Preparing for ICD10

1
Preparing for ICD-10

• Health Information Managers Role

2
Agenda

• Transition Timelines
• Comparison of Coding Systems
• Preparation Plan
• Data Tools

3
Transition Timelines

• HIPAA Administrative Simplification
  Modifications to Medical Data Code Set Standards
  To Adopt ICD10CM and ICD10PCS
• Federal Register
• January 16, 2009
• Includes the code sets and the official coding
  guidelines for those code sets

4
HIPAA Transaction Conversion

• Health Insurance Reform Modifications to the
  Health Insurance Portability and Accountability
  Act (HIPAA) Electronic Transaction
• Federal Register
• January 16, 2009
• Changing business needs

5
ICD-10 Impact

• Diagnosis coding in all settings
• Procedure coding in the inpatient hospital
  setting only

6
HIPAA Transaction Conversion

• Telecommunication Standard Implementation Guide
  Version D Release 0 (D.0) and Equivalent Batch
  Standard Implementation Guide, Version 1, Release
  2 (1.2) for Retail Pharmacy Transactions
• Federal Register
• January16, 2009
• Changing business needs
• Medicare Part D prescription program

7
Timeline for Updates

• Conversion to version 5010 standard and version
  D.0 for pharmacy claims
• Achieve level 1 compliance for Versions 5010 and
  D.0 December 2010
• Achieve level 2 compliance for Versions 5010 and
  D.0 except small health plans January 2013

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Comparison of Coding Systems
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ICD-9-CM

• Lacks sufficient specificity and detail
• Running out of capacity
• Obsolete
• No longer reflects current knowledge of disease
  processes
• Contemporary medical terminology
• Modern practice of medicine
• Hampers the ability to compare costs and outcomes
  of different medical technologies

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ICD-10-CM

• Classification created by the Centers for Disease
  Control and Prevention for use in the United
  States
• ICD-10-CM will be used in all settings for
  diagnosis capture
• Alphanumeric codes
• Uses the same conventions as ICD-9-CM

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ICD-10-PCS

• Developed by 3M for the Centers for Medicare and
  Medicaid for use in the United States
• To be used for inpatient procedures only
• Build a code format
• 7 character codes
• Each character with a defined meaning

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ICD-9-CM vs. ICD-10-CM

• 3-5 digits
• First digit can be alpha or numeric
• Digits 2-5 are numeric
• 14,025 diagnosis codes

• 3-7 digits
• First digit is always alpha
• Digits 2 and 3 are numeric
• Digits 4-7 are alpha or numeric
• 68,065 diagnosis codes

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ICD-9-CM vol 3 vs. ICD-10-PCS

• 3-4 digits
• All digits are numeric
• 3,824 procedure codes

• 7 digits
• Each digit may be alpha or numeric
• I and O not use as may be confused with 1 and 0
• 72,589 procedure codes

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New Code Sets

• Better able to
• Measure quality of care furnished to patients
• Process claims
• Designing payment system
• Track public health
• Conduct research

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ICD-10-CM Example

• ST elevation myocardial infarction of anterior
  wall subsequent to a Non-ST elevation MI 2 weeks
  ago
• ICD-9-CM
• 410.71
• ICD-10-CM
• I22.0, 121.4

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Increased Specificity

• Laterality
• Intra-operative vs. post operative complications
• Encounter information
• Initial, routine healing, non-healing, malunion
• Coma when coma score done
• Pregnancy trimester
• Place holders for growth

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ICD-10-PCS Format
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ICD-10-PCS
Centers for Medicare and Medicaid Services 2009
ICD-10-PCS 2009 code tables and index.
www.cms.hhs.gov/ICD10/01m_2009_ICD10PCS.aspTopOfP
age
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ICD-10-PCS Example

• The code for the insertion of a Foley catheter is
  0T9B7DZ.
• 0 Medical and Surgical
• T Urinary System
• 9 Drainage
• B Bladder
• 7 Via Natural or Artificial Opening
• D Intraluminal Device
• Z No Qualifier

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Preparing for Implementation

• AHIMAs Recommendations

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Preparing for Implementation

• Impact Assessment
• Preparing for Implementation
• Go-Live Preparation
• Post Implementation

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Phase 1 Impact Assessment

• Interdisciplinary steering committee needed to
  oversee implementation
• Education regarding code set change
• What is changing
• Benefit of change
• How to prepare
• Sequencing change

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Implementation Costs

• Training
• Productivity losses
• System changes
• Need to budget these costs

24
Expectations

• Significant short-term productivity losses
• First 6 months of implementation
• No long-term impact on productivity
• Return to pre-conversion productivity levels
  within 6 months

25
Impact Assessment

• Assess organizational readiness for transition
• Assess impact of change on daily operations
• Identify reports/forms requiring modification
• Assess staff education needs

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Assessment

• Assess extent of changes to systems, processes,
  policies/procedures
• Perform comprehensive systems audit for ICD-10
  compatibility
• Determine vendor readiness and timeline for
  upgrading software to new code sets
• Develop implementation budget

27
Opportunities

• Use code set change as opportunity to improve
  data flow, work flows, and processes
• Assess quality of medical record documentation
• Implement documentation improvement program if
  necessary

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Who Needs Education

• Coders
• Other HIM
• Clinicians
• Senior management
• Clinical department managers
• Information systems
• Software vendors
• Data security
• Finance

• Business Office
• Quality management
• Utilization review
• Performance improvement
• Data quality
• Compliance
• Data analysts
• Researchers
• Epidemiologists

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Types of Education

• Overview
• Management
• Data Impact
• Trending
• Quality
• Budgeting
• Coding Staff

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Coding Staff Training Estimates

• ICD-10-CM
• 16 hours of training for an experienced coder
• Probably less for MD office staff
• ICD-10-PCS
• 16-24 hours of training for an experienced coder
• Start 3-6 months from go-live

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HIM Credential

• Commission on Certification
• No new exam requirements for ICD-10
• Extra CEUs may be required by 2013

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Data Tools
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General Equivalency Mapping

• General Equivalence Mappings (GEM)
• Crosswalks and mappings
• Available for diagnoses and procedures
• 2007 Version Documentation and User's Guide
• http//www.cms.hhs.gov/ICD10/
• http//www.cdc.gov/nchs/about/otheract/icd9/icd10c
  m.htm

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GEMS

• Crosswalks work both ways
• Crosswalk identifies if it is a one-to-one
  relationship
• All possible choices are provide based on the
  complete meaning of the code

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GEMS

• Complete meaning
• Tabular instruction
• Index entries
• Guidelines, and
• Applicable Coding Clinic advice
• Coordination and Maintenance Committee will
  maintain for at least 3 years

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Reimbursement Mapping

• Help support the phase out of legacy ICD-9-CM
  systems
• Temporary method for converting ICD-10 codes into
  reimbursement equivalents
• Single recommended mapping of ICD-10 to ICD-9

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Reimbursement Mapping Concerns

• No always a one for one match
• 95 procedure code one-to-one match
• Rules for other 5
• MedPAR data and California Office of Statewide
  Health Planning and Development
• ICD-9-CM Code Clusters
• Group of codes needed to define an ICD-10 code
• www.cms.hhs.gov/ICD10

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AHIMA Resources

• http//www.ahima.org/icd10
• ICD-TEN newsletter
• Preparation checklist

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Questions?
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Contact Information

• Sara Clark, MLS, RHIA
• Phone [phone]
• Email sclark_at_providercs.com

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Contact Information
www.providercs.com