medical terminology and classification of diseases;In the US as of 2014ICD-10-CM (Diagnosis)Will affect inpatient and outpatientICD-10-PCS ( Procedures)Will only affect inpatient in the U.S.NOT UAE -We have CPT for outpatient reimbursement
8 Highlights ICD-10-CM/PCS: Provides codes to allow comparison of mortality and morbidity data; andProvides better data for:Measuring care furnished to patients;Designing payment systems;Processing claims;Providers making clinical decisions;Tracking public health;Identifying fraud and abuse; andConducting research.In the US as of 2014All software will be ICD 10 basedAll certified coders will be ICD 10 basedAll RVU’s will be ICD 10 basedICD 9 CM will no longer be updated after 2012
9 Why Upgrade to ICD 10 CM? 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
10 Upgrade to ICD 10 CM DSP 184 CCSC 092 Amend decision to: Implement ICD 10 CM one year after Implementation in the USAImplement 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-10-CMMechanical complication of other vascular grafts156 codes, includingT – Breakdown (mechanical) of aortic(bifurcation) graft (replacement)T – Breakdown (mechanical) of carotid arterialgraft (bypass)T – Breakdown (mechanical) of femoral arterialT – Breakdown (mechanical) of other vascular graftsT – Breakdown (mechanical) of unspecifiedvascular graftsT – 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 graftsICD-9-CMMechanical complication of other vascular device,implant and graft1 code (996.1)
12 Comparisons ICD-9 Code Format ICD-10 Code Format ICD-10-CM 68,069 14,025Diagnosis CodesICD-9 Code FormatICD-10 Code FormatXXXXXXXXXXXXICD9 code format is a five-digit number truncated three and two and there are about 14,000 to choose from. As we move to the 10th edition or new standards for diagnosis codes we see that ICD10 brings us a data element that is now seven alphanumeric characters long truncated three by three by one and there will be over 68,000 to choose from to start.extensioncategoryetiology, anatomic site, manifestationcategoryetiology, anatomic site, severity
14 Extensions A = initial encounter D = subsequent encounter S = sequela (late effect)Neck Fracture – stressing the Extension which would solve many billing issue in AD
15 Patient Case Scenario 1: Subarachnoid Hemorrhage Patient is discharged with principal diagnosis of nontraumatic subarachnoid hemorrhage, commonly known as a stroke.In ICD-9-CM there is one code: 430 Subarachnoid hemorrhageIn 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.
16 Patient Case Scenario 2: Fracture of the Patella A patient is treated for fracture of the patella to assign an accurate code, sixth and seventh characters are needed in ICD-10-CM.ICD-9-CMFracture of patella, closedICD-10-CMS82.021D - Fracture of patella, displaced longitudinal, right patella - subsequent encounter for closed fracture with routine healing
18 Make Your Plan to ICD 10 CMPhase 1: Implementation plan development and potential impact assessmentsEstablish interdisciplinary steering committee to develop ICD‐10 implementation strategyDevelopment of potential impact assessmentsPhase 2: Implementation preparationTraining/awareness on Codes and Code uses (data etc)Education on the available GEM and how to usePhase 3: “Go live” preparationContracts
19 Make Your Plan to ICD 10 CMImpact 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 modificationsAll 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.
20 Make Your Plan to ICD 10 CMTraining: 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.
21 Make Your Plan to ICD 10 CMICD-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 websiteWe want your feedback: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