ICD-10 FROM A NURSE PERSPECTIVE. Learning Objectives 4/22/2015. Adoption of ICD-10 Classification of Diseases CD-10-CM Diagnostic Codes

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1 ICD-10 FROM A NURSE PERSPECTIVE Learning Objectives 1. New ICD-10-CM diagnostic system for Dermatology. 2. Impact of new codes on nursing and clinical support staff. 3. Education and resources available. Adoption of ICD-10 Classification of Diseases CD-10-CM Diagnostic Codes Mandated and goes into effect October 1, 2015 Required for all physicians and health care professionals. ICD-9 goes away 1

2 Why is ICD-9 going away? ICD-9-CM codes no longer fit with the needs of the 21 st century healthcare system. ICD-9-CM is unable to support current health information needs. ICD-9-CM does not meet current needs to track, identify, and analyze new clinical services and treatments available to patients. ICD-9-CM codes are becoming obsolete and out of date for a modern healthcare delivery system ICD-10-CM (diagnoses) will be used by all providers in every health care setting Will replace ICD-9 codes currently in place are 8 digits in length/alpha numeric sequence, and they always start with an alpha character, which references the chapters of the ICD-10 code book. ICD-10-PCS (procedures) will be used only for hospital claims for inpatient hospital procedures ICD-10-PCS will not be used on physician claims, even those for inpatient visits Developed by WHO (World Healthcare Organization). Been in use by other countries since the 1960 s. Will affect diagnosis and inpatient procedure coding for everyone covered ty the Health Insurance an Portability and Accountability Act (HIPAA) Currently accepted and being used in over 100 industrialized countries 2

3 Expansion of codes selection to reveal; quality of care, so the data can be used in a more meaningful way to better understand complications better design clinically robust algorithms to better track the outcomes of care Will be in align with the rest of the world for tracking healthcare data ICD-10 Classification system Number of codes Digits ICD-9-CM 13, digits Digit 1 is alpha (E or V) or numeric Digits 2-5 are numeric ICD-10-CM 68, digits Digit 1 is alpha Digit 2 is numeric Digits 3-7 are alpha or numeric Quality Problem with ICD-9 -CM Example fracture of wrist Patient fractures left wrist A month later, fractures right wrist ICD-9-CM does not identify left versus right Requires additional documentation 3

4 -ICD-10-CM describes Left versus right Initial encounter, subsequent encounter Routine healing, delayed healing, nonunion, or malunion Physicians and clinicians are at the center The physician is the driver of patient care, but that s not all; Involved in running a business Driving appropriate reimbursement of care provided Keeping abreast of new technology and the ever changing health care regulatory environment Ensures standards of medical necessity, severity of illness, and quality of care are met ICD-10-CM affects all these areas and requires further work, so that better medical outcomes happen. Coding Data Is Also The Basis For Physician Profiling Today s health care trends allow for more transparency CMS has implemented the Physician Comparison Website Information is now made public as of January 1, 2014 With the implementation and trends of ICD-10-CM, physicians will only be viewed to be as good as the data that is collected about them Patients are becoming consumers, and using tools to evaluate, compare, and ultimately select a provider for their care 4

5 Why is Documentation Necessary For payment purposes, each patient s medical record must accurately reflect the health care services provided, and the code(s) billed for those services must be supported by adequate documentation. Documentation also describes what you did and why it was necessary. Supports the billing you submit for your services. From an auditor s perspective, if there is no documentation than the service did not occur. Documenting more (or less) than what was performed, and/or billing for more or less than what was performed and documented is FRAUD. ICD-10 Codes for Dermatology In ICD-9 coding, dermatology comprised of only 13,000 diagnosis codes. In ICD-10 coding, dermatology has expanded to more than 68,000 diagnosis codes to select from. What s new to Dermatology Expansion of codes: - Non pressure ulcers - Wound care - Diabetes - Neoplasm - Other psoriasis - New personal and family history codes Documentation in a patient chart must be more specific 5

6 ICD-10 Codes for Dermatology Codes are now selected for: greater specificity Laterality clinical detail to provide information for clinical decisionmaking and outcomes research ICD-10-CM s also: allow for the creation of a post-procedural category, and other factors that can affect health (e.g., lifestyle, socioeconomic status, and family relationships) Quality coded data is dependent on accurate and complete clinical documentation CLINICAL DOCUMENTATION IMPROVEMENT Pressure ulcers Site (include laterality) Pressure ulcer stage Stage 1 Stage 2 Stage 3 Stage 4 Unspecified Document any associated diagnosis/conditions Document if ulcer (including stage) is present on admission CODING CONVENTION/GUIDELINE: LATERALITY Laterality (side of the body affected) is a new coding convention added to relevant ICD-10 codes to increase specificity. Designated codes for conditions such as ulcers, burns, fractures will require documentation of the side/region of the body where the condition occurs. In ICD-10, laterality descriptions include right, left, bilateral or unspecified designations: Right side = character 1 Left side = character 2 Bilateral = character 3 Unspecified side/region = character 0 or 9 (depending on whether it is a 5 th or 6 th character) 6

7 NEW CODING TERMINOLOGY ICD-9-Terminology Senile Intermediate coronary syndrome Acute myocardial infarction ICD-10 Terminology Age-related Unstable Angina ST elevation (STEMI) or Non-ST elevation (NSTEMI) myocardial infarction CLINICAL DOCUMENTATION IMPROVEMENT Non-Pressure Ulcers Site Ulcer depth Cause of lower limb ulcers With gangrene Document any associated diagnoses/conditions CLINICAL DOCUMENTATION IMPROVEMENT Pressure ulcer coding Ulcer site Unstageable Stage 1 Stage 2 Stage 3 Stage 4 7

8 CLINICAL DOCUMENTATION IMPROVEMENT Diabetes Type Control Insulin use Document any associated diagnoses/conditions Manifestation/ complication ClinicaDocumentation Improvement Neoplasms Behavior Laterality Anatomical site Other conditions Complication(s) History of: WOUND CARE AND ICD ICD-10-CM Diagnosis code Z48.00 Encounter for change or removal of nonsurgical wound dressing Z48.00 is a billable ICD-10-CM Code that can be used to indicate a diagnosis for reimbursement purposes 8

9 Expanded Diagnosis code examples ICD Other Psoriasis ICD-10 L40.0 Psoriasis vulgaris L40.1 General pustular psoriasis L40.2 Acrodermatitis continua L40.3 Pustulosispalmariset plantaris L40.4 Guttate psoriasis L40.8 Other psoriasis L40.9 Psoriasis unspecified Expanded Diagnosis Code Examples ICD Other Psoriasis ICD-10 L40.0 Psoriasis vulgaris L40.1 General pustular psoriasis L40.2 Acrodermatitis continua L40.3 Pustulosis palmaris et plantaris L40.4 Guttatepsoriasis L40.8 Other psoriasis L40.9 Psoriasis unspecified Expanded Diagnosis code example ICD Other malignant neoplasm of skin of trunk, except scrotum ICD-10 C Unspecified malignant neoplasm of anal skin C Unspecified malignant neoplasm of skin of breast C Unspecified malignant neoplasm of skin of other part of trunk C Basal cell carcinoma of anal skin C Basal cell carcinoma of skin of breast C Basal cell carcinoma of skin of other part of trunk C Squamous cell carcinoma of anal skin C Squamous cell carcinoma of skin of breast C Squamous cell carcinoma of skin of other part of trunk C Other specified malignant neoplasm of anal skin C Other specified malignant neoplasm of skin of breast C Other specified malignant neoplasm of skin of other part of trunk 9

10 Reimbursement Changes due to ICD-10-CM Payers might be ok at first for billing general unspecified ICD- 10-CM s will later catch up and reduce your payments significantly Reduction of payments would be a huge loss to a practice trying to provide any level of quality of care, if they cannot afford to staff it If documentation is missing, payers might come back and recoup money paid, and/or audit patient chart notes more frequently, when unspecified diagnosis ICD-10-CM Codes are billed. Minimizing Costs For Your Practice for ICD-10 Education Use free webinar and education training on internet A.A.D. Members have access to tools and resources on the AAD website D.N.A. Website also has tools and resources available Hire an outside vendor Utilize your current EHR Create a more robust IT department If staffing allows, hold regular educational sessions internally with coders and physicians and non-physician providers. How to minimize costs for training of ICD-10 Take advantage of all the free online training CMS, Medicare, and various agencies have to offer, and encourage staff to go online and educate themselves Utilize online member training and tools and tricks that the A.A.D. (Academy of Dermatology) puts out on their website If your practice does hire an outside vendor, make sure when you select them, that their staff is qualified, and they tailor to meet the needs of your practice -Ensure that the vendor focuses on documentation techniques. Codes are important, but appropriate documentation is the key to ICD-10 10

11 Other ways to minimize costs for ICD-10 training Using EHR (electronic health record): - Create EHR Templates internally to meet the needs of your practice. - Templates can prompt staff to select the best specificity and laterality for documentation and coding selection - Revise your current patient health care questionnaire and/or internal forms, to prompt more specific patient information, that can get to better coding practices with the new ICD-10 coding system. - Work with your hospital or staff to create some disease templates with specificity and granularity check boxes. Centers for Medicare & Medicaid Services cms.hhs.gov Provides consumer information and insurance oversight of governmental and private health plans; resources and tools for Medicare and Medicaid/CHIP agencies; regulatory and guidance info; updated quarterly Daily updates (free) Other Resources on Web Provides online tools and resources for both physicians and nonphysicians as it pertains to ICD-10 coding system Can subscribe to newsletters and access their Q&A sessions with other dermatology practices nationwide on ICD-10 education and training. a.k.a. American Health Information Management Association Provides free online education and resources to health care practices. Most experienced and highly cost-effective ICD-10 training provider. Web based software that incorporates the AMA CPT, HCPCS Codes, ICD9-CM and ICD10-CM code look up (crosswalks ICD-9 to ICD-10) 11

12 Other Resources for ICD-10 Education and Training Medicare agency for 10 states to include OR, WA, AZ, WY, ID, UT, ND, MT, SD, and AK. Provides updates to implementation of ICD-10 Hosts live Webinars with Q&A sessions and slide presentations for free Dermatology Nursing association website provides online tools and resources for continuing education and updates within the dermatology community. Vendor and leader in Performance Management and Technology Provides online learning modules and tests for ICD-10 preparation in all aspects of health care settings. 12