The ICD 10 Transition: What Does It Mean for IHS?

Transcription

1 The ICD 10 Transition: What Does It Mean for IHS? IHS National Combined Councils Bethesda, MD July 26, 2011 Howard Hays, MD, MSPH RPMS Investment Manager IHS Office of Information Technology

2 The ICD 10 Challenge With ICD-10, the American health care industry is facing a change that will surpass Y2K in scope and complexity ICD-10 conversion will have major impacts on multiple systems and business processes including clinical documentation, clinical coding, and reimbursement I/T/U electronic systems and staff must be ready to use ICD-10 by Q4, 2013 (two years from now) 2

3 IHS ICD-10 Implementation Timelines Activity Target Date Status High-Level Planning Ongoing Ongoing Awareness and Communication Ongoing Ongoing Detail Planning: Develop Tools, Processes to facilitate activities June 2012 In Progress Requirements Analysis September 2011 In Progress Requirements Freeze Date January 2012 Not Started Design Complete March 2012 Not Started Develop Training Approach February 2013 Ongoing All Development Complete May 1, 2013 Not Started All Testing (internal modular, internal integration, alpha, beta,) Complete May 31, 2013 Not Started All Software Deployable June 2013 Not Started Implementation October 1, 2013 Not Started

4 ICD-10 Prerequisite HIPAA 5010 The HIPAA Transaction Set refers to the standards used for electronic submission of claims. The current version 4010 will be obsolete after this year. Version 5010 must be used for all electronic claims starting January 1, IHS has done most of the work required for HIPAA 5010 and will be compliant by CY2012.

5 What s the Difference between ICD-9 and ICD-10? ICD-10 is not just an update of diagnosis codes in the same format Nor is it just an expanded set of codes but with the same general conceptual framework It is an entirely new model of describing medical diagnoses and procedures The following slides illustrate some of the key differences

6 Comparison: ICD-9-CM and ICD-10-CM Characteristic ICD-9-CM ICD-10-CM Character Type Numeric, only V & E used Alphanumeric Code length 5 digit max 3-7 character max # of Codes 13,500 68,000 Supplementary codes V & E Codes None (incorporated in main code book) Laterality (left v. right) No Yes Trimester No Yes (1 st, 2 nd,3 rd ) Structure of injuries Wound Type Laceration, etc Body part 6

7 ICD-10 Fact Many to 1 relationship Only 20% of ICD-9 codes have a precise 1:1 mapping to ICD-10 No straightforward crosswalk fix Example: Fracture of the Radius ICD-9 = 33 codes ICD-10 = 1818 codes 7

8 How is Diabetes Described in ICD 9 & ICD 10 CM? ICD 9 DM controlled DM uncontrolled Nephropathy (583.81) Neuropathy 250.6_ (357.2) Retinopathy (362.01) DM E08-E13 ICD 10 DM 11.9 Type 2 Diabetes Mellitus w/o complications with diabetic Nephropathy E11.21 Neuropathy E11.40 Retinopathy E

9 The Same Injury in ICD-9 and ICD-10 ICD-9-CM Fracture of shaft of radius, closed 813=Fx of radius and ulna.2=shaft, closed 1=radius (alone) ICD-10-CM S Closed fracture of shaft of left radius S52=Fracture of forearm.3=shaft of radius 0=closed fracture 2=left radius 9

10 Procedure Codes Even More Different: ICD-9-CM Procedure and ICD-10-PCS Characteristic ICD-9-CM Procedures ICD-10 PCS Character Type Numeric codes Alphanumeric codes Code Length 4 digit max 7 character max # of Codes codes 87,000+ codes Code Structure Letters O and I not used 16 Sections Expandable 10

11 Sixteen Types of ICD-10 Procedure Codes 0: Medical and Surgical 1: Obstetrics 2: Placement 3: Administration 4: Measurement & Monitoring 5: Extracorporeal Assistance and Performance 6: Extracorporeal Therapies 7: Osteopathic 8: Other Procedures 9: Chiropractic B: Imaging C: Nuclear Medicine D: Radiation Oncology F: Physical Rehabilitation and Diagnostic Audiology G: Mental Health H: Substance Abuse Treatment 11

12 Example: ICD-10 and Esophageal Surgery ICD-10 PCS Code: 0DB10ZZ 0: Medical and Surgical Section D Gastrointestinal System B: EXCISION: Cutting out or off, without replacement, a portion of a body part. Body Part Approach Device Qualifier 1 Esophagus, Upper 2 Esophagus, Middle 3 Esophagus, Lower 4 EsophagogastricJunction 5 Esophagus 6 Stomach 7 Stomach, Pylorus 8 Small Intestine 9 Duodenum A Jejunum B Ileum C Ileocecal Valve E Large Intestine F Large Intestine, Right G Large Intestine, Left H Cecum J Appendix K Ascending Colon L Transverse Colon M Descending Colon N Sigmoid Colon P Rectum 0 Open 2 Open Endoscopic 3 Percutaneous 4 Percutaneous Endoscopic 7 Via Natural or Artificial Opening 8 Via Natural or Artificial Opening Endoscopic Z No Device X Diagnostic Z No Qualifier 12

13 How is IHS Approaching ICD-10? Established an ICD-10 Steering Committee Building organizational awareness and commitment Identified key stakeholders (HIM, IT, Business Office & Revenue Cycle, Clinical) Evaluating systems and interfaces where codes are captured, exchanged, and reported Assessing areas of risk Identifying all systems that assign, utilize or store diagnosis codes Identifying all processes/policies that utilize diagnosis codes Identifying all contractors and business partners that rely on diagnosis codes Obtaining vendor commitment for readiness Evaluating interface engine support of ICD-10 Developing a plan and beginning implementation activities 13

14 ICD 10 Steering Committee (launched November 2010) OIT Practice Management Clinical Rep Peter Ziegler, MD Executive Officer TBD Tribal Rep Donnie Parish Urban Cynthia Perez CHS Terri Schmidt CHR Cathy Stueckemann OIT Technical Staff ORAP - several HIM - several NBOC Deanna Dennis Statistical Kirk Greenway NIPRS Chris Schiano Plan, Eval Diane Leach EHR David Taylor 14

15 ICD-10 Sub-Groups Business & Revenue Cycle: Kris Kirk, Adrian Lujan Data Management: Kirk Greenway, Chris Schiano Outreach & Awareness: Jan Chase, Barry Dickman Technical Development: Floyd Dennis, Jeanette Kompkoff Training: Jan Chase, Deanna Dennis Clinical: TBD 15

16 Changes to RPMS for ICD applications contain ICD-9 Codes Assessing file structure changes Field size changes, longer code descriptions Numeric vs. alpha characters Logic changes due to the revised code structure Role of mapping codes being assessed Interfaced systems with ICD-9 touch points - I/T/U will have to assess any COTS products 16

17 ICD 10 & ICD 9 Facts Both ICD 9 and ICD 10 will have to be maintained for a period of time Non-covered entities, like worker s compensation and auto insurances claims may still use ICD-9 well after the compliance date of 10/1/2013 Coding backlog and eligibility changes Trending data 17

18 ICD-10 Fact Subject Matter Experts (ICD-10) are essential in the migration to ICD 10 Critical to an accurate conversion Industry wide demand for ICD-10 resources already short supply IHS has none at this time Efficient use of ICD 10 SME 18

19 Clinical and Business Process Changes Understand this is not just an IT or HIM Project Organization wide initiative that impacts Information Systems EHR Templates, Pick-lists Provider Documentation Clinical Documentation Improvement Program Coding and Billing Physician Query Process Revenue Cycle Management Contracting, HR, Finance Quality Improvement, Data Extracts, etc. Areas recommended to conduct an assessment 19

20 Business and Financial Impact Productivity impacts can be expected coding and clinical Coders are looking for more information in the record Learning curve for at least first six months Some productivity impacts may be permanent (based on experience in Canada)

21 Sample Canada Coding Productivity Pre and Post ICD-10 Implementation (Charts Completed Per Hour percent of baseline) Service ICD-9 April 2002 Start ICD-10 July 2002 ICD-10 April 2003 Inpatient (47%) 3.75 (81%) Day Surgery (36%) 8.53 (80%) Emergency (63%) 8.83 (85%) Source: HIMSS, Data taken from Humber River Regional Hospital; Ontario, Canada Investment in training to minimize the impact Invest in Coding Staff Retention and Recruitment 21

22 Who Needs ICD-10 Training? Providers Doctors, Nurses, Ancillary, etc. Coders Billing Staff Quality Management and Utilization Review EHR expands the staff that need to understand codes and coding principles 22

23 Industry Recommended Training Timeline Training activities that should occur now: Awareness training to Administrators, Stakeholders, and users of ICD codes Begin to address ICD 10 coding competency Anatomy & Physiology Medical Terminology Pharmacology, and other biosciences Attend training to gain organizational knowledge IHS ICD-10 Website 23

24 Intensive Training Recommended Intensive Training to begin January March 2013 Use of ICD-10 CM and PCS Coding Books Encoder Use Actual Case Studies Review Coding for Accuracy Identify Further Education Need 24

25 Steering Committee & Sub-Group Discussion Area ICD-10 Coordinator (HIPAA Coordinators) Address Area Implementation, Awareness, Communication Develop In-House ICD-10 Trainer Identify staff that could train within each Area Most cost-effective Option of Hiring Term Staff to Train Competing Resources of existing staff Coding Staff essential to current Revenue Cycle Reduction in 3 rd Party reimbursable services Collaboration with HHS, CMS, VA 25

26 Summary of Key Challenges Resource Constraints (Financial and Staffing) Competing Priorities Meaningful Use Health Care Reform Other Internal and External HIT Mandates Risk of Trading Partner 5010/ICD-10 Implementation Readiness Develop ICD-10 Expertise Address internal needs and training Comprehensive Enterprise Preparedness as a result of many of the I/T/U remote locations 26

27 Questions Thank You 27