ICD-10-CM What is it? Why? Now What? Debbie Johnson, RHIT, CHP American Health Care Association Webinar September 12, 2013 Objectives Learn what ICD-10-CM is what the main differences in ICD-9 and ICD-10 are Why the change is necessary What steps are needed to prepare for ICD-10 implementation What resources are available 1
What is it? In order to understand 10, let s look at 9.. ICD-9-CM: International Classification of Diseases, 9 th Revision, Clinical Modification Was developed 30 years ago Developed by the Word Health Organization (WHO) Classifies morbidity and mortality information for statistical purposes Required for billing for Medicare, Medicaid and other services 2000 HIPAA Transaction & Code Set rule requires for electronic transactions What is it? ICD-10-CM: International Classification of Diseases, 10 th Revision, Clinical Modification Is the international standard Federally mandated to begin October 1, 2014 Will be used by all providers in every health care setting Single implementation date for all users Services provided on or after 10/1/14 Some claims may require split claims 2
Know the difference What is it? ICD-10-CM (diagnoses) All health care settings ICD-10-PCS(procedures) Inpatient hospitals only Important Tip: In the Post-Acute setting: training is not needed for ICD-10 PCS Why the Change? ICD-9-CM is running out of codes Code system is 30 years old ICD-10 better captures advances in medicine and technology Statistical improvement Billing improvement ICD-10 is more specific Allowing better data capture for quality, safety and efficacy of care 3
Differences - Structural ICD-9 3-5 characters Alpha-numeric Characters 2-5 are numeric Always least 3 characters 14,000 codes ICD-10 3-7 characters 1 st character is alpha (all letters except U are used) Alpha characters are not case sensitive Uses dummy placeholders X 68,000 codes Differences New Characteristics Laterality More combination codes Combining conditions and symptoms More specificity Codes to indicate episode of care No more aftercare codes for fractures No more therapy codes 4
ICD-9 V58.49 Examples Aftercare following a healing traumatic fracture of hip ICD-10 S72.141D Displaced intertrochanteric fracture of the right femur, subsequent encounter for closed fracture with routine healing ICD-9 Examples 438.21 Hemiplegia following CVA affecting dominant side ICD-10 I69.051 Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting right dominant side OR I69.052 Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting left dominant side 5
Now What? Impact Analysis Training Plans Implementation Plans Budget Considerations Impact Analysis Identify all areas of diagnosis code use Software What are vendor plans and delivery timeframes? Is the upgrade included in your contract? What costs will be involved? Will the vendor be able to provide dual coding systems at once? Will your software be able to maintain historical data? Do you have multiple software programs to consider? 6
Impact Analysis Billing What are your payers plans for conversion? Are there business associates involved with billing that need to transition? Are there separate applications used for billing and financial reporting? Forms and Reports Identify all forms/documents that need to be revised Identify all reports that need to be revise manual and electronic Impact Analysis Documentation Audit current documentation to assess documentation quality, i.e. laterality, episodes of care, stages of healing, etc. Findings may be used later to identify training needs Other Systems to Consider Case Mix Quality Management Abstracting 7
Training Plans Assess varying levels of training needs Awareness Training General knowledge of the code system and the differences in the systems Operations Senior management Department management Key medical staff Training Plans Assess varying levels of training needs Data User Training Knowledge of the basic structural differences in the systems, implementation plans, data use, areas of impact Business Office Physicians MDS Staff (If not primary coders) 8
Training Plans Assess varying levels of training needs Coders Intensive ICD-10-CM training needed Coding Guidelines and Principles Specialty-specific coding Transitional changes Evaluate knowledge level of coders Anatomy and physiology Medical terminology Should be done 4-6 months prior to implementation Training Plans Assess types of training methods One-to-one training Classroom training Online courses Audio or web-based programs Self-directed learning Pre-training awareness 9
Training Plans Training Sources Professional Associations Commercial Vendors Independent Consultants Colleges and Universities Self-Study Courses REMEMBER: PCS Training is notneeded for Post Acute Care Implementation Plans Develop a time line for your implementation plan Include impact analysis tasks Training Budgeting Awareness Planning Testing Training Go Live Communication 10
Implementation Plan Sample 4 th Quarter 2013 Present ICD-10 Facility Requirements to Leadership Create Steering Committee and begin quarterly meetings (e.g., Quality, Compliance, Risk Management, Billing, IT, Rehab, etc.) Poll Facility - Who codes? Steering Committee completes Impact Assessment Analysis, including forms analysis Consider options for Coder knowledge base -Anatomy & Physiology, terminology, etc. Overview/Awareness to all-staff (what to expect, budgetary impact, training, knowledge base, etc.) Begin exploring options for how ICD-10 training will be accomplished, i.e., consultant, seminars, etc. Implementation Plan Sample 1 st Quarter 2014 Financial Awareness Training for relevant staff Review readiness with vendor software; verify when they plan to have their ICD-10 available in the clinical and financial software (e.g.,state Medicaid agencies, MAC, Managed Care organizations, etc. Facilities order ICD-10 Manualsso they are available for training Determine whether physicians will need any training related to long term care and if they are getting any training at their hospitals, etc. Begin weekly ICD-10 Fact Sheets via e-mail to appropriate staff 11
Implementation Plan Sample 2 nd Quarter 2014 Coder training for relevant staff If available, case mix analysis to determine how, if at all, the new codes change the case mix outcome Determine how long the facility has to support dual systems in the software Steering Committee begins monthly meetings Documentation Review and assess sampling of documentation. Determine if the documentation is supportive of new level of specificity Determine strategy for documentation improvement as necessary Implementation Plan Sample 3 rd Quarter 2014 Assess facility and payer readiness early in quarter Distribute weekly proficiency e-mails for coders Refresher awareness training for the financial staff; they won t need to know how to code but need to be apprised of the status of the implementation Refresher Training for Coders, including Rehab staff 12
Implementation Plan Sample 4 th Quarter 2014 Go live 10/1/2014 Weekly meetings or calls with relevant staff for questions and support Steering Committee monitors claims/denials On-going training for new coders and rehab staff Budget Considerations Try to identify allareas that the transition will affect Identify howvarious department budgets will be impacted Consider budgets for training, software, new forms Lost productivity, increased coding time 13
Budget Considerations Consider how receivables may be affected by transition Remember 5010 Staffing Consultant Fees Resources www.ahima.org/icd10 CMS Implementation Widget and Timelines https://www.cms.gov/icd10/03_icd- 10andVersion5010ImplementationTimelines.asp# TopOfPage CMS ICD-10 E-Mail Updates https://www.cms.gov/icd10/02d_cms_icd- 10_Industry_Email_Updates.asp#TopOfPage 14
Resources HIMSS ICD-10 Playbook http://www.himss.org/library/icd-10/playbook Wedi.org ICD-10-CM books available from all current ICD-9 CM vendors Free online at website: National Center for Health Statistics Questions??? 15