ICD- 10 READY OR NOT ! Terrance Govender, MD, MBBCh, C-CDI, CHBC

OBJECTIVES History of ICD Benefits and Goals Impacts on the Industry How to prepare What next?

HISTORY Core of the healthcare payment system in the United States. Current set: ICD-9, been in use since 1980! Advancement in medicine, but not the code set. Rely heavily on the codes: Medical record words never leave the hospital. Only the codes do. ICD 10 is essentially a new language with which we are expected to describe and report healthcare encounters.

HISTORY ICD-10 copyrighted by the WHO (World Health Organization) They own and publish the classification. Global standard for reporting and categorizing diseases, health related conditions and external causes of diseases and injury. ICD-10 code set has been modified by many countries to suit their own medical systems.

BACK IN TIME 1893: The first International list of causes of death. Bertillon Classification : France convened the first international conference for the revision of the Bertillon of International list of causes of death in : First international conference for the revision of the International list of causes of death. 1948: International conference for the 6 th Revision of the International lists of diseases and causes of death in Paris.

BACK IN TIME : 3 successive decennial revision conferences in 55, 65, 75, recognized the increasing use of ICD for the indexing of hospital medical records. 1977: ICD 9 was published. 1980: ICD-9 implemented in the US. 1983: DRG (Diagnosis Related Groups implemented in the US) : ICD-10 implementation begins outside the US. 1999: US starts to use ICD-10 for mortality stats.

BACK IN TIME 2007: IIPS- Changed to a Medicare Severity DRG system (MS-DRG) 2014: ICD-10 will be implemented in the USA.

IMPLEMENTATION OF ICD-10 AROUND THE WORLD

GOALS OF ICD-10 IMPLEMENTATION ICD-10 will provide greater detail and a more accurate depiction of patient severity. This will enhance the ability to measure quality  more information will be provided/captured about the relationship between a providers performance and the patient’s condition.

GOALS OF ICD-10 IMPLEMENTATION Provide greater specificity of clinical data. Obtain relevant robust clinical data that can be used to make intelligent data driven decisions. Allow for more accurate payments for new procedures. Provide better data for fraud and abuse monitoring. Reduce the number of miscoded, rejected and improper reimbursement claims.

GOALS OF ICD-10 IMPLEMENTATION Offer a better understanding of the value of new medical procedures. Improve the understanding of healthcare outcomes. Provide more ICD codes to address Global Disease Emergencies.

ICD-10 STRUCTURE AND FORMAT ICD-9- CM Diagnosis Codes 3-5 Characters in length. Approximately 13,500 codes. Limited space for adding new codes. Lacks detail Lacks laterality Difficult to analyze data due to non specific codes. Does not support interoperability because not used by other countries. ICD-10-CM Diagnosis Codes 3-7 Characters in length. Approximately 69,000 codes. Flexible for adding new codes. Very Specific Has Laterality Specificity improves coding accuracy and data analysis. Supports interoperability and the exchange of health data between US and others

ICD 10 Overview

IMPACT ON THE INDUSTRY From hospitals to physician offices, health plans to patients  Everyone will be affected. Expect changes in documentation, reimbursement, coverage, insurance plans structure, quality measures, audits, etc.

PAYMENTS Most info regarding payments will not be released until very close to the implementation. Financial Impact really cannot be predicted. Expect delays in payments, teething phase. Expect denials and rejections. Unless there is a drastic culture change in your providers, revenue will drop significantly.

PROVIDER DOCUMENTATION SPECIFICITY-SPECIFICITY-SPECIFICITY!! Not as daunting as it sounds. Get away with a lot in ICD-9. ICD-10 world: Poor documentation = rejection of claim. Not otherwise specified, unless absolutely correct, will not cut it come More queries from coders, increase in documentation times. Clinicians need to be onboard early.

IMPLEMENTING ICD-10 CMS suggests the ffg. Milestones and tasks for the implementation of ICD-10: 1.Planning 2.Communication and awareness 3.Assessment 4.Operational Implementation 5.Testing Phase 6.Transition

BREAKDOWN Important: Must get stakeholders/admin/medical staff involved from the get go! 1.CREATE AWARENESS: » Start today » Designate 1 person to initiate interest in ICD-10 » Use CMS, AMA and WHO as valuable resources for information. » Accountability is important » Frequent meetings and updates

IMPLEMENTATION 2. PLANNING COMMUNICATION: – Different parts of your organization affected – Make sure ALL are on the same page – Identify critical staff members involved eg. Physician Champions, CIO etc. – What’s the best means of communication for your organization or specific groups of individuals

IMPLEMENTATION 3. CONDUCT AN IMPACT ANALYSIS: » Take a look at your systems and how they will be impacted by the transition » Includes things like work flow, operational systems and business processes. » Eg. Revenue cycle alone: Charge Capture Coding and Documentation Utilization Management Managed Care Contracts Billing Collections

IMPLEMENTATION 4. DOCUMENTATION: » 3M suggests that this will be the largest impact area of the implementation. » Assess current documentation » Does it meet current ICD-9 requirements? » Perform an audit- can be done in house. » Start training with clinicians early. » Instill good habits.

IMPLEMENTATION 5. CHECK YOUR VENDORS: » Does your current system accommodate changes to ICD- 10 » Modifications to 4010 transition to 5010 billing form. » What changes and updates will need to be made and how much will this cost me? » Have one individual in charge of dealing with vendors and request frequent updates. » Do this with ALL vendors, document and file the response.

IMPLEMENTATION 6. FINANCIAL EFFECTS: » Creating a steering committee  possible incentives necessary for certain key members. » Upgrade to systems » Implementation of new systems » Awareness and training of staff » Anticipated delays in claims processing. » Possible rejections/denials of claims. » Decrease in coder productivity. » Reimbursement implication. » How long can you survive if claims are delayed for a prolonged period of time (physician practices)

WHAT NEXT? START NOW! Establish awareness among your administration and clinical leadership. Identify those key players: 1 coordination player. Budget accordingly Good luck!

QUESTIONS