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ICD-10

ICD-10. What’s Ahead. What is it?. A renovation of coding, requiring field size expansion, change to alphanumeric digits, and complete redefinition of code values and structure. Mandatory as of October 1, 2013. Overview: Diagnosis Codes. 68,000 alphanumeric diagnosis codes

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ICD-10

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  1. ICD-10 What’s Ahead

  2. What is it? • A renovation of coding, requiring field size expansion, change to alphanumeric digits, and complete redefinition of code values and structure. • Mandatory as of October 1, 2013

  3. Overview: Diagnosis Codes • 68,000 alphanumeric diagnosis codes • Always start with a letter, 3-7 digits • Examples: • J14 H. Flu Pneumonia • L23.2 Allergic Contact Dermatitis, Cosmetics • K11.20 Sialoadenitis, unspecified • L03.115 Cellulitis, right lower limb • S01.01xA Laceration scalp, w/o FB, Initial encounter

  4. Procedure Codes (PCS) • 72,000 alphanumeric codes, starting with a number or a letter, 7 characters • Example: Lysis of adhesions of pleura 0BNN0ZZ • Section (med/surg -0) • Body System (respiratory -B) • Root Operation (release -N) • Body Part (pleura -N) • Approach (open -0) • Device (no device -Z) • Qualifier (no qualifier -Z)

  5. GEMS • General Equivalence Mappings: designed to enable DRG formation before new system in place, and to allow data comparisons from year to year. • Problem: 68,000 diagnosis codes in ICD-10 mapping to 14,000 ICD-9 codes • 72,000 ICD-10 PCS procedure codes mapping to 4,000 ICD-9 codes • Not a one to one translation; not able to easily verify we were paid correctly

  6. Training considerations • HIM • Data Quality/Risk Management • IS • Compliance • Ancillary Services • Physician Practice Staff • Finance – case mix index • Physicians - documentation

  7. Impacts • Payers – ability to accept and recognize data, contract renegotiation • Providers – training and education of all who code, and all who read and write reports • Information Systems – interfaces to other systems, report-writing, testing of modules, maintaining of dual systems, computerized edits • Finance – budget projections, case mix index, annual comparisons of data • Software vendors – data realignments, code structure changes

  8. Also Affects Quality Improvement – HACs, comparisons of quality data; core measures • Human Resources - employee benefits & data to determine costs of insurance, WC • Clearinghouses – massage data from billing system to insurance companies • Laboratories, pharmacies • Audits, medical necessity, RAC • Division of Healthcare Finance & Policy

  9. What stays the same • CPT coding on hospital outpatients, physician office billing • Need for better documentation • Need for trained coders

  10. Next Steps • ICD-10 Task Force to determine needs • Sub-committees to work on special tasks such as working with vendors to identify changes needed, assessing flow of coded data, assessing financial impact of changes. • Educate physicians on specificity of documentation needed – they are affected as well.

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