provider education cathy munn mph rhia cphq sr. consultant basic icd-10 overview
TRANSCRIPT
Provider Education
Cathy Munn MPH RHIA CPHQSr. Consultant
Basic ICD-10 Overview
• Status of ICD-10 Transition– Who, What, Where, When & Why– Industry Update
• Impact of the Change– Providers– Payers– Translation Examples
• Arkansas DMS Remediation Update• Next Steps & Resources
Agenda
• ICD-10-CM (diagnoses) will be used by all providers in every health care setting
• ICD-10-PCS (procedures) will be used only for hospital claims for inpatient hospital procedures
• No impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes
• CPT and HCPCS will continue to be used for physician and ambulatory services including physician inpatient hospital visits
Who: The Healthcare Industry
• ICD-9-CM: International Classification of Diseases, 9th revision, Clinical Modification
– US transitioned from ICD-8 to ICD-9 in 1979– Annual updates
• ICD-10: Developed by the World Health Organization as the nomenclature for all countries
– ICD-10-CM: International Classification of Diseases, 10th revision, Clinical Modification – US only
– ICD-10-PCS: International Classification of Diseases, 10th revision, Procedure Classification System – US only
What: ICD-10 CM/PCS
• Final Rule Originally Published by HHS on January 16, 2009 requiring the adoption of ICD-10 on October 1, 2013
– Dates of Service (outpatient) After 10/1/2013– Dates of Discharge (Inpatient) After 10/1/2013
• House Bill 4302 passed on March 31, 2014 delays the implementation of ICD-10 until “no earlier than October 2015”
• This is a Federal Mandate
When: October 1, 20XX
• Systems will have to utilize both ICD-9-CM and ICD-10-CM for overlap e.g. claims backlog, Arkansas Medicaid allows providers 365 days to submit a claim.
• Inpatient discharges occurring on or after 10-1-20XX will use ICD-10-CM and ICD-10-PCS codes regardless of date of admission.
• Outpatient dates of service occurring on or after 10-1-20XX will use ICD-10-CM codes
• There will be period of time when payers will be processing claims in both ICD-9 and ICD-10
Where: Inpatient vs Outpatient
• Better data will be available for:– Measuring the quality, safety and efficacy of care– Designing payment systems and processing claims for
reimbursement– Conducting research, epidemiological studies and clinical
trials– Setting health policy– Operational and strategic planning and designing healthcare
delivery systems– Monitoring resource utilization– Improving clinical, financial and administrative performance – Preventing and detecting healthcare fraud and abuse– Tracking public health and risk
Why: Data Benefits of ICD-10
ICD-10: Key to the success of
each initiative
ACOs/ Patient Centered Medical
Home
EHR/ Meaningful
Use
Value Based Purchasing
Reimbursement changes
Public Reporting & Quality Measures
Health Insurance Exchanges
Other Competing Priorities
Alpha Character Narrative Description
A and B Certain infectious and parasitic diseases.
C00 to D48 Neoplasms.
D50 to D89 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism.
E Endocrine, nutritional and metabolic diseases.
F Mental and behavioral disorders.
G Diseases of the nervous system.
H00 to H59 Diseases of the eye and adnexa.
H60 to H95 Diseases of the ear and mastoid process.
ICD-10 Chapter Headings
ICD-9 Diagnosis Codes – 13,000 ICD-10 Diagnosis Codes – 69,000
3-5 Characters 3-7 Characters
First character is numeric or alpha (E or V)
First character is alpha
Use of decimal after 3rd character Use of decimal after 3rd character
Characters 2-7 are alpha or numeric – letter U is not used
Use of dummy placeholder “X” for future code expansion
ICD-9 vs. ICD-10 Diagnosis Codes
ICD-9 - E codes reference External Causes of Injury & PoisoningICD-10 - E references the Endocrine System
ICD- 9 - V codes reference Health Status & Contact with Health ServicesICD-10 - V – Y codes reference External Causes of Morbidity
Diagnosis ICD-9 Codes ICD-10 Codes
Fractures 747 17,099
Obstetrics 1,104 2,155
Poisoning 244 4,662
Diabetes 69 239
Migraine Headache 40 44
Impact of ICD-10
ICD-9 Procedure Codes – 4,000 ICD-10 Procedure Codes – 72,000
3-4 Digits 7 Digits
All digits are numeric Alpha or numeric composition• Numbers 0 - 9 • Letters O & I are omitted
Example: Artery suture has 1 code in ICD-9
Example: Artery suture has 195 coding options in ICD-10
Example: Fractured femur has 16 codes in ICD-9
Example: Fractured femur has 1530 coding options in ICD-10
ICD-9 Procedure vs. ICD-10-PCS
The increase in the number of procedure codes is driven by the increased specificity, granularity & laterality contained within the ICD-10 codes. There are also 7th digit designations (A or D) which identify initial or subsequent encounter for care.
• Asthma
Code Translations
ICD-9 Code Description ICD-10 Code Description
493.00Extrinsic asthma, unspecified J45.20
Mild intermittent asthma, uncomplicated
493.00Extrinsic asthma, unspecified J45.30
Mild persistent asthma, uncomplicated
493.00Extrinsic asthma, unspecified J45.40
Moderate persistent asthma, uncomplicated
493.00Extrinsic asthma, unspecified J45.50
Severe persistent asthma, uncomplicated
493.01Extrinsic asthma with status asthmaticus J45.22
Mild intermittent asthma with status asthmaticus
493.01Extrinsic asthma with status asthmaticus J45.32
Mild persistent asthma with status asthmaticus
493.01Extrinsic asthma with status asthmaticus J45.42
Moderate persistent asthma with status asthmaticus
493.01Extrinsic asthma with status asthmaticus J45.52
Severe persistent asthma with status asthmaticus
• Otitis Media
Code Translations
ICD-9 Code Description ICD-10 Code Description
382.00
Acute suppurative otitis media without spontaneous rupture of eardrum H66.001
Acute suppurative otitis media without spontaneous rupture of ear drum, right ear
382.00
Acute suppurative otitis media without spontaneous rupture of eardrum H66.002
Acute suppurative otitis media without spontaneous rupture of ear drum, left ear
382.00
Acute suppurative otitis media without spontaneous rupture of eardrum H66.003
Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral
382.00
Acute suppurative otitis media without spontaneous rupture of eardrum H66.004
Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear
382.00
Acute suppurative otitis media without spontaneous rupture of eardrum H66.005
Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear
382.00
Acute suppurative otitis media without spontaneous rupture of eardrum H66.006
Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, bilateral
382.00
Acute suppurative otitis media without spontaneous rupture of eardrum H66.007
Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, unspecified ear
• Congestive Heart Failure
Code Translations
ICD-9 Code Description ICD-10 Code Description
428.0Congestive heart failure, unspecified I50.20
Unspecified systolic (congestive) heart failure
428.0Congestive heart failure, unspecified I50.21
Acute systolic (congestive) heart failure
428.0Congestive heart failure, unspecified I50.22
Chronic systolic (congestive) heart failure
428.0Congestive heart failure, unspecified I50.23
Acute on chronic systolic (congestive) heart failure
428.0Congestive heart failure, unspecified I50.30
Unspecified diastolic (congestive) heart failure
428.0Congestive heart failure, unspecified I50.31
Acute diastolic (congestive) heart failure
428.0Congestive heart failure, unspecified I50.32
Chronic diastolic (congestive) heart failure
428.0Congestive heart failure, unspecified I50.33
Acute on chronic diastolic (congestive) heart failure
Systems•EHR, Practice Management & Billing Systems•System upgrades/testing/cost•Vendor readiness/testing
Operations•Systems, workflows & operating metrics•Encounter forms/Superbills•Payer readiness/testing
Documentation•Coding audit for documentation of specificity•Identify common codes within the practice•Consider dual coding to gauge accuracy & productivity
Impact on Provider Operations
• AHIMA Online Education Physician Series– Clinical Documentation for ICD-10: Principles &
Practice• Short, self-paced training modules• Case-based, real life examples
– Provides more than 200 bite-sized, on-demand, specialty-specific training modules that can be accessed anytime or anywhere with a mobile device – computer, tablet or smartphone
– Delivers 3-5 minutes modules that cover physician’s 10 – 20 most commonly billed diagnoses & conditions making learning targeted and relevant to their practice specialty.
– www.ahima.org\physicianICD10
Clinical Documentation Resources
• There are a wide variety of training opportunities and materials available through a variety of resources:
– Professional Coding Associations – AAPC, AHIMA
– Online Courses – ICD10 Monitor, Contexo University, Precyse, Nuance
– Webinars – ICD10 Monitor, HCPro
– Onsite Training – Train-the-Trainer approach, Coding Boot Camp
– Arkansas Hospital Association – monthly coding classes
– Non-Traditional - Partner with the HIM Department at a nearby hospital
Training Resources
• Arkansas Medicaid has been working on ICD-10 for over two years
– Completed• Operational assessment • Remediation of Medical Policy, Edits and Audits complete• Provider Manual Updates – HP coordinating revisions• Data Requirements – HP/MMIS, Xerox/ACS, integrated & stand alone systems
– Ongoing• Remediation of Pharmacy Policy & Edits • Remediation of DHS reports, forms, and brochures • Provider Outreach
o Meetings/Webcastso Provider Bulletinso Newsletterso ICD-10 Website www.humanservices.Arkansas.gov/ICD10
• Internal & external testing to begin mid-year
Akansas DHS Current Stated
Leadership & Strategic Direction
Communication & Planning
Systems
Vendors
Training
Documentation
Testing
The Starting Point
• Create a checklist of all systems & work flow processes that currently use ICD-9
• Create a list of vendor contact information• Identify all staff who work with ICD-9• Identify all possible work flow changes that will need to
switch to ICD-10• Identify the practice billing service (if applicable)• Identify the practice clearinghouse • Identify a contact for each of the practice’s payers
AMA ICD-10 Checklist
• Contact vendors to determine their ICD-10 implementation plans
• Contact the practice’s billing service, if applicable, to identify their ICD-10 implementation plans
• Contact payers to determine their ICD-10 implementation plans
• Identify any internal work flow processes that will need to be change for ICD-10
http://www.ama-assn.org/resources/doc/washington/icd10-checklist.pdf
AMA ICD-10 Checklist
• www.CMS.gov/ICD10• www.CMS.gov/NPC• http://www.roadto10.org/• www.AHIMA.org• www.AAPC.com• http://www.cms.gov/Medicare/Coding/ICD-10/Download
s/ICD10SmallandMediumPractices508.pdf
• http://www.himss.org/ASP/topics_icd10playbook.asp• www.WEDI.org• www.humanservices.Arkansas.gov/ICD10
Industry Website Resources
CMS Resources
CMS Resources
CMS Road to I-10
• White Papers (including but not limited to)– ICD-10 A Primer– ICD-10 Clinical Documentation– ICD-10 Physician Impact– ICD-10 Advantages– ICD-10 Specified or Unspecifiedhttp://healthdataconsulting.com/
• Checklists published by CMS for providers (small, medium and large) at:
– http://www.cms.gov/Medicare/Coding/ICD10/ICD-10ImplementationTimelines.html
– http://www.roadto10.org/
Additional ICD-10 Resources
Websites to Watch