1. February, 2013 ICD-10-CM/PCS What does it mean to us? Lynda Starbuck, MS, RHIA, C-CDI AHIMA Approved ICD-10-CM/PCS Trainer

2. ICD-10 Timeline October 1, 2011 - Last full update to ICD-9-CM and ICD-10 (revised with implementation delay) January 1, 2012 - 5010 electronic claims submission October 1, 2014 - ICD-10 codes required on all discharges (NEW DATE) February, 2013

3. What is Coding Used for? All patient encounters are coded by Health Information Management coding staff using physician documentation of diagnoses, signs, symptoms, and procedures. This information is then abstracted onto a billing form and sent to the third party payer for payment of services rendered based on coded data. February, 2013

4. ICD-10-CM/PCS What is it? ICD-10-CM US clinical modification of the World Health Organization’s ICD-10 Diagnostic coding system (no procedure codes) ICD-10-PCS Developed under contract by CMS specifically to replace the ICD-9-CM procedural coding system

5. ICD-10-CM Code Structure Alphanumeric Up to 7 characters Place holders of “x” are used when code is 5 characters and needs a seventh character code extension 21 chapters and codes are dispersed differently V and E codes are incorporated into the main code February, 2013

6. ICD-10-CM Code Extensions CODE S73.011A– Posterior subluxation, right hip, initial encounter 064.0XX1- Obstructed labor due to incomplete rotation of fetal head, fetus 1 of multiple MEANING Initial encounter, subsequent encounter, sequela Fetus number

7. February, 2013 ICD-9-CM Full Code Titles ICD-9-CM 802. Fracture malar, maxillary and zygoma bones - 802.4 Closed - 802.5 Open ICD-10-CM S02.4 - S02.40 – Fracture of malar, maxillary, and zygoma bones, unspecified - S02.400 Malar Fracture, unspec. - S02.401 Maxillary Fracture, unspecified - S02.402 Zygomatic fracture, unspecified - S02.41 LeFort fracture - S02.411 LeFort I fracture - S02.412 LeFort II fracture - S02.413 LeFort III fracture

8. February, 2013 New Features Combination codes for conditions and common symptoms or manifestations Combination codes for poisonings and external causes Added laterality Expanded codes (injury, diabetes, alcohol/substance abuse, postoperative complications) Impending/threatening condition codes Injuries grouped by anatomical site rather than injury category

9. Official Coding Guidelines Chapter Specific Infectious Disease - Urosepsis is a non-specific term – no reference in the alpha index - Post-procedural infection by procedure Mental and Behavioral Disorders - Added disorders due to psychoactive substance use Nervous System and Sense Organs - Hemiplegia/hemiparesis – new rule for dominant vs. non-dominant sides February, 2013

10. Chapter Specific Guidelines continued… Circulatory System - MI timeframes reduced to 4 weeks vs. 8 - Causal relationship assumed between CAD and Angina Obstetrics - Trimester indicated in code (or weeks of gestation) - Fetal extension – used to distinguish to which fetus complication applies February, 2013

11. Chapter Specific Guidelines continued… Injuries - Code extensions used to indicate what phase of care the patient is receiving (initial, subsequent, or sequela) Adverse effects / Poisonings - Includes under-dosing - Codes indicate how the adverse effect occurred February, 2013

12. ICD-10-PCS Code Structure 1 st character is the Section 2 nd character is the Body System 3 rd character is the Root Operation 4 th character is the Body Part 5 th character is the Approach 6 th character is the Device 7 th character is the Qualifier

13. ICD-10-PCS Coding Example PTCA with Stent RCA - Root Term – Dilation = Dilation - Artery >> Coronary >> Four or more sites 0273 >> One site 0270 >> Three sites 0272 >> Two sites 0271 February, 2013

14. ICD-10-PCS Coding Example… 027 table February, 2013

15. ICD-10-PCS Obstetric Delivery- Forceps Extraction –pulling or stripping out or off all or a portion of a body part (10D) - Products of Conception (10DO) - Via Natural or Artificial Opening (10DO7) - No Device (10D07Z) >> Qualifier – Mid Forceps-4 ICD-10-PCS Code 10D07Z4 February, 2013

16. Impact of ICD-10-CM/PCS Hospitals Potentially have the most system changes Advantage in added detail (to identify severity and reduced billing paperwork) Large learning curve for coders (no Coding Clinic guidance as of Oct.,2013) More physician specificity required – thus more queries DRG ‘s / CC’s / MCC’s – have not been formulated for ICD-10 codes.

17. February, 2013 IMPACT Healthcare Providers Non-inpatient facilities including physician offices will only use ICD-10-CM, not ICD-10-PCS CPT will continue to be used by Part B providers to describe procedures (all outpatient claims) Physicians will be asked to document specificity and detail Physicians offices will have to learn ICD-10-CM (diagnosis only) Training and new materials cost Revising Super Bills

18. Staff Training and Preparation Limited knowledge to Business office, Registration staff, Radiology, Lab, Unit secretaries, and IT staff who support coding software. Intermediate knowledge to Hospital Administration, Physicians, Finance, Rehabs, Home Health, Hospice, Case Management, and Outpatient Diagnostic coders High levels of knowledge to Inpatient coders, Outpatient Surgical Coders, Quality, Chief Medical Officer, Educators, Documentation Improvement Managers, and CDI Staff/Nurses. February, 2013

19. Impact of ICD 10 CM/PCS Acute Care Hospitals Required to use ICD-10-CM and ICD-10-PCS Potentially have the most system changes Advantage in added detail (to identify severity and reduce billing paperwork) Coder productivity is predicted to decrease by 1/3 for potentially up to 2 years. Medical Staff will be required to document more accurately February, 2013

20. IMPACT continued… Coding System Changes - Data trending challenges include maintenance of crosswalks among coding systems for longitudinal data analysis and the potential for faulty decisions due to distorted, inaccurate, or misinterpreted data Other Healthcare Providers -Non-inpatient facilities including physician offices will only use ICD-10-CM, not ICD-10-PCS -CPT will continue to be used by Part B providers to describe procedures (outpatient claims) February, 2013

21. Why ICD 10 Is Worth The Trouble Moving to the new code sets will permit improved efficiencies and lower administrative costs due to replacement of a dysfunctional classification system. This in turn allows: Increased use of automated tools to facilitate the coding process Decreased claims submission or claims adjudication costs Fewer rejected and improper reimbursement claims Greater interoperability Decreased need for manual review of health records to meet the information needs of payers, researchers, and other data mining purposes Decreased need for large research organizations to maintain dual classification systems (one for reimbursement and one for research) Reduced coding errors Reduced labor costs and increased productivity Increased ability to prevent and detect healthcare fraud and abuse February, 2013

22. What should we be doing now? Conduct an ICD-10 update once a month in RAC/UR Committee CDI Chart Reviews – early identification of high- impact areas Creation of Queries for ICD-10 in relation to top 10-15 DRG’s February, 2013

23. References: ICD-10-CM/PCS – The Complete Official Draft Code Set, Draft 2012 MLN Matters/CMS CDI: Improve Documentation Now for Effective Transition Later – HCPro, Inc. "Why ICD-10 Is Worth the Trouble." Journal of AHIMA 79, no.3 (March 2008): 24-29. AHIMA ICD-10-CM/PCS Update (2011-2012) Journal of AHIMA (2011 -2013) February, 2013

24. Questions? February, 2013