ICD-10-CM Everything You Need to Know … For Now

1. ICD-10-CM Everything You Need to Know … For Now

2. Main Objective • Create an awareness of ICD-10-CM. • Start to consider the impact the conversion to ICD-10 will have on your operations. • Participants can help spread the “word” throughout the University.

3. What is ICD-10-CM and When is it Coming?

4. What is ICD and ICD-10? • ICD is the World Health Organization's International Classification of Diseases and Related Health Problems and is the international standard diagnostic classification system. • ICD-10 is the abbreviated term used to refer to the 10th revision of the ICD.

5. What is ICD-10-CM and ICD-10-PCS? • ICD-10-CM: • The U.S. clinical modification (CM) of the WHO’s ICD-10, maintained by the NCHS. • Includes diagnoses which will be used by all providers in every health care setting. • ICD-10-PCS: • The procedural coding system developed under contract by the CMS. • Includes procedure codes which will only by used for hospitals claims for inpatient hospital procedures.

6. Implementation Date – October 1, 2013 • On January 16, 2009, the Department of Health and Human Services published a Final Rule for the adoption of ICD-10-CM and ICD-10-PCS code sets. • All HIPAA covered entities must be ICD-10 compliant on October 1, 2013. • The compliance date is firm and not subject to change: • There will be no delay. • There will be no grace period for implementation. • There will be no impact on CPT and HCPCS codes.

7. ICD-9-CM vs. ICD-10-CM

8. Why is ICD-9 Being Replaced? • ICD-9-CM is out of date and running out of space for new codes. • Lacks specificity and detail • No longer reflects current medical practice • ICD-10 is the international standard to report and monitor diseases and mortality, making it important for the U.S. to adopt ICD-10 based classifications for reporting and surveillance. • ICD codes are the core elements of HIT systems, conversion to ICD-10 is necessary to fully realize benefits of HIT adoption.

9. Coding Process Remains the Same • ICD-10-CM code book retains the same traditional format • Index • Tabular • Process of coding is similar • Look up a condition in the Index • Confirm the code in the Tabular

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

11. Comparison of ICD-9-CM and ICD-10-CM ICD-9-CM Code Icd-10-CM code A - Category of code B - Etiology, anatomical site, and/or severity C - Extension 7th character for obstetrics, injuries, and external causes of injury • A - Category of code • B - Etiology, anatomical site, and manifestation A A B C B

12. Comparison of ICD-9-CM and ICD-10-CM Codes: 707.0 Pressure ulcer 707.00 - unspecified site 707.01 - elbow 707.02 - upper back 707.03 - lower back 707.04 - hip 707.05 - buttock 707.06 - ankle 707.07 - heel 707.09 - other site Code Examples: L89.131 – Pressure ulcer of right lower back, stage I L89.132 – Pressure ulcer of right lower back, stage II L89.133 – Pressure ulcer of right lower back, stage III L89.134 – Pressure ulcer of right lower back, stage IV L89.139 – Pressure ulcer of right lower back, unspecified stage L89.141 – Pressure ulcer of left lower back, stage I L89.142 – Pressure ulcer of left lower back, stage II L89.143 – Pressure ulcer of left lower back, stage III L89.144 – Pressure ulcer of left lower back, stage IV L89.149 – Pressure ulcer of left lower back, unspecified stage L89.151 – Pressure ulcer of sacral region, stage I L89.152 – Pressure ulcer of sacral region, stage II … L89.90 – Pressure ulcer of unspecified site, unspecified stage

13. New Features of ICD-10-CM Combination codes for conditions and common symptoms or manifestations Combination codes for poisonings and external causes Added laterality Expanded codes: injury, diabetes, alcohol/substance abuse, postoperative complications

14. New Features of ICD-10-CM Added extensions for episode of care Inclusion of trimester in obstetrics codes and elimination of fifth digits for episode of care Expanded detail relevant to ambulatory and managed care encounters Inclusion of clinical concepts that do not exist in ICD-9-CM Changes in timeframes specified in certain codes

15. Examples – ICD-10-CM Codes • I10, Essential (primary) hypertension • A69.21, Meningitis due to Lyme Disease • O9A.311, Physical abuse complicating pregnancy, first trimester • S52.131A, Displaced fracture of neck of right radius, initial encounter for closed fracture

16. Examples - Combination Codes • Combination codes for conditions and common associated symptoms and manifestations • I25.110, Arteriosclerotic heart disease of native coronary artery with unstable angina pectoris • K50.013, Crohn’s disease of small intestine with fistula • Combination codes for poisonings and their associated external cause • T42.3X2S, Poisoning by barbiturates, intentional self –harm, sequela

17. Examples – Combination Codes http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_038084.hcsp?dDocName=bok1_038084

18. Examples – Added Laterality • C50.212, Malignant neoplasm of upper-inner quadrant of left female breast • H16.013, Central corneal ulcer, bilateral • L89.213, Pressure ulcer of right hip, stage III • H61.20, Impacted cerumen, unspecified, ear • H61.21, Impacted cerumen, right ear • H61.22, Impacted cerumen, left ear • H61.23, Impacted cerumen, bilateral

19. Examples – Obstetrics and New Clinical Concepts • Obstetric codes identify trimester instead of episode of care • O26.02, Excessive weight gain in pregnancy, second trimester • Inclusion of clinical concepts that do not exist in ICD-9-CM • T45.526D, Underdosing of antithrombotic drugs, subsequent encounter • Z67.40, Type O blood, Rh positive

20. New Official Guidelines and Coding Clinic • The AHA Central Office serves as the clearinghouse for issues related to the use of ICD-9-CM. • With the transfer to ICD-10, a new office will be developed called AHA Central Office on ICD-10-CM • Creation of new official guidelines • Development of the AHA Coding Clinic for ICD-10 (similar to the Coding Clinic for ICD-9 but will require a major overhaul)

21. General Equivalence Mappings

22. What are GEMs? “GEMs” stands for General Equivalence Mappings The CMS and the CDC created GEMs to ensure consistent national data when the U.S. adopts ICD-10. The GEMs will act as a translation dictionary to bridge the “language gap” between the two code sets and can be used to map an ICD-9 code to an ICD-10 code and vice versa.

23. Purpose of GEMs • Designed to give all sectors of the healthcare industry that use coded data the tools to: • Convert large databases and test system applications • Link data in long-term clinical studies • Develop application-specific mappings • Analyze data collected before and after the transition to ICD-10-CM

24. Not a Substitute for Coding • The GEMs should not be used as a substitute for learning how to use the ICD-10-CM code sets. • “GEMs are not a substitute for learning ICD-10-PCS and ICD-10-CM coding. They’ll help you convert large data sets.” • Mapping simply links concepts in the two code sets, without consideration of context of specific patient information, whereas coding involves assigning the most appropriate code based on documentation and applicable coding guidelines.

25. Why a GEM Won’t Always Work • A clear one-to-one correspondence between an ICD-9 or ICD-10 code is the exception rather than the rule. • ICD-9 codes: 414.01 Coronary atherosclerosis of native coronary artery and 411.1 Intermediate coronary syndrome (unstable angina) • ICD-10 code :I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina • There are situations when a code in the target system does not exist • T503x6A Underdosing of electrolytic, caloric and water-balance agents, initial encounter

26. Forward and Backward Mapping Forward Mapping Backward Mapping

27. Preparing for ICD-10

28. ICD-10 Implementation Plan Checklist: http://www.ahima.org/icd10/ICD-10PreparationChecklist.mht Year 2009/ 2010 2011 2012 2013 Phase I Awareness and ImpactAssessment Phase II Preparing for Implementation Phase III Go Live Preparation Phase IV Post – Implementation

29. ICD-10-CM Preparation • Create awareness among faculty and staff. • Identify your current systems and work processes, whether electronic or manual, in which you use ICD-9. • Identify potential changes to existing practice workflow and business processes.

30. ICD-10-CM Preparation • Assess status of business associates and vendors ICD-10 readiness. • Budget for implementation costs. • Conduct a detailed assessment of education needs.

31. Assessment of Educational Needs • Identify who will require education: • Coding professionals • Providers • Billing personnel • Clinical personnel • Administrative staff and Management • Researchers • Determine what type and level of education they will need. • Assess the current level of coder education and experience. • Assess the level of knowledge necessary per person/role based on job responsibilities. • Determine the best method of education.

32. Coder Training and Education • Build awareness to understand the impact of the code set change and the differences between the code sets • Develop pre-requisite skills where needed, for example, in the biomedical sciences • Educate on the foundational concepts on the structure and organization of the code sets • Role-based application “just in time” • 3 – 9 months prior to implementation

33. Coder Training and Education • The DHHS recommends inpatient/hospital coders receive 50 hours of training and outpatient coders receive 10 hours of training. • AHA/AHIMA anticipates that a maximum of 16 hours of training may be sufficient for experienced coding professionals on ICD-10-CM only. • 6 hours learning the fundamentals (structure, coding conventions, guidelines and how ICD-10 is different) • 6 hours in more intensive training applying the conventions and guidelines • 4 hours practicing applying codes to typical encounters

34. Education Requirements - AHIMA • AHIMA Certified Professionals are required to participate in a predetermined number of mandatory baseline educational experiences specific to ICD-10-CM. • RHIT – 6 CEUs • RHIA – 6 CEUs • CCS-P – 12 CEUs • CCS – 18 CEUs • CCA – 18 CEUs

35. Proficiency Test - AAPC • AAPC members holding a credential will have two years to pass a proficiency test: • You will be given two (2) years to pass the exam, beginning October 1, 2012 (one year before implementation of ICD-10) and ending September 30, 2014 (one year after implementation) • The test will consist of 75 questions • The test will be open-book, online and un-proctored • Coders will be allowed two (2) attempts to pass for the $60 administration fee

36. Clinical Documentation • The increased specificity of the ICD-10 codes requires more detailed clinical documentation in order to code some diagnoses to the highest level of specificity. • There are “unspecified” codes in ICD-10-CM for those instances when medical record documentation is not available to support more specific codes. • The benefits of ICD-10 can not be realized if non-specific codes are used rather than taking advantage of the specificity ICD-10 offers.

37. Improving Documentation • Conduct medical record documentation assessments • Evaluate records to determine adequacy of documentation to support the required level of detail in new coding systems • Implement a documentation improvement program to address deficiencies identified during the review process • Educate providers about documentation requirements for the new coding system through specific examples • Emphasize the value of more concise data capture for optimal results and better data quality

38. Physician Training • DHHS agrees that some physicians will want intensive training on ICD-10 but some will seek “awareness training”. • Nolan study estimates 8 hours of intensive physician training • Nachimson Advisors, LLC study predicts 12 hours of physician training in both the code set and documentation procedures. • AHIMA believes most physicians would want no more than 4 hours of training.

39. Fee Tickets • AHIMA/AHA study found the process of converting fee tickets to ICD-10-CM is not difficult, time consuming, or expensive. Most can be converted to ICD-10 in just a few hours and they are no longer in length than existing fee tickets. • Making the “fee ticket” more manageable: • Electronic fee ticket • Hybrid coding • Context-specific fee tickets • Limit specificity/code options • List 7th character separate

40. Coder Proficiency • AHA/AHIMA field test demonstrated that people with previous ICD-9-CM experience can learn ICD-10-CM easily. • Proficiency in use of the system will be dependent on a number of factors, including level of coder education and experience. • It is anticipated that most coders will have a high level of proficiency within 6 months of use.

41. ICD-10 Web Resources • 2010 versions of ICD-10-CM, GEMs and the Official Guidelines are all available on-line. • CMS, AHA, AHIMA and NCHS/CDC all have ICD-10 resource centers. • AHIMA has a free monthly ICD-10 Newsletter • http://www.ahima.org/images/newsletters/ICDTen/subscribe.html

42. Conclusion • While it is too early to start learning how to code utilizing the ICD-10-CM code set, it is never to early to start planning/preparing for the transition.