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

2. 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?

3. 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

4. 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

5. 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.

6. 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

7. 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

8. 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

9. ICD-9 to ICD-10 Conversion Obstacles
Commentary
ICD-9-CM Code (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.

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

11. 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

12. 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

13. 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

14. 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

15. 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

16. Questions and Contact Information
Rachel V. Rose, JD, MBA BCE Healthcare Advisors Jerry Williamson, MD. MJ. LHRM

17. 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.