Update to ICD 10 CM Diagnostic Code Set

1. Update to ICD 10 CM Diagnostic Code Set

2. Agenda • Why ICD 10 CM? • Highlights of ICD 10 CM & ICD 10 PCS • Is it a big change? • Timeline • Make your Plans • We want your Feed back.

3. What are the Diagnostic Code Sets? ICD 9 CM • For Mortality & Morbidity coding • 13,000 codes ICD 10 • For Mortality coding • 14,000 to 16,000 codes ICD 10 AM • For Morbidity & Mortality coding • 15,000 codes ICD 10 CM • For Morbidity & Mortality coding • 68,000 codes

4. Because Abu Dhabi continues to use version ICD-9, it has difficulty comparing its health service utilization to other countries.

5. ICD-9-CM Limitations • Space limitations • Codes have already been assigned to inappropriate sections • Leads to challenges for coders • Workarounds • Use of ‘overflow’ chapters compromise the structure of ICD-9-CM • Emerging technology • Not expandable nor detailed enough to capture future healthcare information

6. Why ICD-10-CM?? • Significant improvement in coding primary care encounters, external causes of injury, mental disorders, neoplasms, and preventative health • Recognition of advances in medicine and technology • More detail • Addition of laterality (where the procedure or disease is located) • Expanded distinctions for ambulatory and managed care encounters

7. Highlights • ICD-10-CM/PCS: • Incorporates much greater specificity and clinical information, which results in: • Improved ability to measure health care services; • Increased sensitivity when refining grouping and reimbursement methodologies; • Enhanced ability to conduct public health surveillance; and • Decreased need to include supporting documentation with claims; • Includes updated medical terminology and classification of diseases; • In the US as of 2014 • ICD-10-CM (Diagnosis) • Will affect inpatient and outpatient • ICD-10-PCS ( Procedures) • Will only affect inpatient in the U.S. • NOTUAE -We have CPT for outpatient reimbursement

8. Highlights • ICD-10-CM/PCS: • Provides codes to allow comparison of mortality and morbidity data; and • Provides better data for: • Measuring care furnished to patients; • Designing payment systems; • Processing claims; • Providers making clinical decisions; • Tracking public health; • Identifying fraud and abuse; and • Conducting research. • In the US as of 2014 • All software will be ICD 10 based • All certified coders will be ICD 10 based • All RVU’s will be ICD 10 based • ICD 9 CM will no longer be updated after 2012

9. Why Upgrade to ICD 10 CM? • A revised classification system that: • permits international exchange of data for disease prevention & advanced healthcare research; • increases value of current clinical terminologies and permits greater use of health information technology to improve our health knowledge and decision support while lowering the cost of healthcare. • gives more specificity to Payers to reduce denials due to lack of information

10. Upgrade to ICD 10 CM

11. Is it a big change?Comparison ICD-10-CM Mechanical complication of other vascular grafts 156 codes, including T82.310 – Breakdown (mechanical) of aortic (bifurcation) graft (replacement) T82.311 – Breakdown (mechanical) of carotid arterial graft (bypass) T82.312 – Breakdown (mechanical) of femoral arterial graft (bypass) T82.318 – Breakdown (mechanical) of other vascular grafts T82.319 – Breakdown (mechanical) of unspecified vascular grafts T82.320 – Displacement of aortic (bifurcation) graft (replacement) T82.321 – Displacement of carotid arterial graft (bypass) T82.322 – Displacement of femoral arterial graft (bypass) T82.328 – Displacement of other vascular grafts • ICD-9-CM • Mechanical complication of other vascular device, • implant and graft • 1 code (996.1)

12. Comparisons ICD-10-CM 68,069 ICD-9-CM 14,025 Diagnosis Codes ICD-9 Code Format ICD-10 Code Format X X X X X X X X X X X X extension category etiology,anatomic site,manifestation category etiology,anatomic site,severity

13. Comparisons

14. Extensions • A = initial encounter • D = subsequent encounter • S = sequela (late effect)

15. Patient Case Scenario 1: Subarachnoid Hemorrhage • Patient is discharged with principal diagnosis of nontraumatic subarachnoid hemorrhage, commonly known as a stroke. In ICD-9-CM there is one code: 430 Subarachnoid hemorrhage • In ICD-10-CM - twenty possible codes requiring detail of which artery the hemorrhage came from for accurate code assignment. • right and left carotid siphon and bifurcation; • right and left middle cerebral; • right and left anterior communicating; • right and left posterior communicating; • basilar; right and left vertebral; • and other or unspecified intracranial arteries.

16. Patient Case Scenario 2: Fracture of the Patella • A patient is treated for fracture of the patella to assign an accurate code, sixth and seventh characters are needed in ICD-10-CM. ICD-9-CM 822.0 - Fracture of patella, closed ICD-10-CM S82.021D - Fracture of patella, displaced longitudinal, right patella - subsequent encounter for closed fracture with routine healing

17. Tentative Timeline

18. Make Your Plan to ICD 10 CM • Phase 1: Implementation plan development and potential impact assessments • Establish interdisciplinary steering committee to develop ICD‐10 implementation strategy • Development of potential impact assessments • Phase 2: Implementation preparation • Training/awareness on Codes and Code uses (data etc) • Education on the available GEM and how to use • Phase 3: “Go live” preparation • Contracts

19. Make Your Plan to ICD 10 CM • Impact assessment. The purpose of this assessment is to anticipate who or what will be affected by the transition to ICD-10-CM while determining the degree of impact. • An implementation budget must be created to address the costs associated with upgrading technology and training as well as the potential loss of productivity, which can delay remittance. • A systems inventory is necessary to identify systems requiring modifications • All processes and systems that pertain to ICD codes need to be analyzed and modified to accommodate the expanded alpha-numeric code structure of ICD-10.

20. Make Your Plan to ICD 10 CM • Training: More intense training regarding the specifics of the code set will be required for those who use coded data for the purpose of reimbursement, statistics, and/or research. • Ahimaestimates the training time for experienced codes to be 16 hours with 10 hours practice) • And we mustn’t forget the Documentation Training required for doctors.

21. Make Your Plan to ICD 10 CM • ICD-9-CM to data coded under ICD-10-CM due to the differences in the code sets. This will impact reports that compile statistical data for trend analysis. • Download GEM from CMS website • http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-CM-and-GEMs.html • We want your feedback: • HealthSystemFinance@haad.ae • http://www.shafafiya.org/dictionary/portal/ • ccsc@haad.ae • GEMs and the multiple uses of these GEMs – • Maps are created for many purposes, (exchange of data for patient care purposes, access to longitudinal data, reimbursement, public health data reporting, and KEH. • Correct mapping requires a complete understanding of how data will be used. • Even though standardized mappings will facilitate the process of translating between the old and new code sets, there will still be challenges connecting data coded under