NARROWING THE LANGUAGE GAP BETWEEN ICD-9 AND ICD-10 AHLA ERM Quarterly Education – 09.08.11 RACHEL V. ROSE, JD, MBA JERRY WILLIAMSON, MD. MJ. LHRM

ICD-10 Overview What is ICD-10? Why is the United States Implementing ICD-10? When is it going to be implemented? How is it going to affect providers? What is the clinical documentation impact? How can providers begin to prepare?

ICD History 1893 – First Edition (International List of Causes of Death) 1948 – Sixth Revision (WHO takes over) 1975 – ICD-9 Additional detail of four-digit subcategories Optional five-digit subdivisions WHO begins preparations for ICD-10 1989 – ICD-10 Introduced 1948 – Causes of morbidity included for the first time

What Is ICD-10? A set of classifications associated with health data and reimbursement Copyrighted by WHO Published in 37 languages Provides data Measurement Research Policy Making Decisions (public health, delivery reform) Furthers Electronic Health Record Value

The United States and ICD-10 October 1, 2013 ICD-9’s capacity is near exhaustion and over 30 years old Improved coding and accuracy ICD-10 provides specific diagnosis and treatment information to improve Quality measures Patient safety Evaluation of medical processes and outcomes Add macro healthcare industry items being addressed – value based purchasing (quality component) and Hospital Acquired Conditions/Never Events that Medicare and now Medicaid will not cover.

ICD-10: Implementation October 1, 2013 compliance date set forth by HHS Number of codes increases from approximately 17,000 (ICD-9 CM) to 155,000 (ICD-10 CM and PCS) ICD-10-PCS – inpatient hospital procedures ICD-10-CM – diagnosis codes – used by ALL providers in every health care setting CPT Codes – physician reporting and outpatient services

Clinical Documentation Impact ICD-10-CM Codes Primary care encounters External Injury Causes Mental Disorders Neoplasms Preventive Health Significant emphasis on SOAP and H&P Notes Greater detail on results of screening tests Expanded socioeconomic and lifestyle indicators Future expansion of organ specificity

Impact on Providers ICD-9 payment schemes will be impacted by ICD- 10 Inherent versus intentional impact Inherent = disparities in code sets that are unaccounted for because of unavoidable conversion gaps Intentional = conscious effort to capitalize on the more specific requirements of ICD-10 to positively impact reimbursement (PROACTIVE) NEC – not elsewhere classified; NOS – not otherwise specified; and urosepsis codes are three examples of ICD-9 codes that are not available with ICD-10

ICD-9 to ICD-10 Conversion Obstacles Commentary ICD-9-CM Code 92.27 (Implementation and Insertion of Radioactive Element) Equates to 263 possible anatomic site alternatives in ICD-10 If principal diagnosis in ICD-10 was prostate, the anatomic implant site for the ICD-10 radioactive element implant code = the prostate. Four separate ICD-9-CM clusters that specify three ulcer sites and the stage. L89.40 (Pressure Ulcer of Contiguous Site of Back, Buttock and hip, unspecified stage) The multiple ICD-9 codes are captured in a single ICD-10 code. No gender-specific codes. Gender-specific codes. Gender on patient record is used in the ICD-10 alternative. ICD-9 to ICD-10 conversion examples: insertion of radioactive implant, combination codes, pressure ulcers, and gender-specific codes. There is no simple, direct translation from ICD-9 to ICD-10.

Narrowing Language Gaps Between ICD-9 and ICD-10 Greater emphasis on clinical documentation is required Greater detail Screening test results Expanded socioeconomic and lifestyle indicators Expansion of organ specificity

ICD-9-CM versus ICD-10-CM 3-5 Characters 3-7 Characters First Digit – alpha or numeric First Digit – Alpha (No “U”) 2nd, 3rd, 4th & 5th digits = numeric 2nd & 3rd digits = numeric Other digits = alphanumeric Decimal placement – after 3 characters

Proactive Steps For Providers Begin documenting now to meet ICD-10 standards Train coders on anatomy and physiology Hire additional coders during the “ramp up” period Form a multi-departmental transition team

Organizational Game Plan Education Who needs it What is the best approach Budget Develop a budget for ICD-10 training and implementation Consider: system changes, hardware/software upgrades, additional staff, education

Organizational Game Plan Information Systems Audit for ICD-10 Compatibility System storage capacity Vendor readiness Current contracts and upgrade coverage Impact on Revenue Cycle Provider documentation Ramp up period and loss of productivity Gap Analysis Emphasis on ICD-10/need for a robust CDI Program

Conclusion ICD-10 will provide both challenges and opportunities Providers who are proactive will have a more seamless transition in 2013 Team Approach Enables Everyone to speak and understand the “new language” Appropriate Reimbursement Improved quality of care

Questions and Contact Information Rachel V. Rose, JD, MBA BCE Healthcare Advisors rrose@bcehealthcareadvisors.com Jerry Williamson, MD. MJ. LHRM jwchsi@aol.com

General Equivalence Mappings – to use or not to use Use General Equivalence Mappings (GEMs) Use ICD-10 and ICD-9 Code Books Translating lists of codes, code tables or other coded data Short list of ICD-9-CM codes w/ descriptions Converting a system or application containing ICD-9-CM codes Access to the medical record Creating an ongoing “one-to-one” applied mapping between code sets Access to other forms of clinical information including: text descriptions, research, or clinical software applications Study the differences in meaning between ICD-9CM and ICD-10-CM/PCS for a given code or classification area It is important to recognize that “[a] medical record that will be processed and stored as ICD-10 data should always be coded directly in ICD-10-CM/PCS, using the code books or an encorder.” Ibid at p. 5.