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ICD-10

Missouri State Medical Association April 5, 2014 Dr. Mary Bourland. ICD-10. The Need to Classify Disease and Cause of Death. William Farr. 2. 3. What is ICD-10. International Classification of Diseases

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ICD-10

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  1. Missouri State Medical Association April 5, 2014 Dr. Mary Bourland ICD-10

  2. The Need to Classify Disease and Cause of Death William Farr

  3. 2

  4. 3

  5. What is ICD-10 • International Classification of Diseases • Developed by the World Health Organization, may be modified by country to fit their specific needs • It’s how we classify and record symptoms, diseases, diagnoses and procedures. • The U.S. has been using ICD-9 for 30 years 4

  6. ICD 10 vs. ICD modifications Some 25 countries use ICD-10 for reimbursement and resource allocation in their health system. A few of them made modifications to ICD to better accommodate this use of ICD-10. The unchanged international version of ICD-10 is used in about 110 countries for cause of death reporting and statistics. 5

  7. What Happened Next • Many countries began using ICD 10 in 1994for morbidity data • WHO allowed countries to modify with approval • Australia (ICD 10-AM) • Thailand (ICD 10-TM) • Canada (ICD 10-CA) • US (ICD 10-CM) 6

  8. Worldwide ICD-10 Adoption 7

  9. Three Lessons Learned from Canada • Planning and preparation are keys to success • Education is a must • Network and reach out to others to learn form their experiences 8

  10. Australian Learnings • The Australians love ICD-10. • Medical coders were back to old output rates (That's Australian for productivity) in three months. • Education is key. They started training everyone 18 months from the deadline. • Anticipating problem areas is also important. • It's expensive. Australian vendors are capitalists too. • Australian providers still are adjusting their billing becauseof what they're learning from their ICD-10 data. 9

  11. Moving from ICD-9 to ICD-10 • Government mandate • Far more expansive and precise • Will provide more specific identification of diagnoses and procedures 10

  12. Benefits • Quality • Patient/Community health • Research • Healthcare reform • Enhanced reimbursement 11

  13. Abuse Patterns High Priority • Tobacco abuse • I-10 classifies use of tobacco as:  • nicotine dependence (F17) • use not otherwise specified (Z72.0) • personal history of tobacco dependence (Z87.891) • Nicotine dependence • Type of tobacco • cigarettes • chewing tobacco • other (e.g., pipe, cigars) • Presence of complications, if any:  • uncomplicated • in remission • with withdrawal • with other or unspecified nicotine induced disorders • No I-10 index entry for “abuse, tobacco” or “abuse, nicotine.”  Main term “use” and subterm “tobacco” must be referenced to obtain Z72.0, tobacco use 12

  14. ICD-10-CM • CM = Clinical Modification • Classify diseases and injuries • Each country has its own 2 letters after ICD • Based on World Health Organization • Most commonly 4 characters but can be as many as 7 13

  15. ICD-10-CM Codeshave 3 to 7 digits • Most commonly 4 character • First 3 digits = category • Then etiology, anatomic site, severity • Can be up to 7 digits long 7 G S 2 3 2 1 14

  16. ICD-9 to ICD-10 Crosswalk Common Diagnosis 15

  17. ICD-9 to ICD-10 Crosswalk Common Diagnosis 16

  18. Native Coding   Reference from http://www.roadto10.org/?page_id=71 17

  19. Behavioral Health • Mental and Behavioral Disorders • Anxiety can be further specified as generalized, mixed, other (anxiety depression, anxiety hysteria, or panic disorder without agoraphobia • Dementia requires specificity regarding type: degenerative, primary, old age, persisting, senile, vascular, etc., and also cause (if applicable) 18

  20. ICD-10-PCS • PCS = Procedural Coding System • Only used in USA, not from WHO • Solely for inpatient procedures • Outpatient procedures continue using CPT • Completely new system - once coders learn it, should be easier • All codes have 7 digits – each position has a purpose 19

  21. ICD-10-PCS all codes have 7 digits • Section • Body system • Root operation • Body part • Approach • Device (if one left in) • Qualifier which shows additional attributes. 20

  22. Current Query Process to Physicians 21

  23. Impact of a Single Word: Surgical Scenario Admitting Dx: Perforated Diverticulitis Surgical Procedure: Colon resection Query: Add diagnosis of Peritonitis (agreed and documented by Physician) resulted in MCC Financial Impact: + $13,781 DRG 330: MJR SML & LG BOWEL PROC W CC RW = 2.5609 REIMBURSE = $13752 SOI = 2-MODERATE ROM = 2-MODERATE DRG 329: MJR SML & LG BOWEL PROC W MCC RW = 5.1277 REIMBURSE = $27533 SOI = 2-MODERATE ROM = 3-MAJOR QUERY RESULTING IN ADDING ONE WORD INITIAL DOCUMENTATION FINAL DOCUMENTATION 22

  24. http://www.medicare.gov/ Physician’s Reputation will now be publically reported. 23

  25. Physician/RAC New Activity The MAC, Recovery Auditor, and ZPIC have the discretion to deny other related claims submitted before or after the claim in question. If documentation associated with one claim can be used to validate another claim, those claims may be considered “related.” Claims may be “related” in the following EXAMPLE situations: An inpatient claim and associated documentation is reviewed and determined to be not reasonable and necessary and therefore the physician claim can be determined to be not reasonable and necessary. A diagnostic test claim and associated documentationis reviewed and determined to be not reasonable and necessary and therefore the professional componentcan be determined to be not reasonable and necessary. 24

  26. ICD-10 Education Resources • http://www.cdc.gov/nchs/data/icd9/icd10cm_guidelines_2014.pdf • http://icd10monitor.com/ Below are links to other helpful tools available on the CMS ICD-10 Website: The ICD-10 Transition: An Introduction ICD-10 FAQs ICD-10 Basics for Medical Practices  ICD-10 Basics for Small and Rural Practices Talking to Your Vendors About ICD-10: Tips for Medical Practices ICD-10 Resources List National ICD-10 Provider Education Teleconferences 25

  27. Additional Resources • ACP American College of Physicians- ICD-10 Documentation and Training for Physicians • 3 hour online course • Non Members -$395.00 • Members - $295.00 • AAPC (American Academy of Professional Coders)-ICD-10 Documentation Training for Physicians • 3 Hour on-line course • $295.00 • AHIMA (American Health Information Management Association)-Clinical Documentation forICD-10 by • Specialty: Principles & Practice. • 3 to 5 minute on-line modules • HCPRO’s – ICD-10 Documentation for Physicians 26

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