1. ICD-10 INITIATIVE -Update DRH Practice Management
November 13, 2012

2. Agenda
Introduction Preparation and Strategy; What’s your role? I-10 Implementation Date; What ‘s next? Questions from Group

3. Introduction

4. ICD-10: Advancing Healthcare
The Federal Government, through the Centers for Medicare and Medicaid Services (CMS), is driving the healthcare industry to upgrade diagnosis and inpatient procedure coding standards (ICD-10) by
October 1, 2014
ICD-10 Changes
Implications
ICD-10
(International Classification of Diseases version 10)
The ICD is the international standard diagnostic classification for general epidemiological, health management purposes and clinical use
ICD-10 CM & PCS is an upgrade of the U.S. developed Clinical modification (ICD-9-CM) of Diagnosis and Procedure Codes, first adopted in 1979
Pervasive Impacts
Diagnosis codes and procedure codes flow through mission critical operational systems and analytical tools
Alignment of technology remediation with business and technology strategies
Business process reengineering, training and change management is essential
Comprehensive Benefits
Quality Measurement/ROM/SOI
Public Health Disease Surveillance
Clinical Research
Organizational Monitoring and Performance
Reimbursement
Significant Increase in Clinical Granularity
ICD-9 CM (Diagnosis)
>14,000 unique codes
ICD-10 CM (Diagnosis)
> 68,000 unique codes
ICD-9 CM (Procedure)
ICD-10-PCS (Procedure)
> 4,000 unique codes
> 72,000 unique codes
9 to 10, 10 to 9 translations
CPT/HCPCS will not change

5. Coding and 7th Character Extensions
2 Numeric
3 - 7 Numeric or Alpha
Additional Characters
Alpha
(Except U) . . X M S A X 2 X 6 X X 5 X x A X
Category
Etiology, anatomic
site, severity
Added code extensions (7th character) for obstetrics, injuries, and external causes of injury
3 – 7 Characters

6. Coding in ICD-10-CM Three to five characters Three to seven characters
First digit is numeric but can be alpha (E or V)
First character always alpha
2-5 are numeric
All letters used except U, “X” is used as the placeholder
Always at least three digits
Character 2 always numeric: 3-7 can be alpha or numeric
Decimal placed after the first three characters (or with E codes, placed after the first four characters)
Alpha characters are not case-sensitive
Decimal placed after the first three characters

7. Preparation—Strategy What’s Your Role?
Top Diagnoses
Evaluate Processes
Review Denials (LCD,NCD)
Stay Informed (payors, vendors)
Train—Consolidate Maestro Care and Documentation
Practice

8. What’s In it for Providers?
Documentation specificity will support patient care, quality measures, future payment adjustments, & reimbursement. Therefore, documentation should be consistent regardless of setting—Documentation should support the charge
Value-bases Purchasing Relies on I-10 Specificity
Enables more accuracy in payment
Avoid unspecified/miscellaneous coding
Add incremental value to your code selection
More accurately demonstrates outcomes of care
Reduce medical record requests –Reduce Denials & Rework
Accurate Healthgrades

9. What’s the Bottom Line?
Healthcare is centered on change:
Improving care delivery systems
“If we truly seek better, more affordable health care, then quality improvement, documentation and data analysis in the future will depend on the specificity that ICD-10-CM offers”. Annie Boynton, AAPC

10. We have an Implementation date what’s next?

11. Train…..Educate…..Practice
1.) Training and Education on the changes that Impact Departments Role-based Training (accessible media) Documentation Supports Charges 2.) Practice following Training---Knowledge Maintain current claims processes Accuracy counts

12. Precyse Module E-Learning Example

13. Example of a quiz in Precyse

14. references

15. Questions from Group What are the new codes?
The General Equivalence Mappings (GEMS) for both Diagnoses and procedures (CM and PCS)
Codes are available on the CMS website at
What resources can we access to help prepare:
CMS has lots of information, including plans and timelines for small and large provider groups.
American Health Information Association (AHIMA) has information on planning, training, Superbill examples, etc.
ICD10monitor is a coalition of industry experts providing advice, webinars, and tools related to the conversion.
Coder Mappers available for purchase:
American Medical Association (AMA)
portability-accountability-act/transaction-code-set-standards/icd10-code-set.page

16. QUESTIONS?