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ICD10 Coding System: What is this beast

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Inclusion of trimester in obstetrics codes and elimination of 5th digits for episode of care ... Examples of ICD-10-PCS Codes. Laparoscopic appendectomy: 0DTJ4ZZ ... – PowerPoint PPT presentation

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Title: ICD10 Coding System: What is this beast


1
ICD-10 Coding SystemWhat is this beast?
  • Jody Smith, PhD, RHIA, FAHIMA
  • Professor Chair
  • Health Informatics Information Mgmt
  • Saint Louis University

2
A little history not much, just a little
  • Started by the early Greeks
  • 17th century
  • London Bills of Mortality
  • 18th century
  • Florence Nightingale-compare hospital data to how
    funds were being spent
  • William Farr- International List of Causes of
    Death
  • Jacque Bertillon- Bertillon Classification of
    Causes of Death

3
Speeding through history
  • 1950s-US Public Health Service published the
    International Classification of Diseases, Adapted
    for Indexing Hospital Records by Diseases and
    Operations (ICDA)
  • International Classification of Diseases, 9th
    Revision, Clinical Modification (ICD-9-CM)
  • Supposed to be updated every 10 years
  • Its been 30 years we are a little late

4
ICD-9-CM is used to
  • Calculate payments
  • Adjudicate coverage
  • Compile statistics
  • Access quality

5
Why is ICD-9-CM being replaced?
  • US is behind the rest of the world
  • Lacks sufficient specificity and detail to
    support modern day medicine
  • No longer effective system for reimbursement
  • Cannot pay claims fairly

6
Why is ICD-9-CM being replaced?
  • Running out of capacity to accommodate advances
    in medicine and quality data
  • Cannot support US transition to an interoperable
    health data exchange in US
  • Difficult to measure medical processes and
    outcomes

7
Benefits of transitioning to ICD-10-CM
  • More accurate payment for new procedures
  • Fewer miscoded, rejected, and improperly
    reimbursed claims
  • Improved disease management

8
Comparing ICD-9-CM and ICD-10-CM
  • ICD-9-CM
  • 3 to 5 characters
  • First digit is numeric, E or V
  • 3 digit minimum for diseases
  • Decimal placed after the first three characters
  • ICD-10-CM
  • 3-7 characters
  • First digit alpha
  • All letters used except U
  • 2nd and 3rd digits numeric
  • 4th ,5th ,6th ,7th digits can be alpha or numeric
  • Decimal placed after the first three characters

9
Code Formats
  • ICD-9-CM XXX.XX
  • ICD-10-CM
  • XXX.XXX X

Category
Category
Etiology Anatomic Site Manifestation
Etiology Anatomic Site Manifestation
Extension
10
ICD-10-CM Structure
  • 21 Chapters
  • Some chapters include the addition of a 6th
    character
  • Index and tabular list
  • V codes are now Z codes
  • Factors Influencing Health Status and Contact
    with Health Services

11
ICD-10-CM Structure Continued
  • Inclusion of trimester in obstetrics codes and
    elimination of 5th digits for episode of care
  • Expanded detail relevant to ambulatory and
    managed care encounters

12
Example of expanded code Pressure Ulcers
  • ICD-9-CM
  • 9 location codes
  • 707.00-707.09
  • Show broad location but not depth/stage
  • ICD-10-CM
  • 125 codes
  • More specific location
  • Example
  • L89.131- Pressure ulcer of right lower back,
    stage 1
  • L89.132- Pressure ulcer of right lower back,
    stage 2

13
7th digit for fractures
  • A Initial encounter for closed fracture
  • B Initial encounter for open fracture
  • D Subsequent encounter for fracture with routine
    healing
  • G Subsequent encounter for fracture with delayed
    healing
  • K Subsequent encounter for fracture with nonunion
  • P Subsequent encounter for fracture with malunion
  • S Sequelae
  • Example
  • S42.321A, Displaced transverse fracture of shaft
    of humerus, right arm, initial encounter for
    closed fracture.

14
Implementation October 1, 2013
  • Cost of implementation
  • 84,000 small physician practice
  • 3 million for large practices
  • 14 million for health plans
  • 8 billion to implement ICD-10 nationwide

15
Prepare Now
  • Budget
  • Training
  • Equipment
  • Resources
  • Post implementation
  • Contract negotiation/renegotiation

16
Implementation Planning
  • Develop a plan
  • Identify stakeholders who will be affected
  • Assess impact
  • Lost productivity
  • Develop training plans for employees at all
    levels
  • Average learning curve is 4 to 6 months
  • System upgrades/changes
  • Testing and go live dates
  • Plan for documentation changes

17
Implementation Planning
  • Implementation/Organizing
  • Acquire resources to implement the plan
  • Evaluate financial impact on orgaization
  • Plan for control
  • Develop desired outcomes
  • Develop measurement tools
  • Plan action steps for implementation
  • milestones

18
Impact on information systems
  • Any electronic transaction requiring a diagnosis
    and/or procedure code will need to be reviewed
    including
  • Billing system - Clinical
    protocols
  • Clinical systems - Test ordering
    systems
  • Encoding software - Clinical reminder
    system
  • Abstracting systems
  • Accounting systems

19
RESOURCES
  • http//www.cdc.gov/nchs/icd/icd10cm.htm
  • http//www.cdc.gov/nchs/data/dvs/icd10fct.pdf
  • http//www.cms.hhs.gov/ICD10/
  • http//edocket.access.gpo.gov/2009/pdf/E9-743.pdf

20
  • ICD10-PCS

21
Medical and Surgical Procedures
  • The seven characters for medical and surgical
    procedures have the following meanings

22
Examples of ICD-10-PCS Codes
  • Laparoscopic appendectomy 0DTJ4ZZ
  • Character 1 0 (Medical and Surgical section)
  • Character 2 D (Body System GI)
  • Character 3 T (Root Operation Resection)
  • Character 4 J (Body Part Appendix)
  • Character 5 4 (Approach Percutaneous
    endoscopic)
  • Character 6 Z (Device Without device)
  • Character 7 Z (Qualifier No qualifier)

23
Examples of ICD-10-PCS Codes
  • ORIF with screws 0QQH04Z
  • Character 1 0 (Medical and Surgical Section)
  • Character 2 Q (Body System Lower bones)
  • Character 3 Q (Root Operation Repair)
  • Character 4 H (Body Part Tibia)
  • Character 5 0 (Approach Open)
  • Character 6 4 (Device With internal fixation
    device)
  • Character 7 Z (Qualifier Without qualifier)
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