Transcript Introduction ICD-10

Introduction ICD-10-CM
Overview
Presented By
Erline Franks CCS-P
ICD-10-CM Facts
• The United States is the only nation that has not
implemented ICD-10
• ICD-10-CM set to begin October 1, 2014
• Regular updates which go into effect October 1 of each
year, starting in 2015.
• ICD-10-CM consists of 21 chapters compared to 17 chapters
in ICD-9-CM
• ICD-10-CM is based on statistical classifications of disease
by the World Health Organization (WHO)
• Guidelines have been approved by the American Hospital
Association (AHA), American Health Information
Management Association (AHIMA), CMS, and NCHS
ICD-10-CM Facts cont.
• The transition to ICD-10-CM is happening
because ICD-9 provides limited data about the
medical conditions of patients’ and hospital
inpatient procedures. ICD-9 is 30 years old,
has outdated terms, and is inconsistent with
current medical practice. The structure of
ICD-9 also limits the number of new codes
that can be created, and many categories in
ICD-9 are full.
Diagnosis Code Comparison
ICD-9-CM (Volume 1 & 2)
ICD-10-CM
3-5 characters in length
3-7 characters in length
Approximately 14,000 codes
Approximately 68,000 codes
First digit may be alpha (E or V) or
numeric; digits 2-5 are numeric
Digit 1 is alpha (to indicate the category);
Digit 2 is numeric (in the future, alpha
characters may be used if code expansion
is needed);
Digits 3-7 can be alpha or numeric
Limited space for adding new codes
Flexible for adding new codes
Lacks detail
Very specific
Lacks laterality
Includes laterality (i.e., codes identifying
right vs. left)
Who will be affected?
• ICD-10 will affect diagnosis and inpatient
procedure coding for everyone covered by HIPAA
(Health Insurance Portability and Accountability
Act), not just for those who submit Medicare or
Medicaid claims.
• This change does not affect CPT coding for
outpatient procedures.
• This change includes: Providers, Payers, Software
vendors, Clearinghouses, and third-party billing
services.
What should providers do to Prepare?
• Create a practice ICD-10 Team
• Budget for Implementation Costs
• Create a timeline (including a team leader
responsible for each area)
• Identify current and future educational needs
for staff
• Communicate with your Practice Management
System Vendor
What should providers do to Prepare?
Cont.
• Communicate with your billing Service,
Clearinghouse, and Payers as to hardware and
software concerns
• Communicate with your payers about how
your contracts will be affected
• Identify changes to your Practice Work Flow
and Business Processes
What should providers do to Prepare?
Cont.
Identify your education needs:
• Get a copy of the ICD-10-CM code set.
• Identify your practices’ top 50 diagnosis codes
currently used.
• Remove the unspecified codes. (Remember,
unspecified codes may not be reimbursed with ICD-10)
• Review your documentation and determine the
changes that will need to take place to support the
more specific ICD-10 codes.
• Continue education on the rest of the top 50 codes
Where do I find information regarding
ICD-10-CM?
• CMS (Centers for Medicare & Medicaid Services)
www.cms.gov/Medicare/Coding/ICD10/
• AHIMA (The American Health Information
Management Association)
www.ahima.org/icd10/
• SS&G Healthcare, LLC
www.ssandghc.com
• Specialty Specific Societies
• Software and System Vendors
When should I begin the transition?
• Yesterday!!!
• Health care organizations that submit
transactions electronically are required to
upgrade transaction standards from
4010/4010A to Version 5010 effective January,
2013
When should I begin the transition?
Cont.
• AHIMA Checklist—
www.ahima.org/downloads/pdfs/resources/c
hecklist.pdf
Phase 1: Implementation plan development
and impact assessment (first quarter 2009 to
second quarter 2011)
Phase 2: Implementation preparation (first
quarter 2011 to second quarter 2013)
When should I begin the transition?
Cont.
 Phase 3: “Go live” preparation (first quarter 2013 to
third quarter 2013)
 Phase 4: Post-implementation follow-up (fourth
quarter 2013 to fourth quarter 2014)
• Expect a significant reduction in productivity for the first
three to six months
• Expect an impact in your cash flow
General Equivalence Mapping (GEMs)
• Mappings between ICD-9-CM and ICD-10-CM
classifications have been developed to transition
one code set to another
• The NCHS ( National Center for Health Statistics)
has released the GEMs, along with
documentation and a user’s guide, are available
on the NCHS website
http://www.cdc.gov/nchc/icd/icd10cm.htm and
the GEMs website
http://www.cms.hhs/gov/ICD10)
Use of GEMs
• Appropriate Usage:
• Convert multiple databases from ICD-9-CM to
ICD-10-CM
• Variety of research applications involving data
trend
• Inappropriate Usage:
• Crosswalks- There is not a one -to-one match
between ICD-9-CM and ICD-10-CM codes, for a
multitude of reasons (e.g. new concepts in ICD10-CM , a single ICD-9-CM code may map to
multiple ICD-10-CM codes)