Getting Ready for ICD-10. Part 1: The Basics

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1 Getting Ready for ICD-10 Part 1: The Basics

2 Introduction In the United States, on October 1, 2015 the ICD 9 code set used to report medical diagnoses and inpatient procedures will be replaced by the International Classification of Disease, Tenth Edition (ICD 10). This module will provide an overview of why the change to ICD 10 is occurring and the impact of this change on healthcare documentation.

3 Directions: Review the content of this module and complete the attached posttest. Successful completion of the post test is worth 0.5 PRMC educational credit and will be documented on your NetLearning transcript. Objectives: After completion of this module the learner will be able to: 1. Discuss the need for the change from ICD 9 to ICD Distinguish between ICD 10 CM and ICD 10 PCS. 3. Describe key benefits to changing to ICD 10 Coding for providers, patients and payers. 4. Define GEMS.

4 What is ICD 10? ICD 10 is the updated version of medical codes used for coding patients medical treatments and care. It will replace the ICD 9 codes (International Classification of Diseases, 9 th edition). ICD 10 contains 2 classification code sets: 1. Diagnoses for all providers (ICD 10 CM) CM stands for Clinical Modifications 2. Inpatient hospital procedures (ICD 10 PCS) PCS stands for Procedure Coding System

5 The History of ICD 10 In 1994, ICD 10 CM guidelines were published by the World Health Organization (WHO) and adopted world wide (except for the United States). Using the ICD 10 CM guidelines published by WHO, ICD 10 CM (Clinical Modifications) were developed and modified by the U.S. Centers for Disease Control and Prevention (CDC) with the input of physician specialty associations. The intent is to replace ICD 9 CM. The ICD 10 PCS (Procedure Coding System) was developed and is maintained by the Centers for Medicare and Medicaid Services (CMS) and will replace the ICD 9 CM Volume 3 procedural codes.

6 Why the Change from ICD 9 CM? The change is being made from ICD 9 CM because ICD 9 CM: Is 30+ years old. It is outdated, and includes obsolete classifications of diseases. It does not allow for new technology unheard of 3 decades ago, for example laparoscopy, endoscopy or thoracoscopy. Produces limited data about patients medical conditions and hospital inpatient procedures. Is out of capacity. Data to improve care is incomplete and lacks the necessary detail. Does not allow the physician to see the whole scope of patients conditions.

7 Why the Change to ICD 10? With the change to ICD 10 CM and ICD 10 PCS there will be: Better exchange of health data between the U.S. and other countries. Better data for the National Committee on Vital and Health Statistics (NCVHS); details on injuries, accidents, including what the patient was doing when injured, where injury occurred, what body part. Improved public health reporting and tracking for: Dangerous settings and products Diseases Injuries Terrorism Threats Better examples to identify a public health concern for an entire community, or data for the CDC on the top 10 causes of death.

8 Who Needs to Transition to ICD 10? The transition to ICD 10 is required for every healthcare organization that is covered by the Health Insurance Portability Accountability Act, or HIPAA. This includes: Health Care Providers Payers (including Medicare) Clearinghouses Billing Services NOTE: Non Covered Entities are not required to transition to ICD 10. See next slide.

9 Who Are Non Covered Entities? Property and casualty insurance health plans (auto insurers) Workers Compensation Programs Disability Insurance Programs

10 However, non covered entities may still want to transition to ICD 10 coding... If non covered entities choose to participate in ICD 10 it will be to their benefit because: The expanded detail in injury codes in ICD 10 will help automobile and Workers Compensation programs identify types of injuries. ICD 9 will no longer be maintained. The use of ICD 10 coding facilitates coordination of benefits. It will help non covered entities to be consistent with industry standards.

11 What Improvements Come With ICD 10? ICD 10 CM and ICD 10 PCS will: Better reflect current medical practices. Capture more specific data from clinical documentation much higher level of specificity. Help facilitate patient care coordination across settings. Link diseases. Provide updated terminology with synonyms to make documentation easier. continued on next slide

12 What Improvements Come With ICD 10? ICD 10 CM and ICD 10 PCS will have: More information per code. Better support for care management. Better support for quality measurement. Better support for analytics safety, reimbursement, valuebased purchasing, research and policy. Improved ability to understand risk and severity of condition. Fraud prevention by being able to track a problem for multiple encounters or treatments.

13 Comparison of ICD 9 CM to ICD 10 ICD-9 18,000 codes 14,000 diagnosis codes 4,000 procedure codes 1,592 MCCs (major comorbid conditions) 3,427 CCs (comorbid conditions) Little detail Difficult to analyze data ICD ,000 codes 68,000 diagnosis codes 87,000 procedure codes 3,152 MCCs (major comorbid conditions) 13,594 CCs (comorbid conditions) High definition Laterality, bilaterally dominance Supports data analysis Greater specificity Full description and consistency within the code set Uses modern terminology for descriptions

14 ICD 10 CM replaces ICD 9 CM for Diagnosis Coding: The new structure of ICD 10 CM will be: X X X X X X X category etiology extension anatomic site severity

15 ICD 10 PCS replaces ICD 9 CM (Volume 3, Procedural Codes) for Inpatient Procedure Coding The new structure of ICD 10 PCS will be: Section Root Approach Qualifier Operation Body Body Device System Part

16 So to Review ICD 10 Structure... ICD 10 CM replaces ICD 9 CM for diagnosis coding: ICD 10 CM diagnosis codes will be 3 to 7 digits ICD 10 PCS replaces ICD 9 CM for inpatient procedure coding: ICD 10 PCS codes must be 7 alphanumeric digits Each position has a specific meaning. ICD 10 expands details for many conditions. Please Note: The change to ICD 10 does not affect Current Procedure Terminology (CPT) for outpatient procedures.

17 In making the conversion to ICD-10 you will see and hear the term GEMS. What is GEMS? General Equivalence Maps (GEMS), is located on the CMS website, and is a tool used to convert data from ICD 9 CM to ICD 10 CM and ICD 10 PCS and vice versa. Mappings between ICD 9 and ICD 10 attempts to find corresponding diagnosis codes between the two code sets, insofar as this is possible. This tool provides important information linking codes of one system with codes in the other system. GEMS is intended as a reference, but does not take the place of using the ICD 10 Coding Manual.

18 More About GEMS? GEMS is: a crosswalk between ICD 9 CM to ICD 10 CM. found on CMS and CDC/NCHS websites. (NOTE: Our geographic area is denoted as JL, this includes DC, DE, MD, NJ and PA.) intended for use by payers as a temporary mechanism for Legacy systems. used for education and planning NOTE: GEMS should not be used for coding medical records. Codes are not equivalent because some ICD 9 codes have multiple ICD 10 codes due to increased specificity in ICD 10.

19 An Example of a GEM The following ICD 9 CM Codes Diabetes with ophthalmic manifestations, type II or specified type, not stated as uncontrolled Severe nonproliferative diabetic retinopathy; Diabetic macular edema Would crosswalk in ICD 10 CM as: (GEM) E11341 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema

20 Summary The ICD 10 code set differs significantly from ICD 9. The ICD 10 code set conveys significantly more information and detail than ICD 9. The change in code sets has significant impact on healthcare providers, patients and payors. GEMS will be a part of the transition from ICD 9 to ICD 10. It is important for you to be aware of and understand the coding structure of ICD 10 in order to support Patient Financial Services functions. No coding experience is needed, you are NOT required to become a coder.

21 Resources Sign up for e mail updates on Twitter for the latest news and resources WEDO ICD 10 Implementation NCHS Basic ICD 10 CM Information AHIMA ICD 10 Education General Equivalence Mappings Frequently Asked Questions

22 Congratulations! You have now completed the Getting Ready for ICD 10, Part 1: The Basics and are now ready to take the accompanying post test. Click on the Take Test button located on the upper right side of this screen to take the posttest.

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