Icd 10

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Information about Icd 10

Published on February 25, 2014

Author: BenQuirk2

Source: slideshare.net

INSIGHTS ICD-10 Wednesday, December 18, 2013 Disclaimer: Nothing that we are sharing is intended as legally binding or prescriptive advice. This presentation is a synthesis of publically available information and best practices.

Agenda • • • • • Introductions ICD-10 IMO What’s next? Q&A

Quick Overview October 1, 2014 hard cut-off Affects all entities covered by HIPAA 14,000 ICD-9 codes grow to 68,000 ICD-10 codes No impact on CPT codes Version 5010 standards Significant changes to clinical and revenue cycle systems • Complex conversion to updated codes • System upgrades to expand data fields for longer codes • Staff retraining on new versions and codes • • • • • •

ICD-10 Historical Retrospective

ICD-10 Regulatory Mandates Federal Mandate Department of Health and Human Services Final Rule CMS-0013-F Published January 2009 HIPAA 5010 Transaction formats for payors and providers January 1, 2012 ICD-10 Diagnosis and procedure codes for clinical transactions October 1, 2014

What are ICD-10 Codes? • Granular code set developed by WHO for: – Increased clinical accuracy – Improved disease tracking – Disease trending • More ICD-10 codes compared to ICD-9 ICD-9 14,000 diagnosis codes 4,000 procedure codes 5 digit numeric codes ICD-10 68,000 diagnosis codes 87,000 procedure codes 7 digit alphanumeric codes

Anatomy of ICD-10 Diagnosis Codes • • • • • • 3–7 digits Digit 1 is alpha, including O and I but no U Digit 2 is numeric Digits 3–7 are alpha (not case sensitive) or numeric Decimal is after third digit Examples: – A78 – Q fever – A69.21 – Meningitis due to Lyme disease; and – S52.131a – Displaced fracture of neck of right radius, initial encounter for closed fracture

Anatomy of ICD-10-CM

Anatomy of ICD-10 Procedure Codes • 7 digits • Alpha (not case sensitive) or numeric digits – O and I not used to avoid confusion with 0 and 1 • No decimal • Examples: – 0FB03ZX – Excision of liver percutaneous approach, diagnostic; and – 0DQ10ZZ – Repair upper esophagus, open approach

Anatomy of ICD-10-PCS • “Procedure” – Complete specification of 7 characters PCS Section Body System • Medical and surgical • Heart and great vessels Root Operation • Dilation Body Part • Coronary artery, one site Approach • Percutaneous Device • Intraluminal device Qualifier • Bifurcation

Most Impacted Specialties • Easy transition – Hematology – Oncology • Hard – Musculoskeletal – Injury – Poisoning • Most challenging – Obstetrics – Psychiatry – Emergency medicine (poisoning) • 42% of infectious disease code mappings convoluted, which will impact most specialties

What is SNOMED? • Acronym for Systematized Nomenclature of Medicine – Clinical Terminology • International standard for comprehensive clinical terminology • Available at no cost through the National Library of Medicine • Enables providers and EHRs to communicate in common language – Increased quality of patient care across specialties – Improved accuracy of patient data analysis

What is SNOMED? Continued • Structured into 19 “hierarchies” which define the clinical concept • Broken down into increasing granularity • Very specific clinical concepts to define patient condition • More complex than ICD-10 hierarchy

Why is it important? • MU2 criteria expands upon MU1 requirements to improve and utilize HIT and EHRs – Provide consistent, collaborative care – Interoperability between EHRs and need for understanding each other • Use of common language • Problem list

The ICD-10-SNOMED Relationship • SNOMED CT has better clinical coverage than ICD • Number of codes: – SNOMED CT (Clinical finding): 100,000 – ICD-9-CM: 14,000 – ICD-10-CM: 68,000 • ICD focus is statistical – Less common diseases subsumed under general categories – After-the-fact codes • SNOMED CT is clinically-oriented – Used during care – Clinical relevance and user-friendliness • Clinically coded data generates ICD-10 code for billing

Optimal Project Plan • Developing a plan for 2014 is imperative

Effective Implementation Strategy Impact Analysis Needs Assessment Project Plan Budget Conversion •Identify current systems and work processes that use ICD-9 codes •Talk with payers about effect of ICD-10 implementation on provider contracts •Workflow and business process changes •Staff training •Practice management vendor accommodations •Implementation plan with clearing houses, billing services, and payers •Inventory systems and workflows •Contingency plan for failed go-live •Time and costs related to implementation •Training •IT/IS upgrade •Assistance from outside vendor/consultant •Potential productivity loss •Transaction testing using ICD-10 codes •Historic data conversion •Review coded data for claims reimbursement consistent with ICD-9 rates

Project Considerations External testing Internal testing Provider training Document customization Template customization Core team training

Training • AHIMA recommendation: begin no more than six months before compliance deadline • Approximately 16 hours for ambulatory coders and 50 hours for hospital coders – Physician practice coders need to learn ICD-10 diagnosis coding only – Hospital coders need to learn both ICD-10 diagnosis and ICD-10 inpatient procedure coding • Specialty-specific ICD-10 training • ICD-10 coding training integrated into credential maintaining CEUs • ICD-10 resources and training materials available through CMS, professional associations and societies

Resources • • • • • • • • • • http://www.navicure.com/icd10analyzer http://www.nextgen.com/pdf/ICD-10_Expanded_Timeline.pdf http://www.himss.org/library/icd-10/playbook http://www.aapc.com/ICD-10/training.aspx http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/ICD10 http://www.ama-assn.org/ama/pub/physician-resources/solutions-managingyour-practice/coding-billing-insurance/hipaahealth-insurance-portabilityaccountability-act/transaction-code-set-standards/icd10-code-set.page http://www.cdc.gov/nchs/icd/icd10.htm http://www.ahima.org/icd10/ http://apps.who.int/classifications/apps/icd/ICD10Training/ http://www.medicaid.gov/Medicaid-CHIP-Program-Information/ByTopics/Data-and-Systems/ICD-Coding/ICD-10-Final-Regulation-andTraining.html

Poll • Do you use IMO? – Yes – No

What’s Next? January 8, 2014 – Meaningful Use 1 January 15, 2014 – Meaningful Use 2 January 22, 2014 – PatientCentered Medical Home (PCMH) January 29, 2014 – Accountable Care Organizations (ACOs)

Q&A dan.holleran@quirkhealthcare.com tamina.vahidy@quirkhealthcare.com

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