1. ICD-10 is Coming Ready or Not Dr. Thomas Ayoub Norwalk Hospital

2. 10/1/2013 2 Punishment …of doctors …by the government …for purposes of lowering reimbursements This is not part of “Obama-care”. ICD-10 is NOT

3. 10/1/2013 3 Derives from the World Health Organization. – CMS is acting on behalf of the US government Links to quality of care –Primary purpose is epidemiologic tracking of illness and injury; worldwide outcomes data is important Long overdue –ICD-9 has been in use since 1979 and medicine has changed ICD-10

4. 10/1/2013 4 UK 1995 Nordic Countries 1994-7 France 1997 Australia 1998 Belgium 1999 Germany 2000 Canada 2001 United States Oct 1 st, 2013 ICD-10 adoption by other Countries Another delay will not occur 2014

5. 10/1/2013 5 U.S. will be the only country to use ICD-10 for reimbursement. ICD-10

6. 10/1/2013 6 For a typical practice the total cost depends on the size: Small $83,290 Medium $285,195 Large $2.7 million The Cost

7. 10/1/2013 7 Much worse than Y2K; effects include: Clinical documentation/EHR systems Encounter forms/Superbills Practice management systems Contracts Public health and quality reporting protocols IT Issues

8. 10/1/2013 8 Other Office Issues Staffing: ½ of billers are expected to retire or change jobs Productivity: may drop as much as 50% Dual systems: required from several months prior to several months after…maybe longer Delayed Payments: the industry is expecting significant delays Cash Flow: CMS & Insurers will not accept bills after Oct 1, 2014 in ICD-9 format

9. An opportunity to bring physicians together I'll be more than happy to assist you in finding the help you need to tackle this project. What Lies Ahead 9 10/1/2013

10. You can use our new website www.norwalkhospital/icd-10 with links to resources (try our QR logo on your invitation)www.norwalkhospital/icd-10 You can contact Susan Herson, MD at susan.herson@norwalkhealth.org susan.herson@norwalkhealth.org Resources 10 10/1/2013

11. How Can Physicians Prepare Susan Herson, MD Hospitalist Documentation Improvement

12. 9/26/2013 12 You’ve heard there will be a vast expansion in the number of codes but… 60% of the new code volume pertains to musculoskeletal system New coding system is logical ICD-10

13. 9/26/2013 13 Coding Classifications The new coding is logical because it relates to treatment decisions.

14. 9/26/2013 14 Most Common ICD-9 CMS recommends that offices start by listing their most commonly used ICD-9 codes and becoming familiar with corresponding ICD- 10 codes The best resource is www.CMS.gov/icd10 “Understanding the Basics”

15. 9/26/2013 15 Start with highest volume codes The vast majority of practices use very few codes… 5% of codes account for 70% of the volume Majority Rules

16. 9/26/2013 16 Example: GI Most Common Codes ICD-9 Code & Description# of Encntrs % of Activity ICD-10 Code & Description V76.51 Screen malig neop-colon 469541%Z12.11 Encounter for screening for malignant neoplasm of colon V12.72 Prsnl hst colonic polyps121411%Z86.010 Personal history of colonic polyps 530.81 Esophageal Reflux6706%K21.9 Gastro-esophageal reflux disease without esophagitis 569.3 Rectal & Anal Hemorrhage4514%K62.5 Hemorrhage of anus and rectum 787.91 Diarrhea3963%K52.2 Allergic and dietetic gastroenteritis and colitis K52.89 Other specified non-infective gastroenteritis and colitis R19.7 Diarrhea, unspecified Top 5 ICD-9 codes cover 64% of the Encounters

17. 9/26/2013 17 Principal Diagnosis ICD-9 Screen Malig Neop-ColonV76.51 Prsnl Hst Colonic PolypsV12.72 Esophageal Reflux530.81 Rectal & Anal Hemorrhage569.3 Diarrhea787.91 Top GI Diagnosis in ICD-9

18. 9/26/2013 18 Use free internet sites like http://www.icd10data.com or download free apps Translate ICD-9 to ICD-10

19. 9/26/2013 19 Start typing the ICD-9 text here A broad search occurs; all yellow highlights are possible matches.

20. 9/26/2013 20 Or choose “Convert” to use the code instead of the text

21. 9/26/2013 21 As you start typing the code here, a list of options appear below

22. 9/26/2013 22 Principal DiagnosisICD-10 Encounter for Screening for Malignant Neoplasm of the ColonZ12.11 Personal history of Colonic PolypsZ86.010 Gastro-Esophageal Reflux Disease without EsophagitisK21.9 Hemorrhage of Anus and RectumK62.5 Allergic and dietetic gastroenteritis and colitisK52.2 Other specified non-infective gastroenteritis and colitisK52.89 DiarrheaR19.7 Top GI Diagnosis now in ICD-10

23. 9/26/2013 23 What we learned from the conversion process 3 out of 5 codes were direct conversions / perfect matches 2 out of 5 codes required more documentation GERD requires with or without esophagitis The default will likely be “without” Diarrhea requires etiology - due to infectious or non-infectious process - due to diet - due to allergy We learned not only which diagnoses require more documentation but exactly what type of documentation is required.

24. 9/26/2013 24 Not all ICD 9 unspecified codes exist in ICD 10 e.g. CAD, unspecified the provider must choose native & graft vessel Unspecified codes cause shifts in reimbursement Unspecified codes may not capture relevant data reporting and improved patient care. Unspecified Codes still exist. However…

25. 9/26/2013 25 Document Initial or Follow-up encounter for every visit Use adjectives like acute, chronic, or acute on chronic, and mild, moderate, or severe, early onset, diffuse Link cause and effect with words like "due to" Specify anatomic site particularly left, right, bilateral Use exact dates of injury or disease onset General Documentation Improvement Tips ICD-10 is like learning a new language it is not intuitive but it is logical

26. 9/26/2013 26 Specialty Societies for guidance & billing forms Internet tools and apps www.CMS.gov/icd10 http://www.icd10data.com Norwalk Hospital: 3M videos in 18 subspecialties 1-hour training sessions in April with HC-Pro Quarterly ICD-10 meetings Resources