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ICD-10 is Coming Ready or Not

ICD-10 is Coming Ready or Not. Dr. Thomas Ayoub Norwalk Hospital. Punishment …of doctors …by the government …for purposes of lowering reimbursements This is not part of “Obama-care”. ICD-10 is NOT. Derives from the World Health Organization.

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ICD-10 is Coming Ready or Not

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  1. ICD-10 is ComingReady or Not Dr. Thomas Ayoub Norwalk Hospital

  2. Punishment …of doctors …by the government …for purposes of lowering reimbursements This is not part of “Obama-care”. ICD-10 is NOT

  3. Derives from the World Health Organization. CMS is acting on behalf of the US government Links to quality of care Primary purpose is epidemiologic tracking of illness and injury; worldwide outcomes data is important Long overdue ICD-9 has been in use since 1979 and medicine has changed ICD-10

  4. UK 1995 Nordic Countries 1994-7 France 1997 Australia 1998 Belgium 1999 Germany 2000 Canada 2001 United States Oct 1st, 2013 ICD-10 adoption by other Countries Another delay will not occur 2014

  5. U.S. will be the only country to use ICD-10 for reimbursement. ICD-10

  6. For a typical practice the total cost depends on the size: Small $83,290 Medium $285,195 Large $2.7 million The Cost

  7. Much worse than Y2K; effects include: Clinical documentation/EHR systems Encounter forms/Superbills Practice management systems Contracts Public health and quality reporting protocols IT Issues

  8. Other Office Issues Staffing: ½ of billers are expected to retire or change jobs Productivity: may drop as much as 50% Dual systems: required from several months prior to several months after…maybe longer Delayed Payments: the industry is expecting significant delays Cash Flow: CMS & Insurers will not accept bills after Oct 1, 2014 in ICD-9 format

  9. What Lies Ahead • An opportunity to bring physicians together • I'll be more than happy to assist you in finding the help you need to tackle this project.

  10. Resources • You can use our new website www.norwalkhospital/icd-10 with links to resources (try our QR logo on your invitation) • You can contact Susan Herson, MD at susan.herson@norwalkhealth.org

  11. How Can Physicians Prepare Susan Herson, MD Hospitalist Documentation Improvement

  12. You’ve heard there will be a vast expansion in the number of codes but… 60% of the new code volume pertains to musculoskeletal system New coding system is logical ICD-10

  13. Coding Classifications The new coding is logical because it relates to treatment decisions.

  14. Most Common ICD-9 CMS recommends that offices start by listing their most commonly used ICD-9 codes and becoming familiar with corresponding ICD-10 codes The best resource is www.CMS.gov/icd10“Understanding the Basics”

  15. Majority Rules Start with highest volume codes The vast majority of practices use very few codes… 5% of codes account for 70% of the volume

  16. Example: GI Most Common Codes Top 5 ICD-9 codes cover 64% of the Encounters

  17. Top GI Diagnosis in ICD-9

  18. Translate ICD-9 to ICD-10 Use free internet sites like http://www.icd10data.com or download free apps

  19. Start typing the ICD-9 text here A broad search occurs; all yellow highlights are possible matches.

  20. Or choose “Convert” to use the code instead of the text

  21. As you start typing the code here, a list of options appear below

  22. Top GI Diagnosis now in ICD-10

  23. What we learned from the conversion process • 3 out of 5 codes were direct conversions / perfect matches • 2 out of 5 codes required more documentation • GERD requires with or without esophagitis • The default will likely be “without” • Diarrhea requires etiology • - due to infectious or non-infectious process • - due to diet • - due to allergy We learned not only which diagnoses require more documentation but exactly what type of documentation is required.

  24. Unspecified Codes still exist. However… Not all ICD 9 unspecified codes exist in ICD 10 e.g. CAD, unspecified the provider must choose native & graft vessel Unspecified codes cause shifts in reimbursement Unspecified codes may not capture relevant data reporting and improved patient care.

  25. General Documentation Improvement Tips • Document Initial or Follow-up encounter for every visit • Use adjectives like acute, chronic, or acute on chronic, and mild, moderate, or severe, early onset, diffuse • Link cause and effect with words like "due to" • Specify anatomic site particularly left, right, bilateral • Use exact dates of injury or disease onset ICD-10 is like learning a new language it is not intuitive but it is logical

  26. Resources • Specialty Societies for guidance & billing forms • Internet tools and apps • www.CMS.gov/icd10 • http://www.icd10data.com • Norwalk Hospital: • 3M videos in 18 subspecialties • 1-hour training sessions in April with HC-Pro • Quarterly ICD-10 meetings

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