Introduction ICD-10-CM Overview Presented By Erline Franks CCS-P

ICD-10-CM Facts The United States is the only nation that has not implemented ICD-10 ICD-10-CM set to begin October 1, 2014 Regular updates which go into effect October 1 of each year, starting in ICD-10-CM consists of 21 chapters compared to 17 chapters in ICD-9-CM ICD-10-CM is based on statistical classifications of disease by the World Health Organization (WHO) Guidelines have been approved by the American Hospital Association (AHA), American Health Information Management Association (AHIMA), CMS, and NCHS

ICD-10-CM Facts cont. The transition to ICD-10-CM is happening because ICD-9 provides limited data about the medical conditions of patients’ and hospital inpatient procedures. ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice. The structure of ICD-9 also limits the number of new codes that can be created, and many categories in ICD-9 are full.

Diagnosis Code Comparison ICD-9-CM (Volume 1 & 2)ICD-10-CM 3-5 characters in length3-7 characters in length Approximately 14,000 codesApproximately 68,000 codes First digit may be alpha (E or V) or numeric; digits 2-5 are numeric Digit 1 is alpha (to indicate the category); Digit 2 is numeric (in the future, alpha characters may be used if code expansion is needed); Digits 3-7 can be alpha or numeric Limited space for adding new codesFlexible for adding new codes Lacks detailVery specific Lacks lateralityIncludes laterality (i.e., codes identifying right vs. left)

Who will be affected? ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by HIPAA (Health Insurance Portability and Accountability Act), not just for those who submit Medicare or Medicaid claims. This change does not affect CPT coding for outpatient procedures. This change includes: Providers, Payers, Software vendors, Clearinghouses, and third-party billing services.

What should providers do to Prepare? Create a practice ICD-10 Team Budget for Implementation Costs Create a timeline (including a team leader responsible for each area) Identify current and future educational needs for staff Communicate with your Practice Management System Vendor

What should providers do to Prepare? Cont. Communicate with your billing Service, Clearinghouse, and Payers as to hardware and software concerns Communicate with your payers about how your contracts will be affected Identify changes to your Practice Work Flow and Business Processes

What should providers do to Prepare? Cont. Identify your education needs: Get a copy of the ICD-10-CM code set. Identify your practices’ top 50 diagnosis codes currently used. Remove the unspecified codes. (Remember, unspecified codes may not be reimbursed with ICD-10) Review your documentation and determine the changes that will need to take place to support the more specific ICD-10 codes. Continue education on the rest of the top 50 codes

Where do I find information regarding ICD-10-CM? CMS (Centers for Medicare & Medicaid Services) AHIMA (The American Health Information Management Association) SS&G Healthcare, LLC Specialty Specific Societies Software and System Vendors

When should I begin the transition? Yesterday!!! Health care organizations that submit transactions electronically are required to upgrade transaction standards from 4010/4010A to Version 5010 effective January, 2013

When should I begin the transition? Cont. AHIMA Checklist— hecklist.pdf hecklist.pdf Phase 1: Implementation plan development and impact assessment (first quarter 2009 to second quarter 2011) Phase 2: Implementation preparation (first quarter 2011 to second quarter 2013)

When should I begin the transition? Cont. Phase 3: “Go live” preparation (first quarter 2013 to third quarter 2013) Phase 4: Post-implementation follow-up (fourth quarter 2013 to fourth quarter 2014) Expect a significant reduction in productivity for the first three to six months Expect an impact in your cash flow

General Equivalence Mapping (GEMs) Mappings between ICD-9-CM and ICD-10-CM classifications have been developed to transition one code set to another The NCHS ( National Center for Health Statistics) has released the GEMs, along with documentation and a user’s guide, are available on the NCHS website and the GEMs website

Use of GEMs Appropriate Usage: Convert multiple databases from ICD-9-CM to ICD-10-CM Variety of research applications involving data trend Inappropriate Usage: Crosswalks- There is not a one -to-one match between ICD-9-CM and ICD-10-CM codes, for a multitude of reasons (e.g. new concepts in ICD- 10-CM, a single ICD-9-CM code may map to multiple ICD-10-CM codes)