Transcript (Jenkins-Edwards-Cunningham)

ICD-10 Update:
Analytic Community Involvement Critical to Implementation Success
BUMED M3 Medical Operations
BLUF
 The Centers for Medicare and Medicaid Services (CMS) has mandated International Classification of
Diseases Revision 10 (ICD-10) diagnosis and procedure coding standards for all discharges effective 1
October 2014 (proposed). Conforming to these new standards will require careful planning,
coordination, and execution.
 Key operational and technology areas potentially impacted include:
o End-to-end operations including ordering/scheduling, clinical documentation by providers,
diagnosis coding (inpatient/outpatient/APV), procedure coding (inpatient), and third party billing
and collections
o Military Health System (MHS) funding mechanisms and resulting business planning
o Any information system that contains clinical data (including Navy-specific systems)
o Reporting and statistical databases (including ability to trend data)

Anyone who generates or uses clinical data for analytics will need to be trained on ICD-10 and update
their processes as appropriate

The infrastructure is in place to ensure people will be trained, processes will be optimized, technology
will be improved, and policy will be updated to meet ICD-10 standards.
1
U.S. Lags Behind in ICD-10 Implementation
The World Health Organization (WHO) adopted ICD-10 in 1990 and most industrialized countries
have since wholly adopted it, except the United States. This delay is due in part by the link between
ICD-9 coding and healthcare reimbursement/funding in the US that does not exist in other countries.
The US is the only industrialized nation that is still using ICD-9 for
health care delivery and administrative purposes
2
The Changes and Implications of ICD-10
ICD-10 codes introduce greater detail, specificity, and complexity when recording the diagnosis and
procedures.
ICD-10 Changes
Complete Overhaul of Diagnosis & Procedure Codes
Implications
Pervasive Impacts
 Enterprise training required across most operational
areas
− Additional Anatomy & Physiology education
− Common procedure names not used
ICD-9-CM (Diagnosis)
3-5 digits alphanumeric
≈14,000 unique codes
ICD-10-CM
3-7 alphanumeric characters
> 68,000 unique codes
− Many ICD-9 codes will translate to multiple ICD-10
codes
 Diagnosis codes and procedure codes flow through
mission critical operational systems and analytical tools
 Third party system reliance adds more complexity to
the implementation
 Deterministic crosswalk between ICD-9 and ICD-10 is
not yet proven
ICD-9-CM (Procedure)
3-4 digits numeric
≈ 4,000 unique codes
ICD-10-PCS (Inpatient)
7 digits numeric or
alphanumeric characters
> 72,000 unique codes
 Coders and physicians may struggle with adoption
Multi-Disciplinary Challenge
 Technology strategy, planning and remediation
alignment
 Workflow reengineering, training and change
management is essential
3
Mapping ICD-9 to ICD-10 Code Examples
The following pictures show examples of the possible mapping types for ICD-9 to ICD-10 diagnosis
and procedure codes and illustrates how this is not simply a code set replacement. Coders will need to
read the medical record, find the correct information, and match it to the most appropriate code.
ICD-9 to ICD-10
Procedure Codes
ICD-9 to ICD-10
Diagnosis Codes
0DB60ZZ
Excision of Stomach,
Open Approach
or
Excision of Stomach,
Percutaneous
Approach
Partial Gastrectomy
with Anastomosis to
Jejunum
0D160ZA
Bypass Stomach to
Jejunum, Open
Approach
0DB63ZZ
437
Scenario 1
or
or
0D164ZA
0DB64ZZ
Bypass Stomach to
Jejunum, Percutaneous
Endoscopic Approach
Excision of Stomach,
Percutaneous
Endoscopic Approach
or
0DB67ZZ
or
8962
S98911A
S98912A
Complete Traumatic
Amputation of Right
Foot, Level
Unspecified, Initial
Encounter
Complete Traumatic
Amputation OF Left
Foot, Level
Unspecified, Initial
Encounter
Traumatic Amputation
of Foot (Complete)
(Partial) Bilateral
without Complication
or
or
S98921A
S98922A
Partial Traumatic
Amputation of Right
Foot, Level
Unspecified, Initial
Encounter
Partial Traumatic
Amputation of Left
Foot, Level
Unspecified, Initial
Encounter
0D168ZA
Excision of Stomach,
Via Natural or Artificial
Opening
or
Bypass Stomach to
Jejunum, via Natural or
Artificial Opening
Endoscopic
0DB67ZZ
Excision of Stomach,
Via Natural or Artificial
Opening Endoscopic
Scenario 2
Exact Equivalent
ICD-10 Code
Key
Approximate Equivalent
4
ICD-9 Code
Expected Benefits of ICD-10 are Significant
Today’s data needs are dramatically different than they were 30 years ago when ICD-9 was introduced.
ICD-10 will advance healthcare in many ways, with benefits accruing across four major categories.
 Data availability to assess quality standards, patient safety goals, mandates and
compliance
Quality Measurement
 Higher quality information for measuring healthcare service quality, safety, and
efficiency
Public Health
Research
Organizational
Monitoring and
Performance
 Improved disease and outbreak information
 Improved ability to track and respond to international public health threats
 Better data mining for increased analysis of diagnosis, treatment efficacy, prevention,
etc
 Recognition of advances in medicine and technology
 Enhanced ability to identify and resolve problems
The benefits are significant but will require changes to processes, policy, and technology across operations
5
Anticipated ICD-10 Impacted Functions
Navy Medicine will need a coordinated system-wide effort to prepare for ICD-10 coding. This includes an
in-depth impact assessment of the relevant people, processes, policies, and technology.
Patient
Administration
Inpatient &
Outpatient
Services
Ancillary &
Diagnostic
Services
HIM
Business Office
Analytics &
Quality
Management
R&D
Command
Analysis
Scheduling
Inpatient Care
Laboratory &
Radiology
Inpatient
Coding
Third Party
Collections
Data Quality &
Reporting
Program
Support
Pre-Registration
& Eligibility
Emergency Care
Pharmacy
Outpatient &
APV Coding
Manpower
Assessment
Registration &
Check-in
Outpatient &
APV Care
Clinical
(Medical)
Documentation
Program
Measures &
Controls
ED Registration
Order Entry
Health
Education &
Training
Program
Improvement
Clinical Trials
Surgical
Procedures
Discharge
Processing
Healthcare
Operations
Physician
Credentialing
Technology
6
Impacts to Data and Analytics
•
Explosion in data – providers and coders will be choosing from EIGHT times as many codes
and may require more codes to be used in parallel to capture the full set of information
•
Impact to accuracy – initial decreases in coding accuracy can be anticipated as providers and
coders adjust to the new coding methodology
•
Changes in queries – Many reports are used in data analytics today that rely on queries including
ICD data. These will need to be updated.
•
Trending – comparing “apples to oranges” after the change will be a challenge; ICD-9 and ICD10 data will initially be mixed in the M2 depending on service date
•
Revenue modeling – third party reimbursement and PPS revenue will be impacted if less specific
codes are used
•
Research databases / Quality Measures – any reporting on disease incidence and other clinical
measures will be impacted (including standalone Navy systems)
•
Mapping – TMA has adopted CMS back-mapping between ICD-9 and ICD-10; BUMED is
investigating appropriate use of mapping for M2
7
BUMED ICD-10 Approach
BUMED has a plan that includes a governance model and PMO to provide structure to the ICD-10
implementation and ensure analytic needs are addressed.
Assess
Plan
Execute
FY 2012
FY 2013
Sustain
FY 2014
ICD-10 Program Management Office
•
•
•
•
Support BUMED’s role of oversight & monitoring of issues related to documentation/coding
Execute governance model across M1, M3, M6, M8, Regions, NAVMISSA, NMSC, MTFs, & other Services
Manage & monitor the multiple projects required to implement ICD-10 & provide status reporting against schedule/goals
Communicate ICD-10 related messages across the organization
Impact Assessment
• Conduct operational & IM/IT assessment
• Identify gaps between current & future state ICD-10 requirements
• Determine resolution activities required
Imp. Plan
• Prioritize resolution activities
• Determine timeline & resource requirements
• Validate plan with key stakeholders
Training Strategy
• Determine training needs by position & analyze Navy data to determine priority focus areas
• Determine strategy including delivery mechanism that focuses most intensive training on high priority areas
• Schedule training and set up logistics
Regional Training Events
• Modify training library to meet Navy and attendee requirements
• Conduct awareness, data analytics, clinical documentation, & code selection training depending on audience
at Regional Events (e.g., Train the Trainer)
• Evaluate training & incorporate improvement opportunities into future training
Clinical Documentation Improvement Program
• Design methodology including core processes, supporting technology, & staffing requirements
• Identify steps for executing & report on results/opportunities for improvement once implemented
8
Readiness Activities
To mitigate the potential accuracy issues related to the ICD-10 changes, significant training is required, and
these needs vary by staff type. Below are the anticipated requirements for data analysts.
Data Managers
Estimated
Training Time
• *16 hrs to gain the appropriate knowledge of structure, format, length, and hierarchy of the
ICD-10 codes
Key Activities
for Successful
Transition
• Gain the appropriate knowledge of ICD-10 codes in order to understand the new code sets
enough to forecast what they must alter in the database in order to accommodate this change
• Understand the data comparability issues and impact on longitudinal data analysis
• Understand the differences in classification of diseases and procedures, including definitions
and code category composition, in order to assess impact on data trends
*Note: Estimated training hours are based on AHIMA recommendations and are not necessarily representative of needs for all Navy Medicine staff.
Training hours required will vary on an individual basis, e.g., coding personnel will require up to 50 hours of training.
9
Governance Structure
The Education and Training team and Analytic Reporting team will work together to drive requirements
for analysts
10
Work Team
Roles and Responsibilities
The work teams with responsibility over analytics each have a specific role towards ensuring analytic
requirements are met
Education &
Training




Developing ICD-10 training content and the
training program using input from other ICD10 Work Teams
Developing appropriate education and training
policies and programs for ICD-10
Assessing/evaluating coder, provider and
business training
Providing status reports to the BUMED HIM
ICD-10 PMO
Analytic Reporting


Developing the plans for managing impacted
research data and reports
Reviewing and reporting to the BUMED HIM
ICD-10 PMO on potential ICD-10 impacts to
specific applications such as:
 HEDIS, Population Health, etc.
 M2 Reports, as applicable
 Audit Registry Prototype

Providing status reports to the BUMED HIM
ICD-10 PMO
11
Discussion
•
How do you currently use ICD-9 and other clinical data?
•
What challenges do you foresee for maintaining your data
analytic capabilities in the transition to ICD-10?
•
What mitigation strategies can you think of?
•
At every Region/MTF the Patient Admin Officer and Medical
Records Administrator are your ICD-10 leads, funnel your
thoughts/questions to them who will route to the Regions and
ultimately the Health Info Mgmt (HIM) Department at
BUMED.
12
Who to Contact
CAPT Mary Jenkins
Ms. Jane Cunningham

Phone – (703) 681-6615

Phone – (703) 681-9138

E-mail – [email protected]

email – [email protected]
LCDR Jori Brajer
Mr. Dan Edwards – Deloitte

Phone – (703) 681-9239
 Phone – (202) 431-5167

E-mail – [email protected]
 E-mail – [email protected]
Ms. Shannon McConnell-Lamptey

Phone – (703) 681-9193

E-mail – [email protected]
13
BACKUP SLIDES
14
ICD-9 Diagnosis & Procedure Code Mapping
When mapping ICD-9 codes to ICD-10, occasionally a one-to-one match is discovered, however 80%
of the time, two or more multiple possible matches are identified as noted below. This is not simply a
code set replacement.
Exact (1:1)
Alternatives (1:M)
ICD-9
ICD-9
ICD-10
ICD-10
ICD-10
The ICD-9 maps to a single ICD-10 and both codes have the
exact same meaning.
Approximate (1:1)
ICD-10
The ICD-9 maps to multiple ICD-10 codes, however only one of
these ICD-10 codes is required.
ICD-9
Complex (1:M)
ICD-10
ICD-9
ICD-10
The ICD-9 maps to a single ICD-10 and the two codes have
similar meanings although the definitions are not exactly the
same.
ICD-10
Combination (1:M)
ICD-9
ICD-10
ICD-10
ICD-10
ICD-10
ICD-10
The ICD-9 to ICD-10 mapping consists of both combinations and
alternative mappings.
Other (No Mapping)
The ICD-9 maps to a group of ICD-10 codes which must be
taken together in order to have a similar meaning to the ICD-10.
?
15
Key
Exact Equivalent
ICD-9
Approximate Equivalent
There is no CMS published mappings from ICD-9 to ICD-10 (e.g., injury
codes, extender codes)