ICD-10-CM: Changes Ahead For the Clinical Work Process

Transcription

1 ICD-10-CM: Changes Ahead For the Clinical Work Process KMIT 7/17/2013 Shamsi Daneshvari, PhD This work is licensed under a Creative Commons Attribution-Noncommercial- Share Alike 3.0 United States License.

2 Objectives History of ICD-9 and ICD-10 Structure of ICD-9 and ICD-10 Benefits and Drawbacks of ICD-10 Impact on clinic processes and workflow

3 History of ICD-9-CM World Health Organization (WHO) developed ICD- 9 for use worldwide U.S. developed clinical modification (ICD-9-CM) Implemented in 1979 in U.S. Expanded number of diagnosis codes Developed procedure coding system

4 ICD-9-CM Currently 30 years old Many categories full About 14,000 codes Ability to add codes limited Not as descriptive as ICD-10

5 Benefits of ICD-10-CM Adoption Incorporates much greater specificity and clinical information, which results in: Improved ability to measure health care services Increased sensitivity when refining grouping and reimbursement methodologies Enhanced ability to conduct public health surveillance Decreased need to include supporting documentation with claims

6 Structural Differences ICD-9-CM Diagnoses ICD-9-CM has 3 5 digits Digit 1 is numeric or alpha Digit 2-5 is numeric Examples: 496 Chronic airway obstruction not elsewhere classified (NEC) Unspecified pleural effusion V02.61 Hepatitis B carrier

7 Structural Differences ICD-10-CM Diagnoses ICD-10-CM has 3 7 digits Digit 1 is alpha Digit 2 is numeric Digit 3 is alpha or numeric Digits 4 7 are alpha or numeric Examples: A69.20 Lyme disease, unspecified O9A.311 Physical abuse complicating pregnancy, first trimester S42.001A Fracture of unspecified part of right clavicle, initial encounter for closed fracture

8 Drawbacks of ICD-10-CM Adoption 65,000 codes (ICD-9-CM: 14,000) Very specific Physicians cannot use previous process for documenting Requires significant planning, training, software/system upgrades/replacements

9 Example 1 A pedestrian is walking down the street and is hit by a motorcycle What are the diagnoses codes using ICD-9 and ICD-10?

10 ICD-9-CM E814 Motor vehicle traffic accident involving collision with pedestrian collision between motor vehicle, any kind, and pedestrian Requires fourth digit to specify who was hurt

11 ICD-10-CM Pedestrian injured in transport accident V00-V09 V00 Pedestrian conveyance accident V01 Pedestrian injured in collision with pedal cycle V02 Pedestrian injured in collision with two- or three-wheeled motor vehicle V03 Pedestrian injured in collision with car, pick-up truck or van V04 Pedestrian injured in collision with heavy transport vehicle or bus V05 Pedestrian injured in collision with railway train or railway vehicle V06 Pedestrian injured in collision with other non-motor vehicle V09 Pedestrian injured in other and unspecified transport accidents

12 V02Pedestrian injured in collision with 2 or 3 wheeled motor vehicle V02.0 Pedestrian injured in collision with two- or three-wheeled motor vehicle in nontraffic accident V02.00Pedestrian on foot injured in collision V02.01Pedestrian on roller-skates injured in collision V02.02Pedestrian on skateboard injured in collision V02.09Pedestrian with other conveyance injured in collision V02.1 Pedestrian injured in collision with two- or three-wheeled motor vehicle in traffic accident V02.9 Pedestrian injured in collision with two- or three-wheeled motor vehicle, unspecified whether traffic or nontraffic accident V02.99XA initial encounter V02.99XD subsequent encounter V02.99XS sequela

13 Example 2 An individual fractures left hand. A month later, she/he fractures their right hand. Patient fractures left hand A month later, fractures right hand

14 ICD-9-CM Does not specify: initial, subsequent, or sequela Left, right Nonunion, malunion, delayed or routing healing Open, closed initial fracture

15 ICD-10-CM ICD-10-CM describes: Left versus right Initial versus subsequent S62.51Fracture of proximal phalanx of thumb S62.511Displaced fracture of proximal phalanx of right thumb S62.511A initial encounter for closed fracture S62.511B initial encounter for open fracture S62.511D subsequent encounter for fracture with routine healing S62.511G subsequent encounter for fracture with delayed healing S62.511K subsequent encounter for fracture with nonunion S62.511P subsequent encounter for fracture with malunion S62.511S sequela

16 Example 3 Example combination defibrillator pacemaker device Codes for this device are not in the cardiovascular chapter of ICD-9-CM with other defibrillator and pacemaker devices Coders and researchers have trouble finding these codes with this type of erratic code assignment ICD-10 provides distinct codes for all these types of devices, in an orderly manner that is easy to find

17 ICD-9 and the Current Workflow Each clinic has: ICD-9 code form of top 100 codes used Physician choose diagnoses and turn into billing Assumed that all documentation is present for diagnosis Patient notes completed up to a week later

18 ICD-10 and the Workflow Changes include: Cannot use code form of top codes used ICD-10 too granular Computer chooses diagnoses from patient notes All documentation must be present for diagnosis Patient notes must be completed by end of day

19 How do we implement ICD-10? Fairly significant process and workflow changes for all medical providers in all parts of the health system Focus on improving clinical documentation quality Require retraining on how to document in the new system Dynamic Notes

20 ICD-10 Implementation at UNM Clinical Document Improvement (CDI) Project Goals: Appropriate description of the patient problem list and care plan Appropriate description of the care and care plan for billing purposes Appropriate documentation on disease specificity, complexity and acuity

21 CDI Project Implementation procedure in process Designate Department/Division Champions Training, training and more training On-going feedback to improve process Testing of Dynamic Notes slated for Fall 2013

22 The tsunami of change is coming! ICD-10 implementation: October 2014 Costs of implementation large Cost of non-compliance lethal to organizations Predict that: Money collected will drop Time to complete notes in clinic will increase HUGE workflow change

23 Countries using ICD-10-CM United Kingdom (1995) Nordic countries (Denmark, Finland, Iceland, Norway, Sweden) ( ) France (1997) Australia (1998) Belgium (1999) Germany (2000) Canada (2001)

24 ICD-11-CM?? Due by 2015 Rumored to be a more sophisticated coding system Built upon a robust ontological framework, with linkages to underlying terminologies such as SNOMED CT

25 ICD-10-CM: Changes Ahead For the Clinical Work Process KMIT 7/17/2013 Shamsi Daneshvari, PhD This work is licensed under a Creative Commons Attribution-Noncommercial- Share Alike 3.0 United States License.