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ICD-10-CM - An Introduction
- 1. June Monthly In-service June 1, 2011 9:00 a.m. & 2:00 p.m. Venita Jones, RHIT, Presenter DeVry Community Hospital and Health Services
- 2. Presentation Highlights Introduction to the ICD-10 (10th Revision) HIPAA Rules and Designations in Coding Reasons for Replacing the ICD-9-CM The Benefits of Converting to the ICD-10-CM Comparison between the ICD-9-CM and the ICD-10- CM Structure and Format of the ICD-10-CM
- 3. Presentation Highlights cont. Users of the ICD Implementation Considerations Conclusion Q & A/ Resources Website references
- 4. Introduction to the ICD-10 Statistically Thinking History of the ICD World Health Organization (WHO) Classification systems Mortality Morbidity Creation of the ICD-10 Reason for change Emerging technology
- 5. HIPAA Rules and Designations ICD-9-CM incompatibility with HIPAA Cooperating Parties American Hospital Association (AHA) American Health Information Management Association (AHIMA) Centers for Medicare and Medicaid Services (CMS) National Center for Health Statistics (NCHS) Adoption and Implementation of the ICD-10-CM Implementation Date: October 1, 2013 !!!!
- 6. Reason for Replacing ICD-9-CM Outdated in the 21st century Mortality recording Why upgrade Tracking and Responding Maintenance of clinical data Lack specificity Running out of capacity Obsolete Current knowledge Disease processes Contemporary medical terminology Modern practice of medicine Hampers ability to compare costs and outcomes Incompatibility Health data exchange
- 7. The Benefits of Converting to ICD-10-CM ā¢Quality measurement and medical error reduction (patient safety ā¢Outcomes measurement ā¢Clinical research ā¢Clinical, financial, and administrative performance measurement ā¢Health policy planning ā¢Operational and strategic planning and health care delivery systems design ā¢Payment systems design and claims processing ā¢Reporting on use and effects of new medical terminology ā¢Provider profiling ā¢Refinements to current reimbursement systems, such as severity-adjusted DRG systems ā¢Pay-for-performance programs ā¢Public health and bioterrorism monitoring ā¢Managing care and disease processes ā¢Educating consumers on consumer costs and outcomes treatment options (Bowman 2008b)
- 8. Benefits continued ā¢Increased use of automated tools to facilitate the coding process ā¢Decreased claims submission or claims adjudication costs ā¢Fewer rejected and improper reimbursement claims ā¢Greater interoperability ā¢Decreased need for manual review of health records to meet the information of payers, researchers, and other data mining purposes ā¢Decreased need for large research organizations to maintain dual classification systems (one for reimbursement and one for research ā¢Reduced number of coding errors ā¢Reduced labor costs and increased productivity ā¢Increased ability to prevent and detect healthcare fraud and abuse (Bowman 2006b) ā¢RAND Corporation Study ā¢More accurate payment for new procedures ā¢Fewer rejected claims ā¢Fewer fraudulent claims ā¢Better understanding of new procedures ā¢Improved disease management (RAND Corporation 2004)
- 9. Types of Code Changes ļ±Grouping of codes ļ±More complete descriptions ļ±Fifth and sixth characters ļ±Laterality ļ±Increased specificity ļ±Use of seventh character ļ±Combination codes ļ±Terminology used ļ±Postprocedural conditions ļ±Trimester specificity ļ±New codes
- 10. Comparing ICD-9-CM & ICD-10-CM ICD-10-CM differs from ICD-9-CM in its organization and structure, code composition, and level of detail. ICD-9-CM ICD-10-CM ļ· Consists of three to five characters ļ· First digit is numeric or alpha (E or V) ļ· Second, third, fourth, and fifth digits are numeric ļ· Always at least three digits ļ· Decimal placed after the first three characters ļ· Consists of three to seven characters ļ· First digit is alpha ļ· All letters are used except for U ļ· Second and third digits are numeric ļ· Fourth, fifth, sixth, and seventh digit can be alpha or numeric ļ· Decimal placed after the first three characters Code Structure of the ICD-10-CM versus ICD-9-CM ICD-10-CM codes may consist of up to seven digits, with the seventh digit extensions representing visit encounter or sequelae for injuries and external causes. ICD-9-CM Format ICD-10-CM Format X X X . X X ļ First three digits represents the category ļ Fourth and fifth digit represents etiology, anatomic site, manifestation X X X . X X X X ļ First three digits represents the category ļ Fourth, fifth, and sixth digit represents etiology, anatomic site, severity ļ Seventh digit represents the extension
- 11. Structure of the ICD-10-CM Similar to the ICD-9-CM Volume 3 of the ICD-9-CM will be replaced to ICD-10- PCS (Procedural Coding System) Three Volumes Volume 1 ā The Tabular List Volume 2 ā The Instructional Manual Volume 3 ā The Alphabetical Index
- 12. ICD-10-CM cont. In the ICD-10 the information about diseases and conditions and their causes are grouped as followed: Communicable diseases General diseases that affect the whole body Local diseases arranged by site Developmental diseases Injuries External causes
- 13. Volume 1-The Tabular List Alphanumeric listing All alphabetic letters are used except for U V and E codes are incorporated Three-digit character codes Disease groups and health-related problems Contains inclusions and exclusion notes and some coding rules There are 22 chapters in the Tabular list and over 11400 four-character codes
- 14. ICD-10 Volume 2-The Instructional Manual Contains an introduction to the classification and instructions regarding how to use the classification to code death certificates, hospital medical records and other forms of health information. Specifically contains: Guidelines for certifications and rules for mortality coding (i.e. causes of death) Guidelines for recording and coding for morbidity data (i.e. hospital statistics)
- 15. Volume 3-The Alphabetic Index Alphabetic listing of diseases and conditions More entries in the index than in Tabular list Also contains: Guidance on selecting the appropriate codes for many conditions not displayed in the Tabular List A Table of Neoplasms An Index of External Causes of Diseases A Table of Drugs and Chemicals
- 16. Golden Coding Rule Number 1 Volumes 1 and 3 must be used together to correctly find codes for each case such as cause of death or diagnosis. Rules to follow: First, check the Index (Volume 3) for a code representing your diseases Then, confirm your choice in the Tabular List (Volume 1) Volumes 1 and 3 are Inseparable!
- 17. ICD-10 Volume 1 Chapters 22 Chapters (19 Chapters in ICD-9) Most associated with particular body systems Special disease chapters Chapter XX ā External Causes of Morbidity and Mortality Chapter XXI ā Factors Influencing Health Status Chapter XVII ā Coding Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not elsewhere classified
- 18. Golden Coding Rule Number 2 The special diseases categories take priority over the body systems categories. Example: Neoplasm of the lung
- 19. Volume 1 Chapters Format CHAPTER II_________________________________ Neoplasms (C00-D48) Malignant neoplasms of lip, oral cavity and pharynx (C00āC14) C00 Malignant neoplasm of lip Excludes: skin of lip (C43.0, C44.0) C00.0 External upper lip Upper lip: ā¢NOS ā¢Lipstick area ā¢Vermillion border Chapter ļ Block ļ Category ļ Code ļ
- 20. Users of the ICD Certifiers Coders Users of coded data
- 21. Last but not least Implementation considerations Conclusion/Questions and Answers Sources Basic ICD-9-CM Coding, Lou Ann Schraffenberger, MBA, RHIA, CCS, CCS-P, FAHIMA. (2010) pp. 355-385 ICD-10 Interactive Self Learning Tool (highly recommended. http://apps.who.int/classifications/apps/icd/icd10traini ng/ AHIMA website ā www.ahima.org
Editor's Notes
- Welcome to the June 2011 monthly In-service. My name is Venita Jones and I am glad to see you here today for our exciting inservice on the ICD-10. As many of you know, the ICD-10 will go into effect October 1, 2013. Today we will focus on the introduction the ICD-10-CM. This and future in-services on this subject will help us transition to the new ICD-10 coding sets.
- Our presentation highlights will be as follows: (Speaker will read the bulleted items)
- (Speaker will continue to read the bulleted items)
- The Census Bureau depends on people to make a count of the population. The ICD helps make a count of diseases, injuries, symptoms, reasons for the encounter, factors that influence health status, and external causes of disease and death, such as accidents. Such information is used for epidemiology, prevention, prevention, managing health care, allocation of resources, outcomes monitoring, in research, clinical context and primary care. Information is reported, categorized, analyzed, presented, and decisions are based on this information at any level of a health system, ICD makes people count. ICD stands for the International Classification of Diseases, is a classification system that is used in 194 countries. It has been developed internationally since 1893. It also serves a way to capture mortality and morbidity for reporting purposes. There have been ten major revisions with the most being ICD-10. The World Health Organization (WHO) maintained the ICD for over fifty years. The current edition of the ICD, the ICD-9-CM has been in existence for over thirty years. Ā Currently the ICD-9-CM is outdated because it does currently support the 21st health information systems. With the emergence of technology, new diseases, new treatment methodologies and many advancement s in healthcare, the ICD-9-CM is obsolete in current trends.
- The ICD-9-CM is incompatible with HIPPAās transaction sets codes. This means that the ICD-9-CM is not compatible with electronic transaction mediums such as reimbursement and electronic languages. Ā Cooperating parties are responsible for maintaining the ICD-9-CM. Those parties are the American Hospital Association (AHA), American Health Information Management Association (AHIMA), the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). These four organizations have a role in maintenance of the ICD-9-CM. The AHA sponsors the Central Office on ICD-CM and publishes the Coding Clinic, the source of official coding guidelines for ICD-9-CM. AHIMA is provides coding education, and certifies professional coders, the CMS maintains the procedure classification. The NCHS maintains the disease classification. Ā The ICD-10 has been in use since 1989 for mortality recording. Remember the implementation date is October 1, 2013, which is less than two years from now.
- The ICD-9-CM was developed in the 1970s, its coding systems no longer fits with the 21st century healthcare system. Initially, the ICD-9-CM was used just for classification and coding purposes. But today it no longer fits into the current health information needs. (AHIMAa). Ā The United States is virtually the only industrialized nation that has not upgraded its morbidity classification system. In 1999, the United States implemented ICD-10 for mortality or death certificate coding; however, morbidity reported with the necessary clinical modification of ICD-10 has been delayed. Ā Upgrading to ICD-10-CM/PCS will improve the United Statesā ability to track and respond to international public health threats, increase the values of the U.S. investment in SNOMEDĀ®, and better achieve the benefits of an electronic health record (EHR) (AHIMA 2009a). Ā Additionally, replacing the ICD-9-CM withICD-10-CM will better maintain clinical data comparability with the rest of the world concerning the conditions prompting healthcare services. ICD-10-CM will make it easier to share disease and mortality at a time when such global data sharing is critical for public health such as documenting the West Nile virus and SARS complexes for earlier detection and better tracking. Also provide the ability to track bioterrorism events and other public health outbreaks. Ā The ICD-9-CM lacks sufficient specificity and detail to fully describe the patientās condition. Ā It is running out of capacity, and the limited structural design cannot accommodate advances in medicine and medical technology and the growing need for quality data. Ā It is obsolete and no longer reflects current knowledge of diseases processes, contemporary medical terminology, or the modern practice of medicine. Ā It hampers the ability to compare costs and outcomes of different medical terminologies Ā It cannot support the U.S. transition to an interoperable health data exchange in the United States (AHIMA 2009a).
- (Speaker will read the bulleted items)
- Moving to the new code sets will also permit improved efficiencies and lower administrative costs due to the replacement of a dysfunctional classification system. This in turn allows: (Speaker will read the bulleted items to audience) (When speaker get to the RAND Corporation Study, the speaker will say the following before reading the bulleted items) In a 2004 cost/benefit analysis for HHS, the RAND Corporation quantified some of the benefits of improved data derived from the ICD-10-CM and ICD-10-PCS. RAND concluded that the benefits far outweigh the costs of implementation, estimating the dollar value and the benefits in the following categories: (Speaker will then read the remaining bulleted items)
- Grouping of codes: Conditions have been grouped in a more logical fashion than in ICD-9-CM. In many cases, this improvement was accomplished by moving conditions from one chapter to another or one section to another. Numerous codes have been added to, deleted from, combined, or moved in ICD-10-CM. ICD-10-CM includes four more chapters than the ICD-9-CM, although conditions were classified to other chapters in ICD-9-CM. Ā More complete descriptions: In ICD-10-CM, the subcategory titles are usually complete so that the coding professional does not have to read previous codes to understand the meaning of the code. Ā Fifth and sixth characters: Fifth and sixth characters are incorporated into the code listing rather than having common fifth characters listed at the beginning of a chapter, section, or category. Ā Laterality: ICD-10-CM incorporates laterality of conditions or injuries at the fifth- or sixth-character level. Ā Increased specificity: ICD-10-CM offers greatly expanded detail for the various conditions. Many categories that were limited to three or four digits in ICD-9-CM have fifth, sixth, and even seventh characters, or extensions, in the ICD-10-CM. In some cases, single ICD-9-CM codes were split up into several ICD-10-CM codes to provide greater specificity. Ā Use of seventh character: Seventh characters are used in ICD-10-CM to provide additional information. They are most found in the injury codes but also found in other chapters. Ā Combination codes: Numerous codes in ICD-10-CM group etiology and manifestation. In ICD-9-CM, generally two codes are required to code etiology and manifestation. Ā Terminology used: Many of the category code/subcategory code titles have been changed to reflect new technology and more recent medical terminology. Ā Postprocedural conditions: Many codes have been added to ICD-10-CM to describe postoperative and Postprocedural conditions. Ā Trimester specificity: ICD-10-CM codes in the pregnancy, delivery, and puerperium chapter include those designating the trimester in which the condition occurs. Ā New codes: ICD-10-CM provides codes for many conditions that were not included in ICD-9-CM, most notably, codes for blood type and alcohol level. Ā Ā
- (Speaker will read the contents of this slide and show the comparisons)
- The structure of the ICD-10-CM is similar to the ICD-9 by having three volumes. The difference is that Volume 3 of the ICD-9-CM will be replaced to ICD-10-PCS. The PCS stand for the procedural coding system which will presented at a later inservice date. The ICD-10 have three volumes. Volume 1 is the tabular list, volume 2 is the instructional manual, and volume 3 is the alphabetical index.
- (Speaker will read this slide)
- The hierarchal structure is the same as the ICD-9 but the ICD-10 codes are alphanumeric and all the letters are used except for U, which is reserved for new diseases of certain etiology. V and E codes are incorporated into the main classification of ICD-10-CM Some three-digit codes are left vacant to allow for code revisions and future additions The tabular list is grouped into disease groups and health-related problems It may also contain inclusions and exclusion notes and some coding rules
- (Speaker will read the contents on the slide)
- Volume 3, the Alphabetic Index, is an alphabetical list of the diseases and conditions which have codes in the Tabular List. There are more entries in the Index than there are in the Tabular List because some diseases have more than one name and some diseases are grouped under one code. (Speaker will read the contents in the Also contains)
- (Speaker will read the Golden Coding Rule Number 1 and after reading Volumes 1 and 3 are inseparable the speaker will read) Volumes 1 and 2 have to be used together for each case such as cause of death or diagnosis.
- Volume 1 has 22 chapters as compared to the ICD-9 having 19 chapters. Most chapters in ICD-10 are associated with particular body systems. For example, Chapter 11 relates to diseases of digestive system. There are also some specific disease chapters. These are to capture types of diseases which might affect the whole body or many different sites or are considered systemic-- Example Chapter 2-Neoplasms and Chapter 15-Pregnancy, Childbirth and the Puerperium. Chapter 20 is for coding external causes of morbidity and mortality. External factors are the reason why a person was injured, how it happened, reason for contact with the health services not relating to ill-health, and other factors affecting health Chapter 21 is for coding factors influencing health status and contact with health services. Chapter 17 is used to code symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified. The chapters you will use most contains codes for either diseases of a specific body system or special diseases.
- Gold Coding Rule Number 2, The special diseases category take priority over the body systems categories. For example, Neoplasm of the lung, we would choose Neoplasm instead of diseases of lung and respiratory system.
- The ICD is divided into chapters, based on diseases of body systems, special diseases or external factors. Look at the sample presented here, we are looking at Chapter 2 which represents Neoplasms. The code range for neoplasms are C00 to D48). You see here that neoplasms have two alphabetical sequencesāc and d. Now look at the block section. The block groups together categories having some common factor. On the slide here, we have category codes C00 to C14 which represents the Malignant neoplasms of lip, oral cavity and pharynx. Blocks are divided in categories represented by three-character codes. See that we have the category code C00 representing Malignant neoplasm of the lip with an exclusion note. These three-digit codes may be subdivided into codes with specific fourth characters, certain codes. It may also have optional supplementary characters to add more detail. Look at the code section, we have code C00.0 representing the External upper lip with inclusions upper lip, NOS, lipstick area and vermillion border. Remember that some diseases may have just the category code as the highest specificity.
- The users of ICD are certifiers, coders, and users of coded data. A certifier of causes of death is a person authorized by law who issues a certificate, on the prescribed form, stating to the best of his/her knowledge and belief, the cause of death and other facts related to the death for submission to prescribed authorities. Depending on the local circumstances, this may be the doctor who attended the deceased in his/her illness, or the coroner for deaths of persons who were not attended during the last illness or for unnatural death due to violence or accident, or some designated official. A coder is a trained individual who translates the documented causes of or deaths or morbidity into standardized ICD codes using the rules of conventions inherent in the classification. Users of coded data do not need to code but they may analyze the codes such as statisticians and epidemiologists or they may need to make decisions based on information gained from coded data such as resource allocators, politicians, or case-mix experts. http://apps.who.int/classifications/apps/icd/icd10training/ICD-10%20training/Start/index.html
- There are many facilities are slowly accepting implementation of the ICD-10. Other things to put in consideration is the cost of training, upgrading systems and other things of that nature. In conclusion, we have looked at an introduction to the ICD-10-CM, its history, why we need to change to the new system. We were able to do comparisons between the ICD-9 and ICD-10, we looked at a sample code, the three volumes that comprised of the ICD-10-CM and learning two of the golden rules of coding. We also identified the users of the ICD and the implementation of the ICD-10. We must get ready for the bigger and better changes that lies ahead in health information. Thank you for your participation!