ICD-10 Implementation

1. ICD-10 Implementation Facts, Fiction and the Future Erin Stamm, MBA, RHIA, NCP AHIMA Approved ICD-10 Trainer

2. ICD-10 Where Are We Now? • January 16, 2009 • HHS announced final rule for mandatory implementation date of October 1, 2013 • February 16, 2012 • HHS publishes an announcement with “intent to delay” deadline Prior to 2/16/12 Fact: All HIPAA-covered entities must implement the new code sets with dates of service that occur on or after Oct. 1, 2013.Fact: HHS has no plans to extend the compliance date for implementation of ICD-10. All covered entities should plan to complete the steps required in order to implement ICD-10 on Oct. 1, 2013.

3. ICD-10 Where Are We Now? • April 9, 2012 • HHS has proposed a 1 year delay PROPOSED IMPLEMENTATION DATE: OCTOBER 1, 2014 • Currently in 30 day Comment Period http://www.ofr.gov/OFRUpload/OFRData/2012-08718_PI.pdf

4. Why The Intent To Delay? • AMA, MGMA letter to CMS describing payment problems since 5010 Transaction set Go-Live. • Physicians are overwhelmed by • Meaningful use • Accountable Care Organizations • ICD-10

5. The Facts ICD-10 vs. ICD-9 • Why is ICD-9 Being Replaced? • Out of room for new codes • No longer reflects current medical practice (Jan. 1979) • Lack of detail • Difficult to monitor/compare diseases and mortality with the rest of the world I-10 since 1994 • United Kingdom, Norway, Belgium, Finland, Denmark, Sweeden, France, Canada, Australia and Germany • US – only industrialized country not using I-10

6. Countries Using ICD-10

8. Major Differences Between ICD-9-CM and ICD-10-CM

9. Why So Many Codes?

10. Structure

11. Today vs. Tomorrow

12. General Equivalency Mappings • ICD-9 to ICD-10 • ICD-10 to ICD-9 CDC http://www.cdc.gov/nchs/icd/icd10cm.htm CMS http://www.cms.hhs.gov/Medicare/Coding/ICD10/2012_ICD10CM_and_GEMs.html

13. One to One

14. One To Many • 24950 E08311 • 24950 E08319 • 24950 E0836 • 24950 E0839 • 24950 E09311 • 24950 E09319 • 24950 E0936 • 24950 E0939 • 24950 E1339 http://www.cms.hhs.gov/ICD10/

15. GEM Example http://www.aapc.com/ICD-10/codes/index.aspx

16. When To Use GEM’s • During Transition • Data trending • Contract Negotiations • Converting forms with ICD-9 Codes (superbills, order sheets, etc) • CMS has agreed to maintain GEM’s through implementation and up to 3 years after, if needed

17. ICD-10 Myths American Diabetes Association: Improved codes and combination codes American Psychiatric Association: Terminology/concepts harmonized with DSM-IV American Academy of Neurology: Neurology enhancements and current terminology American Academy of Orthopedic Surgeons: Musculoskeletal chapter enhancements American Academy of Pediatrics: Perinatal chapter enhancements American College of Obstetricians and Gynecologists: Addition of trimester codes in obstetrics chapter ICD-10-CM/PCS was developed without clinical input

18. ICD-10 Myths ICD-10-CM/PCS was developed years ago, so it’s probably already out of date • Updated annually • Includes advances in medicine and technology ICD-10 requires unnecessarily detailed medical record documentation • 09/2003 AHA and AHIMA field testing study: • Much of the detail needed in ICD-10-CM is already being documented but we don’t use it in ICD-9. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_020969.pdf

19. ICD-10 Myths Why Not Just Wait for ICD-11? • More complex, costly • ICD-11 is alpha-numeric • Foundations of ICD-11 rest on ICD-10 • Rework—many already preparing • No more room • ICD-9 Procedure codes • Extra time for U.S.A. modification • Modifying for United States Disease-Entity Coding System (USDECS) • Estimated additional 4 years--Oct. 1, 2020

20. What Do I Need To Do Now? • Champion/Steering Committee • Project Team • IT, HIM, CBO, MD’s, Decision Support, etc Develop Project Plan • http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_048737.pdf • http://www.himss.org/asp/topics_ICD10Playbook.asp

21. ICD-10 Implementation Plan

22. Documents to Begin Developing • ICD-10 Project Plan • IT ICD-10 Project Plan • Inventory of all internal systems that store ICD-9 data • Inventory of all external parties (payors, lab vendors, software, etc) • Inventory of inbound and outbound interfaces impacted by ICD-10 • Inventory of reports and/or reporting systems • Internal Testing Plan • Vendor Testing Plan • Payor Testing Plan • Training Program Plan • Communication Plan

24. How Much Will This Cost?

25. Cooperating Parties Cooperating Parties for ICD-9 and ICD-10 • American Hospital Association (AHA) • American Health Information Management Association (AHIMA) • The Centers for Medicare and Medicaid Services (CMS) • The National Center for Health Care Statistics (NCHS)

26. CMShttp://www.cms.gov/ICD10/ • ICD-10 Reference Guides • GEM Table and Instruction Guides • Industry Email Updates • Announcements of I-10 Education and National Provider Calls • Transcripts of CMS sponsored Teleconferences • Implementation Guides based on practice type (large providers, small providers, payers and vendors http://www.cms.hhs.gov/Medicare/Coding/ICD10/ICD-10andVersion5010ImplementationTimelines.html

27. AHIMAhttp://www.ahima.org/icd10/ • Numerous resources related to “Preparing for ICD-10” • ICD-10 Toolkit • Readiness Assessment and Prioritization Tool • Role Based Timelines • Budgeting resources • Vendor readiness checklist • Clinical documentation improvement toolkit • Education and Training Assessment Monthly ICD-10 Newsletter

28. Resources • Talk Ten Tuesdays www.icd10monitor.com 9am CST Every Tuesday • American Academy of Professional Coders www.aapc.com • HIMSS www.himss.org