ICD-10 International Classification of Diseases – CM “Time to Plan for Transition”

1. ICD-10International Classification of Diseases – CM “Time to Plan for Transition” March 28, 2014 11:00 am – 12:00 pm

2. PRESENTED BY Rhonda Anderson, RHIA, President rhonda@ahis.net 714-299-0573 (mobile) Anderson Health Info. Systems, Inc. 940 W. 17th Street, Suite B Santa Ana, CA 92706 Tel. 714-558-3887 Fax 714-558-1302 Office@ahis.net Complimentary of AHIS, Inc.

3. OBJECTIVES • Participants will identify: • Dates for New ICD-10 • Documentation support • Some general coding guidelines • YOUR Work plan Complimentary of AHIS, Inc.

4. ICD—10 “HAS TWO PARTS” • ICD-10 CM – Clinical Modification – Skilled Nursing will use “CM” • ICD-10 PCS – Procedural Code System (used for procedures, operations within the hospital inpatient setting) Complimentary of AHIS, Inc.

5. HIPAA • Assigning ICD-10 diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA) Complimentary of AHIS, Inc.

6. FINAL REGULATION • January 15, 2009 Final Regulation Released • EXCHANGE the ICD-9 for the ICD-10 by October 1 (originally 2013, changed to 2014) • ICD-10 for billing purposes as far as ability to accept the code known as “5010” was required by October, 2011 Complimentary of AHIS, Inc.

7. WHAT DOES ICD-10 COMPLIANCE MEANS? • ICD-10 compliance means that everyone covered by HIPAA is able to successfully conduct health care transactions using ICD-10 codes Complimentary of AHIS, Inc.

8. WHO IS AFFECTED?? • Freestanding providers • Ancillary services – “that means all of us really” who provide services and bill for them under Medicare, Medi-Cal and private insurances Complimentary of AHIS, Inc.

9. WHO IS AFFECTED?? -2 • Developed for the provider and the coder….(person who may review the documentation and determine if code is accurate) • Consistent, complete documentation in the medical record is a major emphasis Complimentary of AHIS, Inc.

10. WHO IS AFFECTED?? -3 • More specific in documentation to support the ICD-10 diagnostic code convention, general and specific coding guidelines Complimentary of AHIS, Inc.

11. REVIEW OF FEW DETAILS • No you will NOT code! • You will need • To provide your Board of Directors with some information about the importance • To know your resources • Identify your own champions • Obtain assurance from the computer system • To know that coding is correct Complimentary of AHIS, Inc.

12. WHY ICD-10 IS HAPPENING? • ICD-10 CM/PCS – Increased level of detail • Required for medicine advancements in technology • $$, improved data quality for clinical and financial decision making • To support value based purchasing and facilitate quality reporting Complimentary of AHIS, Inc.

13. WHY ICD-10 IS HAPPENING? -2 • ICD-9 codes have limited data about resident’s medical condition & hospital inpatient procedures • ICD-9 is 30 years old • Has outdate and obsolete terms • Inconsistent with current medical practices Complimentary of AHIS, Inc.

14. STATE MEDICAID PROG. NEED TO TRANSITION TO ICD-10 • Like everyone else covered by HIPAA, state Medicaid programs must comply with ICD-10 Complimentary of AHIS, Inc.

15. CODES CHANGE EVERY YEAR • ICD-10 codes will be updated every year Complimentary of AHIS, Inc.

16. ICD-10 DIFFERENCES • Organization – Two volumes • Structure – Alphanumeric categories rather than numeric categories.(has “includes and excludes notes: • Categories are three digits • Chapters – re-arranged • Titles have Changed – examples on following slides Complimentary of AHIS, Inc.

17. ICD-10 DIFFERENCES -2 Complimentary of AHIS, Inc.

18. ICD-10 DIFFERENCES -3 Complimentary of AHIS, Inc.

19. ICD-10 DIFFERENCES -4 Complimentary of AHIS, Inc.

20. ICD-9 DIFFERENCES • Lacks detail • Lacks laterality Difficult to analyze dated due to non-specific and do not adequately define diagnoses needed for medical research • Does not support interoperability because it is not used in other countries Complimentary of AHIS, Inc.

21. ICD-10 • Code composition – increased specificity • Level of detail • May consist of up to 7 digits with the seventh digit extensions representing visit encounter or sequelae as stated above • Includes full code titles and no reference back to common 4th and 5th digits) • V and E codes are no longer supplemental Complimentary of AHIS, Inc.

22. ICD-9-CM DIAGNOSIS CODES – FORMAT & STRUCTURE • 3-5 characters in length • Approximately 14,000 codes • First digit may be alpha (E or V) or numeric • Digits 2-5 are numeric • Always at least three digits, • Decimal placed after the first three characters • Limited space for new codes Complimentary of AHIS, Inc.

23. ICD-10-CM DIAGNOSIS CODES – FORMAT & STRUCTURE • 3-7 characters in length • Approximately 68,000 codes • Digit 1 is alpha, digit 2 and 3 are numeric; digit 4-7 are alpha or numeric • Decimal placed after the first 3 characters, • All letters used except “U” • Flexible for adding new codes • Very specific • Has laterality Complimentary of AHIS, Inc.

24. CODE FORMAT Complimentary of AHIS, Inc.

25. FIVE-SIX CHARACTER SUBDIVISION • Way too much detail…but it looks like this!! • J10.8 – Influenza due to other influenza virus with other manifestations • J10.81 – Influenza gastroenteritis • J10.89 – Influenza with other manifestations: • Influenzal encephalopathy • Influenzal myocarditis Complimentary of AHIS, Inc.

26. FIVE-SIX CHARACTER SUBDIVISION -2 • Way too much detail…but it looks like this!! • ANOTHER EXAMPLE – WITH SPECIFICITY AND LATERALITY: • S55.011 Laceration of ulnar artery at forearm level, right arm Complimentary of AHIS, Inc.

27. ICD-10 STRUCTURE • Index and Tabular list similar to ICD-9 • ICD-10 index larger, categories, subcategories and codes are contacted in the tabular list • Former V=codes are now Z =codes and in Chapter 21. Factors Influencing Health Status and Contact with Health Services (NEW)… Complimentary of AHIS, Inc.

28. ICD-10-CM DIAGNOSIS CODES • Specificity improves coding accuracy and depth of data for analysis • Detail improves the accuracy of data used in medical research • Supports interoperability and the exchange of health care data between other countries and the U.S. Complimentary of AHIS, Inc.

29. MAPPING TOOLS • Mapping from ICD-9 to 10 tools are available, General Equivalence Mappings (GEMS) – translation dictionary for diagnoses • Called “GEMS” – general equivalence mappings • CM – GEMS available • PCS – GEMS just available last of September (acute hospital mostly) Complimentary of AHIS, Inc.

30. GEM FILES • Do not despair…you vendor should prepare as much of a crosswalk as possible • NOTE: will require some conversion for long term resident’s diagnoses by the effective date of ICD-10 • Later TRAINING and how to use them…Key to early review!!! Complimentary of AHIS, Inc.

31. THE WORKPLAN TRANSITION TO ICD-10 Complimentary of AHIS, Inc.

32. IMPLEMENTATING ICD-10 • Notification to Board • Click here for HO #1 (ICD-10 for Governing Body) • Timeline • Click for HO #2 (ICD-10-CM Expanded Implementation Plan (Part 2)) Complimentary of AHIS, Inc.

33. IMPROVE DOCUMENTATION NOW • All of the information that is required to code according to ICD-10 is information that is necessary to an individual’s care and is already documented in the medical record Complimentary of AHIS, Inc.

34. ICD-10 CODES REQUIRE • Clear focus to better documentation • Absolutely critical to the success of ICD-10 • Good resident care: • Affect so many facets of health care downstream • Quality measures to analytics, research, payment and surveillance • Must be as accurate as possible Complimentary of AHIS, Inc.

35. ICD-10 CODES REQUIRE -2 • Good resident care (cont.) • Accurate coding require physician’s efforts to provide good documentation as well as nursing • No reason to delay implementation of good documentation practices • Information that is required to code according to ICD-10 is information necessary to resident and is already documented in the medical record Complimentary of AHIS, Inc.

36. ICD-10 CODES REQUIRE -3 • Good resident care (cont.) • What are you documenting today? • Ways more appropriately document? • Failure to fully properly document has medical, financial, and even regulatory ramifications Complimentary of AHIS, Inc.

37. DEVELOP THE RELATIONSHIP BETWEEN CLINICIANS • Clinicians (DON) do not need to understand all of the intricacies of coding, and coders do not need to understand all of medicine – but the 2 must work together to ensure optimal accuracy • Who codes need to understand basic anatomy and pathophysiology increase in questions from coders Complimentary of AHIS, Inc.

38. STRATEGIES FOR TRAINING • Leadership those individuals who are responsible for moving things through the organization: • Understand what the impact of ICD-10 will be • What challenges anticipated Complimentary of AHIS, Inc.

39. STRATEGIES FOR TRAINING -2 • Training Medical Record, MDS/PPS, DON, Medical Director: • Have training • Parallel coding taking the same cases and coding them accurate to ICD-9 and ICD-10 • Parallel training and testing • Start in early 2014 Complimentary of AHIS, Inc.

40. STRATEGIES FOR TRAINING -3 • Leadership should understand enough about the coding changes to understand the implications: • Documentation • Business practices • MDS / Medicare PPS • $$ impact for training, implementation and billing Complimentary of AHIS, Inc.

41. RESOURCES • HIM Consultant – Be sure ICD-10 Certified or Specialized Training • Centers for Medicare & Medicaid Services (CMS) • Includes official codes and guidelines Complimentary of AHIS, Inc.

42. ICD-10 CODE SETS • www.cms.gov/ICD10 Complimentary of AHIS, Inc.

43. WHY PREPARE NOW? • Major understanding for providers, payers and vendors • Will drive business and systems changes, hospital, SNF, Physicians, Outpatient, et’l, from large national health plans to small provider offices, laboratories, medical testing centers • Staff time – start looking who affects now and what they need to know • Financial resources • Also option for ICD-10 transition Complimentary of AHIS, Inc.

44. TYPES OF TRAINING – PROVIDERS / STAFF • Six months before the compliance deadline • Projected to take 16 hours for coders to 50 hours • ICD-10 resources and training materials available: • Through CMS • Professional associations, societies, software/system vendors, HIM Consultants Complimentary of AHIS, Inc.

45. ICD-10 PROJECT PLAN • Develop and complete an ICD-10 project plan: • Identify each task, deadline and who is responsible • Develop plan for communicating with staff and business parts about ICD-10 • Estimate and secure budget Complimentary of AHIS, Inc.

46. ICD-10 PROJECT PLAN -2 • Check with: • HIM Consultants, • Payers, • Software/systems vendors • Clearinghouses • Billing services • Labs • Physicians Complimentary of AHIS, Inc.

47. ICD-10 PROJECT PLAN -3 • Check out: • Systems changes • A timeline • Costs • Testing plans Complimentary of AHIS, Inc.

48. ICD-10 PROJECT PLAN -4 • Evaluate current documentation • Identify most commonly used diagnoses by checking out: • Reports – past coding Medicare coverage issues “ADR” • Documentation to support those diagnoses • Medical staff / Medical Director support • Clinical documentation improvements Complimentary of AHIS, Inc.

49. SPECIFIC INFO. NEEDED TO ACCURATELY CODE • Diabetes Mellitus • Type of diabetes • Body system affected • Complication or manifestation • If type 2 diabetes, long-term insulin use Complimentary of AHIS, Inc.

50. SPECIFIC INFO. NEEDED TO ACCURATELY CODE -2 • Fractures • Site • Laterality • Type • Location Complimentary of AHIS, Inc.