ICD-10 Transition: Challenges and Opportunities for the 21 st Century

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ICD-10 Transition: Challenges and Opportunities for the 21 st Century May 2015 The Montana Hospital Discharge Data System

International Classification of Diseases (ICD) Statistical classification of diseases and health problems

International Classification of Diseases (ICD) Codes Medical Billing (Clinical Modification) Morbidity Mortality

International Classification of Diseases (ICD) Ms. B has Type 1 diabetes without complications ICD-9: 250.1; DM without mention of complication, Type I, not stated as uncontrolled ICD-10: E10.9; Type 1 DM without complications

International Classification of Diseases (ICD) ICD-10-AM (Australia) ICD-10-CA (Canada) ICD-10-GM (Germany). ICD-10-CM (USA)

International Classification of Diseases (ICD) ICD-10-CM must conform to WHO conventions Changes at fifth, sixth, and seventh digits

Structure of ICD-10

Versions ICD-9: Ratified in 1975, still in use in United States for morbidity ICD-10: Ratified in the early 1990s, in use in mortality since 1999.

Versions ICD-10 1995 - England 1999 Australia / US mortality 2000 Canada

Versions ICD-9-CM to ICD-10-CM Oct 1, 2015 US transition date

ICD-10 Transition Date

ICD-10 Transition Date Medical Coders AHIMA, AMBA Hospitals AHA Insurers BCBS Association, Anthem

ICD-10 Transition Date The vast majority of hospitals expect to be ready to transition to ICD-10 by Oct 1, 2014. There should be no further delay in moving. AHA July 2013

ICD-10 Transition Date

ICD-10 Transition Date For more than a decade, the AMA kept ICD-10 at bay and we want to freeze it in carbonite! Robert M. Wah, President of the AMA, Nov 2014

ICD-10 Transition Date Oct 1, 2013: Jan 15, 2009 Oct 1, 2014: April 1, 2014 Oct 1, 2015:?

ICD-10 Transition Date Political History Affordable Care Act (2010) Protecting Access to Medicaid Act (2014)

ICD-10 Depth ICD 9: 15,000 codes ICD 10: 70,000 codes

Included among these codes will be 312 new codes for injuries from animals; 72 new codes for injuries just from birds; 9 new codes for injuries from the macaw. Rand Paul ICD-10 Depth

ICD-10 Depth

ICD-10 Depth Basic structure Digits 1-3 will now refer to the category Digits 4-6 will cover clinical details such as severity, etiology, and anatomic site (among others), and are either alphabetic or numeric Digit 7 will serve as an extension when necessary, and will be either alphabetic or numeric

ICD-10 Depth

ICD-10 Depth Ms. Jones is a 22-year-old university student that sustained a fall on left outstretched hand. She presented to clinic with obvious deformity and history, physical exam, and imaging consistent with left distal radius fracture (extra and intracular).

ICD-10 Depth Closed fracture of lower end of forearm, unspecified (813.40) Fall (E888.9)

ICD-10 Depth Fracture, radius, lower end, extraarticular, left, initial encounter for closed fracture. (S52.552A) intrarticular (S52.572A) Fall, unspecified, initial encounter (W19.XXXA)

ICD-10 Changes Codes for new diseases Ebola ICD-9-CM: 065.8 (Other specified arthropod-borne hemorrhagic fever) ICD-10-CM: A98.4 (Ebola virus disease)

ICD-10 Changes Laterality S40.211: Abrasion of right shoulder S40.212: Abrasion of left shoulder

ICD-10 Changes Phase of treatment S40.211A: Abrasion of right shoulder (Initial encounter) S40.211D: Abrasion of right shoulder (Subsequent encounter)

ICD-10 Changes Combination codes Mild nonproliferative diabetic retinopathy due to uncontrolled Type II diabetes

ICD-10 Changes Combination codes ICD-9-CM: 250.50 (Diabetes with opthamalic manifestations, Type II, not stated as uncontrolled); 362.03 (Mild nonproliferative diabetic retinopathy) ICD-10-CM: E11.329 (Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema)

ICD-10 Changes External Cause Place of Occurrence ICD-9: 10 Codes ICD-10: Hundreds of codes

ICD-10 Changes Ms. Jones is a 22-year-old university student that sustained a fall on left outstretched hand while assisting a patient in the bathroom of the nursing home where she works.

ICD-10 Changes ICD-9-CM: E849.7 (Residential institution) ICD-10-CM: Y92.12 (Bathroom in nursing home)

Mortality ICD-10 Impact

ICD-10 Impact Minimal initial impact on hospital payments 98.93% of Diagnosis Related Groups (MS-DRGs) the same -.04% change in payments Additional detail simplifies billing

ICD-10 Impact Difference Mortality vs Morbidity Primary diagnosis MS-DRG 88 Concussion w MCC 89 Concussion w CC 90 Concussion w/o CC/MCC Underlying cause

ICD-10 Impact Medical record Documentation