ICD 10: Implications For Content Conversion in Vendor Products

Transcription

1 ICD 10: Implications for Content Conversion in Vendor Products Ardith Campbell, CPC, CPC H, CCP Manager, Charge and Revenue Integrity Services MedAssets

2 ICD 10: Implications for Content Conversion in Vendor Products OVERVIEW Implementation of ICD 10 requires attention to both internal and external systems. Begin preparing your external content for ICD 10 implementation now. Learn what steps you can take to make your conversion easier. LEARNING OBJECTIVES Participants will learn to recognize the major differences between ICD 9 and ICD 10 coding systems. Participants will learn to recognize how this change is going to affect software and other systems within a given facility and how it will impact workflow processes. Participants will recognize a need for an effective action plan. Participants will identify key steps to make the transition easier and identify key areas of focus. FACULTY Ardith Campbell, CPC, CPC H, CCP Manager, Charge and Revenue Integrity Services MedAssets Ardith Campbell is Manager of Charge & Revenue Integrity Services for MedAssets. Beginning her healthcare career in 1987, she has also worked for Central Washington Comprehensive Mental Health and Yakima Valley Radiology where her jobs have included working with coding, reimbursement and utilization review. In her current role, Ardith works with the internal controls of three MedAssets products to ensure compliance with federal regulations and established coding conventions. She has also written articles for several industry publications, and has spoken at several industry related events throughout the country. She is certified as a CPC and CPC H through the American Academy of Professional Coders and as a CCP through the Professional Healthcare Institute of America. INTENDED AUDIENCE Revenue cycle leaders, PFS and patient access directors, managed care directors, reimbursement directors and other healthcare leaders responsible for quality and process improvements

3 INSTRUCTIONS FOR OBTAINING CONTINUING EDUCATION CREDIT To be eligible for CE NASBA credit: Attendees must be badge scanned for attendance and submit a completed evaluation form for this session Attendees should contact Dayna Baskerville (dbaskerville@medassets.com) to obtain their Certificate of Completion.

4 ICD 10: Implications For Content Conversion In Vendor Products Ardith Campbell, CPC, CPC H, CCP Manager, Charge and Revenue Integrity Services MedAssets CONFIDENTIAL PROPERTY OF MEDASSETS. MedAssets is a registered trademark of MedAssets, Inc. Copyright MedAssets, All rights reserved. Objective To understand the implications of the October 2013 deadline for implementation of the International Classificationof of Diseases (ICD), 10th Revision on my facility. 2 1

5 Goals To recognize the difference between ICD 9 and ICD 10 To understand how this will affect my software Identify steps I can take to make the transition easier 3 Agenda Introduction to the ICD 10 Internal versus external content Why focus on external content? What should you be doing now? 4 2

6 History of ICD 10 Diagnosis and Procedure History of ICD 10 ICD 9 developed by World Health Organization (WHO) for useworldwide worldwide. United States (US) developed clinical modification (ICD 9CM). Implemented in 1979 in US Expanded diagnosis codes Volumes I & II Developed procedure coding system Volume III 6 3

7 History of ICD 10 (cont d) Health Insurance Portability & Accountability Act (HIPAA) designated as a standardized code set Volumes I & II (diagnosis codes) for professional & facilities Volume III (procedures) for inpatient claims only Currently around 14,000 ICD 9 diagnosis ICD 10 expands to almost 68,000 Approximately 4,000 procedure codes ICD 10PCS expands to approximately 87,000 Current Procedural Terminology (CPT ) for professional & outpatient claims 7 History of ICD 10 (cont d) Why is a new coding system needed? ICD 9 is 30 years old Running out of room Technology has changed Not descriptive enough Lack of specificity requires supporting documentation submission prior to claim adjudication Data/quality tracking limited 8 4

8 History of ICD 10 (cont d) ICD 9 Diagnosis has three digits Chapters1 17begin with numbers Supplemental Chapters V & E begin with letters Used by all providers Examples: 311 Depression, not otherwise specified Diabetes with other coma, type II or unspecified type, uncontrolled E916 Struck accidentally by falling object 9 History of ICD 10 (cont d) ICD 10 Diagnosis codes three to seven digits First digit is alpha Second digit is alpha or numeric Third digit is alpha or numeric Fourth through seventh digits may be alpha or numeric Case insensitive alpha characters Beginning alpha expands classification from 12 to

9 History of ICD 10 (cont d) Examples: J32.0 Chronicmaxillary sinusitis L Pressure ulcer of right lower back, stage I S52.131a Displaced fracture of neck of right radius, initial encounter for closed fracture Code Mechanical complication of other vascular device, implant, and graft Expands to 156 different codes T Displacement of femoral arterial graft (bypass) 11 History of ICD 10 (cont d) ICD 10 Procedural Coding System (PCS) affects inpatient claimsonly Expanding to seven digits Can be either alpha or numeric character Letters I and O not used Avoids confusion with numbers 1 or 0 Identifies bodypart, approach, anddevice(s) device(s) used 12 6

10 History of ICD 10 (cont d) Example 3 Administration 0 Circulatory 2 Transfusion; putting in blood or blood products 3 Peripheral vein 3 Percutaneous N Red blood cells 1 Nonautologous 13 History of ICD 10 (cont d) Code Angioplasty is one ICD 9 code For ICD 10, expands to 1170 codes 047K04Z Dilation of right femoral artery with drug eluting intraluminal device, open approach 047K0DZ Dilation of right femoral artery with intraluminal device, open approach Will ICD 9 become a dead language? Example later New code set effective October 1,

11 Internal vs. External Content Internal vs. External Content Internal Within your facility Your staff Discussed later How will your facility handle the transition? Identify affected departments Create committees to explore possibilities Consider/budget training & development costs Inventory existing systems Contact vendors Consider doing a general system upgrade 16 8

12 Internal vs. External Content External Outside the facility Are the vendors ready? Can they support both ICD 9 and ICD 10? For how long will they support both? 17 Focus On External Content Why? 9

13 Focus on External Why? We are a vendor Identify vendor relationships Center for Medicare & Medicaid Services (CMS) vendor Medicaid Insurance carriers Vendor products used internally 19 Focus on External (cont d) May impact many information systems Where to look Billing Case management Pharmacy Reporting 20 10

14 Focus on External (cont d) Evaluate work flow processes Medical necessity tools Point of service collection tools Pre certification processes Claim scrubbers Claim clearing houses Any other vendors 21 Focus on External (cont d) Inpatient versus outpatient ICD 10 diagnosis affects all provider types Outpatient will continue to use CPT for procedures ICD 10PCS affects inpatient only Will vendor transition to ICD 10PCS or map back to ICD 9? Your use of ICD 10PCS vs ICD 9 procedures Statistics Map ICD 9 to ICD 10 or convert? 22 11

15 Focus on External (cont d) CMS has developed General Equivalence Mappings (GEMS) Works bi directionally Not a 1:1 mapping system ICD 9 to ICD 10 results may be different than ICD 10 to ICD 9 lookup GEMS to be updated only three years post conversion 23 Focus on External (cont d) Data requirements Can be two way way What do you require from vendor? What does vendor require from you? If mapping to GEMS, what happens after 3 year period? Dead language example 24 12

16 Focus on External (cont d) Discussion with providers Inpatient procedures different thanoutpatient Will this affect order entry? What about lab requisitions? Your charge description master (CDM)? Will conversion be done on the back end? 25 What Should I Be Doing? 13

17 Major Steps for ICD 10 Readiness Organize the Team Conduct a Business Process Analysis Develop a Communication Strategy Perform Technology Assessment Training, Training, Training Create a Deployment Strategy 27 Organize the Team Cross functional team with key areas of focus Define the project andthe scope of the project Budget planning Assess impact to vendor operations Review impact on operations 28 14

18 Conduct a Business Process Analysis How will ICD 10 impact your business practices Review Health Plan Contracts Patient Care and Service Impact PROJECT TEAM Health Plan Contracts Patient Care Service ICD 10 Impact 29 Develop a Communication Strategy Develop a Leveled Communication Strategy Knowledge Application Expert Stress benefits of ICD 10 Share timeline Conduct periodic briefings 30 15

19 Perform a Technology Assessment Complete assessment of each electronic process ELECTRONIC MEDICAL RECORD (EMR) HEALTH INFORMATION MANAGEMENT (HIM) SCHEDULING SYSTEMS BILLING AND COLLECTIONS ORDER ENTRY PHARMACY UTILIZATION MANAGEMENT PURCHASING AUDITING 31 Training, Training, Training 32 16

20 Create a Deployment Strategy Implementation Schedule Test vs live environment Adjust for potential issues Assess performance issues Re training 33 Resources 17

21 Resources CMS AHIMA html AMA assn.org/amednews/2008/09/08/gvsa0908.htmplace Holder 35 18