Preparing for ICD-10 Advance Preparation for Implementation Charles Brownlow, OD

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1 Preparing for ICD-10 Advance Preparation for Implementation Charles Brownlow, OD International Classification of Diseases (ICD-9, ICD-10) Both include codes for all medical conditions, causes, etc. Created by World Health Organization (WHO) Originally created to ease recording in medical research; 5-digit code rather than looong name Adopted by Medicare and other insurers for reporting diagnosis codes on claims ICD-9 in use in US through 9/30/2015 ICD-10 in use in most other developed countries since 1994 ICD-10 Key Facts ICD-10 has two sections ICD-10-CM for outpatient services, will be used by all physicians US physicians will continue to use codes from Healthcare Common Procedure Coding System (HCPCS), including CPT, for reporting procedures, materials, etc. Note: US is adopting ICD-10 much later than the rest of the world because physicians did not want to give up CPT-9 CM for reporting procedures and services ICD-10-PCS for procedures ICD-10 When? Only used for inpatient procedures in the US Not used by US physicians Centers for Medicare and Medicaid Services (CMS) sets the date for implementation So, Honey, is it a date? CMS first said October 1, 2013 Promised no delays or changes Implementation will begin for all services on or after October 1, P age PMI, LLC Charles Brownlow, OD, FAAO [email protected]

2 ICD-10 must be used for diagnosis coding for all services performed on or after the implementation date ICD-9 must be used for diagnosis coding for all services performed for all dates prior to the implementation date. Medicare Promises Benefits with ICD-10 Some benefits are for payers, some for providers, some for patients ICD-9 didn t have room for new codes ICD-10 will provide better data needed to Objectively measure quality, safety, efficacy of care Reduce the need for attaching additional info to claims Design better payment systems and processing claims Conduct research, epidemiological studies, clinical trials Medicare s Forecast Benefits, continued ICD-10 Value American health systems will be able to Set health policy that meets providers /patients needs Do effective long range planning for health care Design more effective health care systems Monitor utilization of health care resources Improve all phases of health care delivery, including Clinical Financial Administrative Prevent/detect/prosecute health care fraud and abuse Track public health and risks ICD-10 brings values 2 P age PMI, LLC Charles Brownlow, OD, FAAO [email protected]

3 Laterality is included within the code Sense organs (eye, ear) separated from nervous system A condition code is different than an injury code, and injury sequelae have codes too It s not just a coding project ICD-10 is considered part of clinical documentation Huge Increase in Number of Codes and Complexity with ICD-10 ICD-9 has approximately 14,000 codes ICD-10 has over 70,000! Potential number is in hundreds of thousands ICD-10 codes are 3-7 characters First is always a letter Second is always a number 3-7 may be number or letter Always a decimal point after the third character ICD-10-CM Provides More Possible Codes to Capture More Information Code can include left/right/bilateral E.g. H = Central corneal ulcer, bilateral Code can include combinations of conditions, symptoms, manifestations E.g. E = Type II diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema Code may include an x as a placeholder E.g. T15.02XD = Foreign body, cornea, left eye, subsequent encounter Code may include concepts not included in ICD-9 More ICD-10 Advantages E.g. patient s blood type, Z67.40, Type O, Rh+ 3 P age PMI, LLC Charles Brownlow, OD, FAAO [email protected]

4 New system provides more possible codes for Injuries Diabetes, retinopathy code will include diabetes type diagnosis Substance abuse Postoperative complications ICD-10 includes Injuries are grouped by anatomical site rather than type of injury Classification/chapter listing is different than ICD-9 Changes reflect current medical knowledge New definitions for conditions previously listed in ICD-9 Conditions previously given V codes or E codes are now included in main ICD-10 classification Two Separate References Needed for Accurate ICD-10 Code Choices The Tabular List permits you to find a code based on the numeric group for the diagnosis, e.g. all glaucoma diagnoses H40-H42 H40 comes before H42 This is a huge database 873 KB The Alphabetic Index permits you to find a diagnosis via its actual name, e.g. Primary Open Angle Glaucoma, another huge database E.g. conjunctivitis is listed before glaucoma Just the ICD-10-CM Guidelines for Coding and Reporting, 2012, takes 113 pages! Differences and Similarities ICD-9 to ICD-10 Comparing ICD-9 and ICD-10 Codes Taxonomy Keys for Coding Eye Diagnoses First three characters-- 4 P age PMI, LLC Charles Brownlow, OD, FAAO [email protected]

5 And also H00 through H59 = Diseases of eye and adnexa H00-H05, eyelid, lacrimal system and orbit H10-H11, conjunctiva H15-H22, sclera, cornea, iris and ciliary body H25-H28, crystalline lens H30-H36, choroid and retina H40-H42, glaucoma First Three Characters, Concluded H43-H44, vitreous body and globe H46-H47, optic nerve and visual pathways H49-H52, muscles, binocular movement, accommodation, refraction H53-H54, visual disturbances and blindness H55-H57, other disorders of eye and adnexa H59, intraoperative and postprocedural complications/disorders of eye and adnexa, not elsewhere classified Further Divisions of First Three Characters Examples H30-H36, disorders of retina and choroid H30, chorioretinal inflammation H31, other disorders of choroid H32, chorioretinal disorders in diseases classified elsewhere H33, retinal detachments and breaks H34, retinal vascular occlusions H35, other retinal disorders H36, retinal disorders in diseases classified elsewhere 5 P age PMI, LLC Charles Brownlow, OD, FAAO [email protected]

6 Doctors and Staff Will Probably Use Online and Computer Programs, not Books Tabular plus Alphabetical ICD-10 = Thousands of Pages! Online references will be necessary for Look Ups! We Codeheads probably won t be able to win any How Do You Code? contests at future CE events, unless we have a smart phone app! How Complex Is This? Complexity depends on the condition H Dry eye syndrome of both lacrimal glands H35.31 Non-exudative age-related macular degeneration H25.13 Age-related nuclear cataract, bilateral H40.11x1 Primary open angle glaucoma, mild stage H43.03 Vitreous prolapse, bilateral E T2D with mild NPDR, without DME Computer Programs Will Help EHR systems will probably be able to automatically combine various features in the chart to choose an ICD-10 code Diagnoses ICD-10 What? Complicating conditions Symptoms/complaints Initial or follow up visit Cause of condition/complications Good idea to prepare for ICD-10 Gradually Accept the reality It WILL happen on 10/1/15! Don t rush! Lots of free or inexpensive information available Lots of time to prepare 6 P age PMI, LLC Charles Brownlow, OD, FAAO [email protected]

7 Additional excellent training material will be developed Don t spend a lot of money Yet! Early training materials and seminars are often more expensive than those provided later Consultants and other businesses may try to scare you into purchasing materials, seminars, etc. Some key issues may change between now and the implementation date, making early education obsolete ICD-10 What? Lots of Good Resources at CMS.gov Tutorial, slide show Very easy to find online help for converting an ICD-9 diagnosis to ICD-10 ICD-9, , microcystoid degeneration of retina, unspecified eye ICD-10, H (H35 = retina, 42 = microcystoid degeneration, 9 = unspecified eye) AOA Coding Resources AOA Marketplace (formerly Order Department) AMA ICD-10 Manual (apprx. $100) Codes for Optometry, AMA Current Procedural Terminology, and AOA Codes for Optometry ICD-9 abridged for the eye Documentation Guidelines Correct Coding Initiatives from Medicare HealthCare Common Procedure Coding System (HCPCS) for Coding Materials in Medicare 7 P age PMI, LLC Charles Brownlow, OD, FAAO [email protected]

8 Companion readable CD, $25 No Office is an Island Many resources available but it s up to you to seek the answers Don t be shy about ing your questions to [email protected] or [email protected] This is a free service to WOA members and their staff Questions? Thank You! 8 P age PMI, LLC Charles Brownlow, OD, FAAO [email protected]