presented by sithara satiyadev africode consulting ... · icd-10 & clinical validations current...
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Presented by Sithara Satiyadev
Africode Consulting
September 2013
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Agenda
ICD-10
Background
MIT
Phase 3
Phase 4
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Background to ICD-10
Owned by WHO
Adopted by NDoH in
1997
Adopted by PHISC in
2000
Task Team (NTT)
established in 2004
ICD-10 Implemente
d in July 2005
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Background to ICD-10
2000: Private stakeholders complaint to
MoH
2001: MoH request CMS to
investigate
2004-Feb 2011
NTT: auspice of
CMS 2003: CMS
report & recommendation to
MoH
Medical
Schemes Act,
Reg . 5 (f)
May 2011:
DG TT
March 2012:
MoH:
appointed
ICD-10 TT
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MoH: Terms of Reference for the ICD-10
Task Team
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Structure of ICD-10 Task Team
Chairperson
Communication & Monitoring
sub-committee
Privacy & Security sub-
committee
ICD-10 Morbidity sub-committee
ICD-10 Mortality sub-committee
Training sub-committee
NDoH: Secretariat and support to Task
Team
Participation from all
healthcare stakeholders
Ministerial ICD-10 Task team
Advise and recommend ICD-10 standards: adopted as policy by
the NDoH
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ICD-10 MIT: Master Industry Table
Failure to update systems with this file
will lead to rejections of claims by
medical aids and inaccurate health data
collections
Are about 1600 codes changes: added,
deleted or modified
Many more convention changes, e.g.
notes, excludes, includes, etc
Last file update was in 2007
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ICD-10 MIT: Master Industry Table
Examples of new codes
J09: Influenza due to certain identified
influenza virus
new code to be used for swine flu &
avian flu
K02.5: Caries with pulp exposure
G90.4: Autonomic dysreflexia
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ICD-10 MIT: Master Industry Table
Examples of Modified Codes
Old: O60: Preterm labour and delivery: was
valid for use
New: O60: not valid
O60.0: Preterm labour without delivery
O60.1: Preterm spontaneous labour with
preterm delivery
O60.2: Preterm spontaneous labour with
term delivery
O60.3: Preterm delivery without
spontaneous labour
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ICD-10 MIT: Master Industry Table
Old Version
I70: Atherosclerosis
I70.0:
Atherosclerosis of
aorta (was valid for
use)
New version
I70.0:
Atherosclerosis of
aorta (not valid-need
5th characters)
I70.00:Atheroscleros
is of aorta without
gangrene
I70.01:Atheroscleros
is of aorta with
gangrene
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ICD-10 MIT: Master Industry Table
Examples of deleted codes
• H54.7: Unspecified visual loss
• K35.0 Acute appendicitis with
generalized peritonitis
• K35.9: Acute appendicitis, unspecified
Above have been replaced with new codes
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ICD-10 Coding Tools
ICD-10 Browser
NDoH/TT to go out on tender
Secure SP Development to commence
in 2013
Current version: BHF/DXS 2007 (only valid until 31 May 2013)
Acquire from PMS or Private
companies
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SA ICD-10 Coding Standards
Documents
Examples: Z01.6, Z01.7,
Finalise standards Publish NDoH website
Z code (DSN 21) Review
Codes proposed for deletion Default codes (overuse)
ICD-10 Coding Morbidity Coding Standards Document
Policy Document Morbidity ICD-10 standards
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ICD-10 Mortality Coding Standards
Document
• Ready for sign off by DG
• Will be posted on NDoH website
Version 1 of Standards Document
• Circulated for comments
• Collated and published in next version
Outstanding standards/ Guidelines
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ICD-10 Implementation
Phased Approach:
Phase 1: 01/07/05 to 30/09/05-education
Phase 2: 01/10/05 to 31/12/05-valid ICD-10 code
Phase 3: 01/01/06 to date-validations
Phase 4: to commence in 2014
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Current Situation Implementation
Phase 3: current phase: not fully implemented (private & public healthcare sectors)
MoH/NDoH: phase 3 to be fully implemented nationally by 01/07/14 to support NHI and quality disease stats.
The NDoH & CMS: all schemes and administrators to commence full scale phase 3 and phase 4.1. validations on 01/07/14 (CMS accreditation)
Currently: only 3 schemes/administrators are doing primary ICD-10 code validations (Pdx)
Hospitals: header level validation on all codes
Drs and Allied Staff: line level validations on all codes
Full scale ICD-10 phase 3 validations can lead to a great deal of claims rejections if providers are not compliant to phase 3
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ICD-10 Technical User Guide
Non-compliance will result in claims rejections
Implementation: 01/07/14
Phase 3 and 4.1
NDoH website
Funder messages : 01/06/13 Funder messages : 01/06/13
ICD-10 Technical User Guide for Phase 3
Phase 3 Phase 4.1
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ICD-10: Phase 3 Requirement Implementation date: 01 July 2014
ICD-10
Correct 3, 4, 5 character Codes (all
codes-pdx & sdx)
Appropriate Pdx codes as
Per MIT
MIT: Version 2007 (BHF)
Update: June 2013
SA Coding Standards Version 5
Sequelae Codes
Dagger &
Asterisk
S & T codes: Must have V,W,X,Y codes
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ICD-10 Phase 4: Clinical Validation
Phase 4.1 Implementation date: 01/07/14
Age edits
Gender edits
ICD-O Morphology codes for all neoplasms
Neoplasms to
have
morphology
codes
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ICD-10 Phase 4: Clinical Validation
Planned: 2015 Phase 4.2
Validation: examples
Dagger & Asterisk mapping
MP & Hospital code
validations
ICD-10 to pharmaceutical code
validations
SA Coding Stds
(Enforce)
Above details to be finalised by the ICD-10 Task Team in 2013
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ICD-10 & Clinical
Validations Current Situation:
Clinical validations can ONLY take place within
contractual agreements & for the management of
PMBs.
No other claims can be subject to clinical validation until
phase 4.2 is implemented
For PMBs: medical aids can do validations of codes
between hospital and Dr, ICD-10 to CSSA/RPL
validations, ICD-10 to lab and path code validations,
ICD-10 to NAPPI validations
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ICD-10 All the latest ICD-10 information can be obtained as follows:
Documents prior to 2012:Council for Medical Schemes Website, under the ICD-10 portal http://www.medicalschemes.com
2012 Documents & circulars:
www.doh.gov.za and click on:
Resource Centre - Legislation- Notice
Contact Details: Africode Consulting Tel: 011 026 2985 Cell: 082 578 7897 Email: [email protected]; [email protected];[email protected] Website: www.africode.co.za