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On Your Marks, Get Set, Go: Prepare Physicians and Mid-Level Practitioners for ICD-10

On Your Marks, Get Set, Go: Prepare Physicians and Mid-Level Practitioners for ICD-10. Adelaide M. La Rosa, RN, BSN, CCDS Director of Clinical Documentation Improvement Program St. Francis Hospital-the Heart Center, Roslyn, NY. ICD.9.CM. 30 years old not allowing for new technology

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On Your Marks, Get Set, Go: Prepare Physicians and Mid-Level Practitioners for ICD-10

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  1. On Your Marks, Get Set, Go: Prepare Physicians and Mid-Level Practitioners for ICD-10 Adelaide M. La Rosa, RN, BSN, CCDS Director of Clinical Documentation Improvement Program St. Francis Hospital-the Heart Center, Roslyn, NY

  2. ICD.9.CM • 30 years old not allowing for new technology • Outdated / obsolete terms and classification of several conditions • Does not support today’s health Information needs • Can not meet the need for accurate and complete health care data in US • Lacks detail and laterality

  3. ICD.10.CM • US is the only industrialized country which has not implemented ICD.10.CM for morbidity reporting • Detailed and has laterality • New codes can be added • Permits exchange of health data between US and other countries – Record both mortality and morbidity data by many countries

  4. How To Get Started: • Stratify your population of patients being treated within your hospital • Top 25 ICD.9.CM Principal Diagnosis Codes • Top 25 ICD.9.CM Secondary Procedure Codes • Top 25 ICD.9.CM Principal Procedure Codes

  5. Diagnosis Codes

  6. How To Get Started: • Identify principal and secondary diagnoses and principal procedures which will require more specific documentation ICD.10 = Higher Level of Specificity

  7. Preparing for ICD.10: • Documentation • Education and Training • IT Systems • Billing / Financial • Processes

  8. Physician Engagement • Engagement Starts with Awareness • Annual Clinical Documentation Improvement Program Celebration Week. • 3rd Week of September which aligns with Fiscal Year (October 1st) Coding / DRG updates. • Theme: Bridging the Gap…, • Staying in Shape with Clinical Documentation, • CDIP Has You Covered with ICD-10

  9. Bridging the Gap… BRIDGING THE GAP … CLINICAL DOCUMENTATION IMPROVEMENT PROGRAM

  10. Staying in Shape with Clinical Documentation

  11. CDIP Has You Covered with ICD-10 C D I P Has you covered for ICD.10 Oct 1st , 2013 Sep 14th , 2010

  12. ICD – 10 Timeline ________________________________________ 1 / 10 2 / 10 6 / 09 12 / 09 Transition to ICD-10 Implementation Workgroup ________________________________________

  13. ICD – 10 Timeline ___________________________________ 6 / 10 7-8 / 10 9 / 10 10 / 10 11-12 / 10  AHIMA ICD-10-CM/PC Expert Trainers in Diagnosis and Procedure Coding Director CDIP Assistant Director CDIP Physician Advisor CDIP •  ICD-10 Exam •  Prepared Physician • Educational Session •  Identified High Volume • Principal & Secondary • diagnosis • Prepared budget to include ICD-10 cost for education & training • Educated CDS Staff regarding specific ICD-10 documentation opportunities •  Physician • Education • Session • Clinical Documentation Improvement Celebration Week • ICD-9 Coding/DRG Changes Effective •  Updated • ICD-10 • Coding Rules • & Regulations • Physician Practice Manager Educational Session • Schedule 2011Physician Specialty Meetings • DevelopedPhysician Practice Manager Newsletter • Administration Staff Presentation on ICD-10 Monthly: Medical Staff Newsletter (May 2008 CDIP given an official column) System ICD-10 Transition Task Force Meeting Hospital ICD-10 Steering Committee Meeting Clinical Documentation Improvement Steering Committee

  14. 2011 Clinical Documentation Specialist: • Assessing and Determining / Educational Needs Refresh or Expand knowledge in: • Anatomy and Physiology • Pharmacology • Pathophysiology • Medical Terminology • Official Coding Guideline • Documentation Opportunities • Internally and Externally providing Education and Training utilizing a monthly 2 hour meeting • Physician Specialty Education Session • Mid Level Provider Education Sessions • Budgeting for continued cost for Education and Training

  15. Cerebrovascular disease Documentation ICD.9.CM

  16. CVA Severity Of Illness Documentation ICD.9.CM

  17. Comparison of ICD.9.CM to ICD.10.CM Nontraumatic Intracerebral Hemorrhage ICD.9.CM ICD.10.CM

  18. Comparison of ICD.9.CM to ICD.10.CM ICD.10.CM ICD.9.CM

  19. Comparison of ICD.9.CM to ICD.10.CM ICD.9.CM ICD.10.CM

  20. Comparison of ICD.9.CM to ICD.10.CM ICD.9.CM ICD.10.CM

  21. ST Elevation (STEMI) Myocardial Infarction of Anterior Wall

  22. ST Elevation (STEMI) Myocardial Infarction of Inferior Wall

  23. ST Elevation (STEMI) Myocardial Infarction of other site

  24. ST Elevation (STEMI) Myocardial Infarction of Unspecified site

  25. Non-ST Elevation Myocardial Infarction

  26. ASHD of Native Coronary Artery ICD.9.CM ICD.10.CM

  27. ASHD of Coronary Artery Bypass Graft(s) ICD.9.CM ICD.10.CM

  28. ASHD of Autologous Artery Coronary Artery Bypass Graft(s) ICD.9.CM ICD.10.CM

  29. ASHD of Autologous Vein Coronary Artery Bypass Graft(s) ICD.9.CM ICD.10.CM

  30. Asthma • Mild intermittent • Mild persistent • Moderate persistent • Severe persistent

  31. Diabetic Mellitus • DM due to underlying condition • Drug or Chemical Induced DM • Type I DM • Type II DM • Other specified DM • Documentation that Impacts Severity of Illness • Manifestations • Complications

  32. Laterality (Right / Left) • Cancers • Cerebral Infarction • Pressure Ulcers • Extremity Atherosclerosis • Arthritis • Fractures • Sprains • Injury • Joint Pain • Joint Effusion • Tears, Meniscus, Cruciate Ligament • Dislocations

  33. Bone, Joint and Muscle • Site - upper, lower • Laterality – left, right

  34. Fractures Type (Gustilo open fracture classification) Specific anatomical site Displaced or not Laterality Type of encounter

  35. Traumatic Fractures • Initial Encounter • Subsequent Encounter

  36. Gout: Acute or Chronic Site Specific • Left • right • ankle • elbow • foot joint • hand joint • hip • knee • multiple site • shoulder • specific joint NEC • wrist Due to • Drug induced • Idiopathic • Due to renal impairment • Lead induced • Primary • secondary = Code to highest level of specificity

  37. Infection • Identify all infections • Document as antibiotics resistant

  38. Ulcers • Cause • Site • Laterality • Severity (Stage 1 – Stage 4)

  39. 2012 & 2013 Clinical Documentation Specialist: • Assessing Effectiveness of Education and Training • Chart Audit Review • Queries Review • Continue Education and Training

  40. Questions ?

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