1 What is this course?This course is designed to provide a basic awareness and understanding of ICD-10 and why it is so critical to our organization.
2 What is icd-10?We have all been hearing the whispers … and screams … about the transition to ICD-10. For many of you, you may know all too well what it means and how it affects you in your job. For others, you may not know much about ICD-10 and what the fuss is all about.
3 International classification of diseases (ICD) ICD-9 is currently the official system of assigning codes to diagnoses and procedures associated with hospital, outpatient, clinical and physician utilization in the United StatesWe will be transitioning to the next version of ICD codes – ICD-10
4 The DIAGNOSTIC CODE is like the rebar in the cement of a building You may not know it’s there, but it provides the structure and it is everywhere!Defines Patient Illness (diagnosis, signs, symptoms, diseases, disorders, treatment, and medication)Provides for Billing and ReimbursementMeasure Quality of CareFacilitates Clinical ResearchDetermines Medical NecessityCaptures Data for Reporting
5 Farewell ICD-9World Health Organization (WHO) took over responsibility for ICD at its creation in 1948 in its Sixth Revision (ICD-6) to provide a consistent way to monitor and trend diagnoses and diseasesThe United States has been using ICD-9 for over 30 yearsPayers cannot pay claims fairly using ICD-9, since the classification does not accurately reflect current technologyIt is difficult to evaluate the outcome of new procedures and emerging healthcare conditions when codes are not preciseThe healthcare industry cannot accurately measure Quality of Care, particularly causes of mortalityClinical Research will be improvedImpacts Billing and ReimbursementCMS has cited 2 main reasons for why we need to implement ICD-10 now:Payers cannot pay claims fairly using ICD-9, since the classification does not accurately reflect current technology.Significantly different diagnoses and procedures are assigned to a single ICD-9 code.These limitations are translating directly into limitations in the DRG groups and, therefore, the resulting payments.The healthcare industry cannot accurately measure the quality of care using ICD-9.It is difficult to evaluate the outcome of new procedures and emerging healthcare conditions when codes are not precise.Most importantly, the industry has a mission to improve its ability to provide patient care, which is limited by ICD-9 diagnoses.More info: The problem is that ICD-9-CM can no longer keep up with medicine. After 30 years, the code set is outdated and can no longer meet the demands of healthcare’s data needs. It cannot accurately describe the diagnoses and inpatient procedures for care delivered. The uses being made of coded data today go well beyond the purposes for which ICD-9-CM was designed, or even contemplated, in the 1970s.ICD-9 terminology and classification of numerous conditions and procedures are outdated, vague, or inconsistent. The system cannot adequately accommodate dramatic advances in medicine and medical terminology.Laser and laparoscopic surgeries were not performed at the time ICD-9-CM was implemented, for example, but today the technology is common. New procedures and technology are often classified to a single code developed for older procedures or lumped into an “other” category. Inaccurate or limited data and insufficient detail affect our knowledge of diagnoses, procedures, severity, quality, and technology.For these reasons, ICD-9-CM cannot support many of the health IT and data exchange initiatives targeted as healthcare’s future. A nationwide health information network requires modern classifications like ICD-10 for summarizing and reporting data.The longer the ICD-10 upgrade is delayed, the longer and more expensive it will be to achieve a fully functioning EHR with the interoperability necessary for advanced data sharing.ICD-9 Outdated
6 Worldwide icd-10 adoption The U.S. is one of the few developed nations that has not transitioned to the ICD-10 system.Public HealthThe US is the only industrialized nation not using an ICD-10–based classification system for morbidity purposes. This makes it difficult to share disease data internationally at a time when such sharing is critical for public health. The US’s ability to track and respond to global threats in real time is thus limited.The US belongs to the World Health Organization, which requires member states to notify the organization of all events that constitute a public health emergency of international concern and to respond to requests for verification of information regarding such events. The vision is that every country should be able to detect, rapidly verify, and respond appropriately to epidemic-prone and emerging disease threats to minimize their impact on the health and economy of the world’s population.3SOURCE:
7 When does the change from Icd-9 to icd-10 happen? The deadline for organizations to convert from ICD-9 codes to ICD-10 codes is October 1, 2015
8 Benefits of icd-10We will be able to capture more detailed data to support clinical research, quality outcomes, and patient careFor an academic organization, ICD-10 will accommodate data capture of new technologies and procedures and allow us to better define the complexity of care providedICD-10 data will be more easily retrieved in electronic format, resulting in less manual work in reporting, quality reviews, and auditing
9 Benefits of ICD-10 (cont’d) ICD-10 was designed with the idea that healthcare delivery and technology are not static, but constantly changing. It has far greater granularity, specificity, and more current healthcare informationAn important benefit and result: The widespread efforts within our organization to prepare for ICD-10 will yield improved workflows, improved efficiency, and greater organizational integration and teamwork
10 How do we make this change happen? There are seven UAHN - ICD-10 teams who will be leading the implementation effort:Clinical Documentation Team – responsible for facilitating effective clinical documentationCoding Team – responsible for transition to new ICD-10 codesEducation Team – responsible for staff trainingRevenue Cycle Team – responsible for redesign of revenue cycle processesReimbursement/Finance Team – responsible for ensuring payer and contract readiness, reimbursement and financial reportingTechnology Team – responsible for remediation and integration of IT systems for ICD-10 implementationThe Health Plan – responsible for implementation as a payer
11 Integration with epicThe Physician Advisory and Executive Steering committees oversee the ICD-10 implementationThe Physician Advisory Committee also provides oversight for the Epic ProjectICD-10 teams and Epic teams are integratedEnables both projects to be in sync with one another
12 Icd-10 implementation process Education needs are based on the staff member’s position within the organizationSeveral different forms of training will be used: learning modules via HealthStream, posters, group forums, etc.Coordination with Epic teamEpic includes both ICD-9 and -10 for dual coding optionsICD-10 tools are embedded in Epic to facilitate the transition
13 What Changes can we expect? The number of diagnostic codes will increase from approximately 17,000 today to 140,000 after ICD-10 is implementedClinical documentation will require greater specificityAll providers and staff involved in documentation and coding must have a thorough understanding of ICD-10UAHN systems and workflows will need to be modified to include ICD-10
14 Next stepsThe ICD-10 Teams will coordinate with the departments impacted by the changeAdditional implementation training for providers and staff directly affected by ICD-10, will be rolled out through September, 2015An ICD-10 information site can be accessed via the intranetFrom the home page, click on Departments and ICD-10Regular communications will keep everyone informed of project progress
15 IN summary…ICD-10 is a significant change, but we are all used to BIG and constant changesICD-10 impacts all of us in some way, making it vital that we understand what it is and how it will change our industryThorough preparation for ICD-10 will allow for a successful transition