ICD-10 DELAY: Relief or Grief?

Transcription

1 ICD-10 DELAY: Relief or Grief? PETER EDU MD, CPC, CPC-I, CCS Healthcare Sr. Training Manager TeleDevelopment Services, Inc.

2 OUTLINE 1. Background 2. What s new with ICD-10? 3. Impact of ICD-10-CM implementation on different sectors 4. Causes for ICD-10-CM implementation delay

3 OUTLINE 5. Updates on ICD-10-CM implementation 6. Effects of ICD-10-implementation delay 7. Conclusions and next steps

4 BACKGROUND What is ICD-10? Classification system for diseases and health problems, created and published by the WHO Basis for the compilation of national mortality and morbidity statistics by WHO member states Also used for reimbursement and resource allocation by some countries

5 BACKGROUND International versions Different countries have their own clinical modifications for their specific purposes Australia, Canada, France, Germany, Korea, Netherlands, South Africa, Sweden, Thailand, United States, UAE, etc Philippine modification created in 2008

6 BACKGROUND Historical aspects WHO members first used ICD-10 in 1994 New version (ICD-11) is already being developed, with target completion in 2017

7 BACKGROUND American version Used by the Philippine BPO industry ICD-9-CM (current), composed of 3 volumes Volumes 1 and 2 = diagnosis codes Volume 3 = hospital procedure codes

8 BACKGROUND American version ICD-10-CM and ICD-10-PCS (new, upcoming) ICD-10-CM = diagnosis codes ICD-10-PCS = hospital procedure codes

9 BACKGROUND American version: History 1978: ICD-9 published by WHO, adopted by US as ICD-9-CM same year 1990: WHO published ICD : US began development of ICD-10-CM 1998: ICD-10-CM first version release

10 BACKGROUND ICD-9-CM Chapters Chapter 1 Infectious and Parasitic Diseases Chapter 2 Neoplasms Chapter 3 Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders Chapter 4 Diseases of Blood and Blood- Forming Organs Chapter 5 Mental, Behavioral and Neurodevelopmental Disorders Chapter 6 Diseases of Nervous System and Sense Organs Chapter 7 Diseases of Circulatory System Chapter 8 Diseases of Respiratory System Chapter 9 Diseases of Digestive System Chapter 10 Diseases of Genitourinary System Chapter 11 Complications of Pregnancy, Childbirth, and the Puerperium Chapter 12 Diseases of Skin and Subcutaneous Tissue Chapter 13 Diseases of Musculoskeletal System and Connective Tissue Ch 14,15 Congenital Anomalies; Certain Conditions Originating in Perinatal Period Chapter 16 Symptoms, Signs, and Ill-Defined Conditions Chapter 17 Injury and Poisoning and E Codes

11 BACKGROUND

12 BACKGROUND Rationale for ICD-10-CM implementation Compatibility with global classification standards (WHO ICD-10) Obsolete basis of classification in ICD-9-CM Lack of space for new diseases / pathophysiologic mechanisms in ICD-9-CM

13 WHAT S NEW WITH ICD-10? Structure (max # of digits) Structure (characters used) ICD-9-CM ICD-10-CM 5 7 Numbers only Alphanumeric Specificity Number of codes

14 WHAT S NEW WITH ICD-10? ICD-9-CM vs ICD-10-CM comparison More relevant ambulatory care and encounter codes More specific injury coding More combination codes (eg, disease + symptom description in one code)

15 IMPACT OF ICD-10-CM On healthcare providers More conscientious documentation Retraining/reorientation of staff Investment on software upgrades/updates Migration to digital records (EMR)

16 IMPACT OF ICD-10-CM On insurance companies Update of entire CMS Retraining/reorientation of staff Greater need for auditing claims from providers Obamacare is a confounding factor!

17 IMPACT OF ICD-10-CM On HIM service providers Retrain certified coders and ensure compliance to new standards Updating of software and/or hardware Supply of knowledgeable manpower to cover for learning curve of existing coders retraining

18 CAUSES OF I-10 IMPLEMENTATION DELAY 12-year gap between I9 and I10 release (WHO) Rapid growth of health records and HIM technology Economic factors Logistical nightmare for everyone

19 UPDATES ON I-10 IMPLEMENTATION Centers for Medicare and Medicaid Services (CMS) initially announced an October 2014 date, but this was delayed Latest FINAL implementation date has been set to October 1, 2015

20 RESULTS OF I-10 DELAY On healthcare providers More time for staff to learn new system Preserve status quo for doctors Those that already invested will wait another year to implement new system Readiness to adapt to I10 by 10/1/15

21 RESULTS OF I-10 DELAY On payers More time to learn new system and grow I10 compliant staff Those that already invested will wait another year to implement new system Readiness for dual coding and new rules by 10/1/15

22 RESULTS OF I-10 DELAY On HIM service providers More time to learn new system and grow I10 compliant staff Those that already invested will wait another year to implement new system Readiness for dual coding and new rules by 10/1/15 Can better service clients come 10/1/15

23 CONCLUSIONS Relief or grief? RELIEF More time to hire and train staff More time to setup, test and implement new system HIM service providers can better serve clients for dual coding and ICD-10-CM requirements in 2015 GRIEF Wasted (?) early investment on ICD-10-CM compliant systems Early training of staff may require refreshers prior to implementation date

24 NEXT STEPS Building a knowledgeable workforce from local healthcare pool 50-60,000 new RNs every year Availability of US-licensed medical coding instructors locally New AAPC inpatient coding credential in Oct 2014 Very good outcome of local coder training programs High cost of acquiring existing coders in the market

25 NEXT STEPS Achieving ICD-10-CM compliance among currently certified coders Online AAPC and AHIMA exams available for I10 compliance demonstration ICD-10-CM and PCS training available from licensed coding instructors

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