1. ICD-10 5th Edition Implementation
Preparing for implementation
Clinical Classifications Service

2. ICD-10 5th Edition checklist
Here’s a checklist to help you plan and manage the ICD-10 5th Edition implementation
You may not need everything included here
But, it will help you identify what needs to happen
Take what is useful for you and your organisation ……..

3. Overview of ICD-10 5th Edition
Topics covered
Overview of ICD-10 5th Edition
What is ICD-10
Impact and number of changes
Products delivered centrally
Implementation planning and strategies
Organisation, systems and coding readiness
Go live preparation
Post implementation
Links to central resources

4. Overview of ICD-10 5th Edition

5. Overview of ICD-10 5th Edition
World Health Organisation International Statistical Classification of Diseases and Related Health Problems – Tenth Revision, 5th Edition
Commonly referred to as ICD-10 5th Edition

6. Overview of ICD-10 5th Edition
What is ICD-10?
NHS Information standard
Used to classify hospital diagnoses for secondary uses such as statistical purposes and reimbursement
Comprises a list of alphanumeric codes, organised into chapters, categories and subcategories

7. Overview of ICD-10 5th Edition
Under the Health and Social Care Act 2012 the following bodies must have regard to this information standard:
the Secretary of State
NHS England
Monitor
public bodies exercising functions in connection with health services or adult social care
anyone providing publicly funded health services or adult social care commissioned by or on behalf of a public body
in addition, this information standard applies to NHS IT system and software suppliers who provide software to support NHS business functions and interoperability, according to new and existing contractual arrangements.

8. Overview of ICD-10 5th Edition
Scope of ICD-10 5th Edition mandate:
All “in-patient” episodes and day cases that contain diagnoses must be recoded using the mandated version of ICD-10

9. Overview of ICD-10 5th Edition
ICD-10 data uses include:
National data collections including Admitted Patient Care Commissioning Data Sets (CDS)
Hospital operational and strategic planning to support business processes including reimbursement

10. Overview of ICD-10 5th Edition
ICD-10 update cycle:
ICD-10 version:
NHS implementation on:
ICD-9 -
ICD-10
1 April 1995
ICD-10 Reprinted (with corrections and updates) 2000
1 April 2004
ICD-10 4th Edition
1 April 2012
ICD-10 5th Edition
1 April 2016

11. Overview of ICD-10 5th Edition
ICD-10 5th Edition compliance
1 April 2016
Compliance date for NHS implementation of ICD-10 5th Edition
Inpatient episodes and day cases ending on or after 1 April 2016 must be coded using ICD-10 5th Edition

12. Overview of ICD-10 5th Edition
Impact of ICD-10 5th Edition change
Minor impact
Processes understood and in place
Requires upload of new data into systems
People ready, aware and trained where appropriate
ICD-10 5th Edition does not require ‘conversion’ training

13. Overview of ICD-10 5th Edition
No change to architecture of ICD-10
Changes made in both the Tabular List and Alphabetical Index
New entries fall within existing chapters
Addition, retirement and modifications to existing code descriptions and notes

14. Overview of ICD-10 5th Edition
NHS and system supplier formal notification
Standardisation Committee for Care Information (SCCI) oversees the development, assurance and approval of information standards, data collections, and data extractions
Advanced Notification (AN) – gives warning of update and implementation requirement published by SCCI on 1 April 2015:
Information Standards Notice (ISN) – for publication in September 2015, mandates the implementation of ICD-10 5th Edition on 1 April 2016 subject to acceptance of the standard by SCCI:

15. Overview of ICD-10 5th Edition
Number of changes
Tabular List
Approximately 900 changes to individual index entries
Removal of morphology codes not included in figures
Changes
Number
Additions
215
Deletions 70
Modifications
169
TOTAL
455

16. Overview of ICD-10 5th Edition
Changes to ICD-10
ICD-10 5th Edition contains updates released by the World Health Organisation (with implementation dates up to 2016)
Draft summary of changes available at:
Public consultation on proposed changes and implementation support held 29-Mar-2014 to 25-Apr-2014 and 20-May-2015 to 19-Jun-2015
Final summary of changes will be available in September 2015 at:

17. Overview of ICD-10 5th Edition
New codes include:
Multiple system atrophy, cerebellar type [MSA-C] (G23.3)
Locked in syndrome (G83.5)
Specified types of atrial fibrillation (I48.-)
Aneurysm and dissection of vertebral artery (I72.6)
5th characters for type I, II and unspecified respiratory failure (J96.-)
Caries with pulp exposure (K02.5)
Incisional, parastomal and ventral hernias (K43.-)
Haemorrhoids by degree and perianal venous thrombosis (K64.-)
Excessive and redundant skin and subcutaneous tissue (L98.7)
Acquired hydrocephalus of newborn (P91.7)
Personal history of female genital mutilation (Z91.7)
Dependence on artificial heart (Z99.4)
Emergency use of codes (U06 and U07)
Resistance to antimicrobial and antineoplastic drugs (U82-U85).

18. Overview of ICD-10 5th Edition
Morphology codes
Removal of ICD-O morphology codes in the ICD-10 5th Edition Volumes 1-3
Morphology codes in 4th Edition not compliant with current version of ICD-O
WHO advise full ICD-O is used for morphology coding
Removal does not affect data files
ICD-O used by cancer registries
Morphologies can still be recorded locally and policy owners/Information managers will need to review local requirements and advise their Clinical Coders accordingly.
Codes in chapter II Neoplasms (C00-D48) must be used to code neoplasms (topography/site)
For more information see:

19. Overview of ICD-10 5th Edition
Products delivered centrally
Draft Summary of Changes (April 2015)
Final Summary of Changes (Sept 2015)
ICD-10 5th Edition Volume 1-3 via The Stationary Office (Oct 2015)
ICD-10 5th Edition data files and technical specifications (2 Nov 2015)
National Clinical Coding Standards reference book, Key Learning Points and ICD-10 5th Edition Update Powerpoint presentation (Jan 2016)
Updates to Clinical Coding Standards Course and Clinical Coding Standards Refresher course materials released to approved clinical coding trainers (Jan 2016)
ICD-10 5th Edition eVersion (Feb 2016)
Terminology to ICD-10 5th Edition cross-maps (SNOMED CT, CTV3 and V2) (March 2016)

20. Overview of ICD-10 5th Edition
National Tariff
The HSCIC National Casemix Office is responsible for the mapping of ICD-10 codes to Healthcare Resource Groups (HRG) for use in associated groupers. The ICD-10 updates will be incorporated into the HRGs to ensure the codes are accepted in the grouper(s) to be used from April 2016 onwards. See for details about HRGs.
National Tariff will include updates in ICD-10 5th Edition

21. Implementation planning and strategies

22. Implementation planning and strategies
Consequences of poor preparation
Compliance issues
Coding backlogs
Decisions based on inaccurate data
Incorrect reimbursement
Problems can be mitigated with proper advance preparation

23. Implementation planning and strategies
Don’t delay getting started
Early initiation of the planning process, thorough preparation, adequate education and proper testing will result in smoother implementation and earlier realisation of benefits

24. Implementation planning and strategies
Who is leading within your organisation to prepare a plan for implementation?

25. Implementation planning and strategies
Suggested phases
Phase 1 – organisation readiness
Phase 2 – systems readiness
Phase 3 – coding readiness
Phase 4 – go live preparation
Phase 5 – post implementation
Phases may vary, depending on the type, size and complexity of your organisation, phases may overlap

26. Implementation planning and strategies
Phase 1 - Organisation readiness

27. Implementation planning and strategies – Phase 1
Phase 1 - Organisation readiness:
Project team established
Assess organisational readiness
Conduct survey of all business areas to determine extent of the impact
Analyse impact on all business processes
Develop communications plan
Document all risks and issues relating to implementation
Delay to impact assessment will jeopardise ability to implement ICD-10 5th Edition by compliance date

28. Implementation planning and strategies
Phase 2 - Systems readiness

29. Implementation planning and strategies – Phase 2
Phase 2 – systems’ readiness:
Perform systems’ audit
Identify new or upgraded hardware or software requirements (if necessary)
Consider impact on electronic tools (e.g. encoders)
Ensure access to legacy data
Build flexibility of IT systems under development to ensure compatibility with ICD-10 5th Edition

30. Implementation planning and strategies – Phase 2
Systems/applications potentially impacted include:
Electronic Patient Record systems
Clinical systems
Patient Administration systems
Encoding software
Medical record abstracting systems
Decision support systems
Resource Utilisation
Quality management
Casemix systems
Case management
Financial
Compliance software

31. Implementation planning and strategies – Phase 2
Determine your business readiness
Determine vendor readiness and timelines for software upgrades
Information Standards Notices are included in NHS Contracts but check:
Which systems upgrades or replacements are needed, if any, to accommodate ICD-10 5th Edition?
Will upgrades will be covered by existing contracts, what other costs are involved?

32. Implementation planning and strategies – Phase 2
Determine system supplier readiness
When will upgrades be available for testing and implementation?
What customer support and training will they provide if required?
How will their products and services accommodate ICD-10 4th Edition and ICD-10 5th Edition?
How long will their products accommodate both code sets?

33. Implementation planning and strategies – Phase 2
Project plan is in place
Project lead to ensure all the activities and tasks required for local Trust implementation are included in the project schedule tracking tool and estimates for these tasks are regularly reviewed for accuracy

34. Implementation planning and strategies
Phase 3 - Coding readiness

35. Implementation planning and strategies – Phase 3
Phase 3 – Coding readiness
Review final Summary of changes available in September 2015 at:
Consider local impact of proposed changes and plan accordingly

36. Implementation planning and strategies – Phase 3
Assess quality of medical record documentation
Evaluate samples of various types of medical records to determine whether documentation supports level of detail found in ICD-10 5th Edition
Implement documentation improvement strategies where needed

37. Implementation planning and strategies – Phase 3
Coding and documentation - always work toward better documentation
Avoids misinterpretation
Provides a more accurate clinical picture of the quality of care provided
Supports current and future initiatives aimed at improving quality and improved patient care
Issues related to poor documentation must be resolved by the provider
Develop closer links between clinicians and coders to effect improvement

38. Implementation planning and strategies – Phase 3
Gap analysis
Conduct gap analysis of coding professionals’ knowledge and skills
Assess coding professionals’ knowledge
Refresh coding staff’s knowledge as needed on basis of assessment results

39. Implementation planning and strategies – Phase 3
Education and training
Minor update, changes represent improvements to reflect latest clinical knowledge, better indexing of conditions and aid coding of diagnostic information.
Code format and coding process will not change, so conversion training not required
Coders to review the Key Learning Points and the table of changes and full coding standard in the updated National Clinical Coding Standards ICD-10 reference book, available in January 2016.
Trainers, managers and coders can use the ICD-10 5th Edition Update Powerpoint presentation alongside the KLP’s and updated reference book to learn about the changes being made in ICD-10 and the main changes to National Standards, available in January 2016.
Trusts to assess and decide level of update awareness training required to suit local needs.

40. Implementation planning and strategies – Phase 3
Consider update awareness needs for:
Clinical coders
Information personnel
Clinicians
Senior management
Information technology
Finance
Auditors
Commissioners
Clinical department managers
Data analysts
Researchers
Epidemiologists

41. Implementation planning and strategies – Phase 3
Data uses
Performance improvements
Corporate compliance
Data quality management
Data security
Clinical documentation
Reimbursement

42. Implementation planning and strategies – Phase 3
Identify all implementation expenses and estimate associated costs including:
Education / training
Hardware / software upgrades if applicable
Staff time / temporary or contract staff
Systems’ testing related costs
Data conversion
Maintenance of dual code set
Purchase of ICD-10 5th Edition books

43. Implementation planning and strategies – Phase 3
Additional implementation preparation steps
Refine project plan, timeline and budget as needed
Assess potential reimbursement impact
Develop strategies to minimise problems and maximise opportunities
Assess impact of
Decreased coding productivity
Decreased coding accuracy

44. Implementation planning and strategies – Phase 3
Register now ….
Agree the authorised person within the organisation to accept licence agreements on TRUD
Pre-register on TRUD for the ICD-10 data files sub-packs in readiness to download the files when released. Requestor will be notified when files become available.

45. Implementation planning and strategies
Phase 4 – Go live preparation

46. Implementation planning and strategies – Phase 4
Phase 4 – Go live preparation
Follow-up on readiness of systems suppliers
Develop business continuity plan in case critical systems are adversely affected when the ICD-10 5th Edition implementation goes live
Completion of communication plan
Provide senior executives and stakeholders with updates

47. Implementation planning and strategies – Phase 4
Information Standards Notice (ISN)
Review ISN and Standard Specification and ensure system suppliers have read and are taking appropriate actions to meet planned deliverables (ISN published September 2015 subject to SCCI approval of standard)

48. Implementation planning and strategies – Phase 4
ICD-10 5th Edition data files
Download data files released via Technology Reference Update data Distribution (TRUD) in November 2015:
ICD-10 5th Edition codes and title and metadata
ICD-10 5th Edition table of coding equivalences
Technical specification documents

49. Implementation planning and strategies – Phase 4
Complete tasks identified in Phase 1 - during impact assessment
Implement system changes
Provide education to users where needed
Implement and monitor documentation improvement strategies
Re-engineer processes and workflows identified in Phase 1 if necessary
Complete internal testing
Begin external testing once system suppliers are ready

50. Implementation planning and strategies – Phase 4
ICD-10 5th Edition volume sets
Purchase ICD-10 5th Edition Volumes sets from The Stationary Office from August 2015, see
Clinical coders should not attempt to manually add the ICD-10 5th Edition changes into their ICD-10 4th Edition books because of the number of changes and of the risk of introducing errors which will impact data collection and statistical outputs.

51. Implementation planning and strategies – Phase 4
Training and education
Deliver training requirements where needed
Download key learning points and National Clinical Coding Standards ICD-10 reference book from TRUD in January 2016
Download ICD-10 5th Edition Update Powerpoint presentation from TRUD in January 2016.
Ensure protected time for clinical coders to review:
Changes to the classification
Key Learning Points and the table of changes and full coding standard in the updated National Clinical Coding Standards ICD-10 reference book.

52. Implementation planning and strategies – Phase 4
ICD-10 5th Edition eVersion
Download from TRUD from February 2016
Clinical Coders
Advise Trust IT department that the ICD-10 eVersion will be available for download in February 2016
Request Trust IT department to download and install the eVersion on computer if necessary permission have not been granted
IT Manager/ IT department
may need to white list ICD-10 5th Edition eVersion TRUD download website at to ensure access
Ensure users have correct rights to run executable file required to install and use the application
Assist Clinical Coders to install the application, as necessary
Read detailed installation instructions and user guide, included with the eVersion application, before installation

53. Implementation planning and strategies – Phase 4
SNOMED CT users:
Download data via Technology Reference Update data Distribution (TRUD) website in March 2016:
SNOMED CT to ICD-10 5th Edition Cross-maps
Cross-maps Change Report
Cross-maps Tables Technical Specification

54. Implementation planning and strategies – Phase 4
Legacy terminologies
Download released data via Technology Reference Update data Distribution (TRUD) website in March 2016:
Read Version 2 (V2) to ICD-10 5th Edition cross-maps
Clinical Terms Version 3 (CTV3) to ICD-10 5th Edition cross-maps
V2 and CTV3 are both deprecated terminologies scheduled for withdrawal in April 2020
Consequently the V2 and CTV3 cross-maps to ICD-10 5th Edition and OPCS-4.7 will cease to be maintained following the April 2016 Terminology release
Static legacy cross-maps files will continue to be available from HSCIC, on request.

55. Implementation planning and strategies – Phase 4
Data analysis
Determine impact on longitudinal data analysis
Will legacy data be converted? If so, how will it be converted?
Determine which data will be linked by using mapping applications and which data will be maintained separately according to the source code set

56. Implementation planning and strategies – Phase 4
Equivalences
Equivalences are mappings to assist users in navigating the complexity of translating meaning from the content of one code set to another code set
They should not be used for coding medical records
The ICD-10 5th Edition Tables of Coding Equivalences are part of the data files available for download from TRUD from 2 November 2015.

57. Implementation planning and strategies – Phase 4
Continue to assess and improve coding documentation
Continue to assess quality of medical record documentation, implementation documentation and strategies as needed, and monitor impact of documentation improvement strategies
Coders should continue to gain familiarity with ICD-10 5th Edition codes and coding standards and improve skills in areas identified in gap analysis

58. Implementation planning and strategies
Phase 5 – Post implementation

59. Implementation planning and strategies – Phase 5
Phase 5 – Post implementation
Lessons learned and post implementation review
What can you learn for next time?
What went well?
What didn’t go well?
Did you implement the 5th Edition on time?
Did you implement the required changes that were identified in each phase of your implementation plan?
Informs future updates

60. Did this help you?
Let us know if this implementation support helped, and how we can improve for future releases ………..

61. Links to central resources
Technology Reference Update data Distribution (TRUD)
Health and Social Care Information Centre – Clinical Classifications Service
New interactive environment that provides information about emerging and changing standards
Information standards helpdesk