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ICD-10 for physicians: its about good patient care and clinical documentation
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ICD-10 for physicians: its about good patient care and clinical documentation

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They key thing for physicians to know about ICD-10 is that if they are using good clinical documentation practices, the coders will do the hard work. Much of the burden of ICD-10 comes to those......

They key thing for physicians to know about ICD-10 is that if they are using good clinical documentation practices, the coders will do the hard work. Much of the burden of ICD-10 comes to those physicians who currently do not document the details of the patient condition. Those that do will feel less pain from the ICD-10 transition.

The number and type of new concepts required for ICD-10 are not foreign to clinicians. The focus of the documentation should really be about good patient care. Patients deserve to have accurate and complete documentation of their conditions.

If other industries understand the value of accurate and complete documentation of data about encounters, shouldn't healthcare?

ICD-10 reimbursement will introduce changes based on what was done and why. Certainly any physician interested providing good care cannot argue with this?

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  • 1. ICD-­‐10  For  Clinical  Staff   Clinicians     Health  Data  Consul�ng  
  • 2. ICD-­‐10   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   A  Cornerstone  of  Healthcare  Informa�on   Pa�ent   Provider   Condi�on   ICD-­‐10-­‐CM   Service   ICD-­‐10-­‐PCS   Source:    Health  Data  Consul�ng   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 3. ICD10  Quick  Facts   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com     ICD-­‐10  interna�onal  version   –  Adopted  by  WHO  in  1990   –  Most  countries  other  than  the  US  currently  use  ICD-­‐10   –  ICD-­‐10  (Interna�onal  version)  ~  12,500  diagnos�c   codes   –  ICD-­‐10  used  for  mortality  repor�ng  in  the  US  -­‐  1999     ICD-­‐10-­‐CM  (US  version)     –  ~  69,000  diagnos�c  codes   –  Final  rule  published  –  2009   –  Compliance  date  –  Oct  1,  2014     ICD-­‐10-­‐PCS   –  ~72,000  codes   –  Not  part  of  an  interna�onal  standard   –  Inpa�ent  procedures  only   –  Compliance  date  –  Oct  1,  2014   Source:    Health  Data  Consul�ng   For  a  complete  copy  of  this  presenta�on  contact   us:   ICD-­‐10@noworldborders.com  
  • 4. Nature  of  the  Changes   Volume   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   0   10,000   20,000   30,000   40,000   50,000   60,000   70,000   80,000   ICD-­‐9-­‐CM   ICD-­‐10-­‐CM   ICD-­‐10  (WHO)   ICD-­‐9-­‐CM   ICD-­‐10-­‐PCS   ICD-­‐10  (WHO)   Diagnosis   Procedure   Diagnosis   Procedure   Source:    Health  Data  Consul�ng   Source:    Health  Data  Consul�ng   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 5. Same  Condi�on  –  Different  Codes   September  2014   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   What’s  the  Difference?   October  2014   ICD-­‐9       ICD-­‐10       82111:   Open  fracture  of  Sha�  of  Femur       S72351C:   Displaced  comminuted  fracture  of  sha�   of  right  femur,  ini�al  encounter  for   open  fracture  type  IIIA,  IIIB,  or  IIIC   All  codes  for  femur  fractures  =  16       All  codes  for  femur  fractures  =  1530       Source:    Health  Data  Consul�ng   For  a  complete  copy  of  this  presenta�on  contact   us:   ICD-­‐10@noworldborders.com  
  • 6. ICD9  Comparison  to  ICD10-­‐CM   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Diagnosis  Codes  –  Clinical  Example   A  pa�ent  is  admi�ed  as  the  result  of  [rupture  of  the  cardiac  wall  without  bleeding   into  the  pericardium].    The  pa�ent  is  [within  4  weeks]  of  a  [myocardial  infarc�on].   ICD9 Code Description 42979 Certain  sequelae  of  myocardial  infarc�on,  not  elsewhere  classified,   other ICD10 Code Description I233 Rupture  of  cardiac  wall  without  hemopericardium  as  current   complica�on  following  acute  myocardial  infarc�on Source:    Health  Data  Consul�ng   For  a  complete  copy  of  this  presenta�on  contact   us:   ICD-­‐10@noworldborders.com  
  • 7. ICD9  Comparison  to  ICD10-­‐CM   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Diagnosis  Codes  –  Clinical  Example   A  pa�ent  is  admi�ed  as  the  result  of  [rupture  of  the  cardiac  wall  without  bleeding   into  the  pericardium].    The  pa�ent  is  [within  4  weeks]  of  a  [myocardial  infarc�on].   ICD9 Code Description 42979   Certain  sequelae  of  myocardial  infarc�on,  not  elsewhere  classified,   other ICD10 Code Description I233 Rupture  of  cardiac  wall  without  hemopericardium  as  current   complica�on  following  acute  myocardial  infarc�on Source:    Health  Data  Consul�ng   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 8. Current  Distribu�on  of  ICD-­‐9  diagnosis  codes   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   All  claims  data  sample  containing  565  million  codes  (1  year  of  data)     0.0%   10.0%   20.0%   30.0%   40.0%   50.0%   60.0%   70.0%   80.0%   5%   10%   15%   20%   25%   30%   35%   40%   45%   50%   55%   60%   65%   70%   75%   80%   85%   90%   95%   100%   Total  Charges  by  Diagnosis  Code  (ICD-­‐9)   3years  -­‐  $10  Bill   Charge  %   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 9. ICD-­‐10  PCS  Factoids     ICD-­‐10  PCS  is  a  system  of  coding  for  ins�tu�onal  procedures.     These  procedure  codes  do  not  apply  to  coding  for  services  or   procedures  delivered  in  a  non-­‐ins�tu�onal  environment     ICD-­‐9CM  chapter  3  is  the  equivalent  of  ICD-­‐10PCS     The  WHO  (World  Health  Organiza�on)  is  not  involved  in  the   standardiza�on  of  ins�tu�onal  procedure  codes       CMS  is  responsible  for  maintenance  of  ICD-­‐10PCS  codes     Contract  with  3-­‐M  to  develop  the  codes  in  1993;  first  dra�  in   1993.     1998  ini�al  release  of  ICD-­‐10  PCS  with  annual  updates  every   year   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 10. ICD9  Comparison  to  ICD10   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Ins�tu�onal  Procedure  Codes  –  Clinical  Example   While  hospitalized,  a  pa�ent  has  a  procedure  done  through  an  [endoscope]   inserted  [through  the  skin]  to  [bypass]  the  blood  flow  from  the  [abdominal  aorta]   to  the  [right]  [renal  artery]  using  a  [synthe�c  material]   ICD9 Code Description 3924 Aorta-­‐renal  Bypass ICD10 Code Description 04104J3 Bypass  Abdominal  Aorta  to  Right  Renal  Artery  with  Synthe�c   Subs�tute,  Percutaneous  Endoscopic  Approach Source:    Health  Data  Consul�ng   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 11. ICD9  Comparison  to  ICD10   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Ins�tu�onal  Procedure  Codes  –  Clinical  Example   While  hospitalized,  a  pa�ent  has  a  procedure  done  through  an  [endoscope]   inserted  [through  the  skin]  to  [bypass]  the  blood  flow  from  the  [abdominal  aorta]   to  the  [right]  [renal  artery]  using  a  [synthe�c  material]   ICD9 Code Description 3924 Aorta-­‐renal  Bypass ICD10 Code Description 04104J3 Bypass  Abdominal  Aorta  to  Right  Renal  Artery  with  Synthe�c   Subs�tute,  Percutaneous  Endoscopic  Approach [Note]  For  all  codes  related  to  Aorta-­‐renal  Bypass:   • ICD-­‐9  codes  =  2   • ICD-­‐10  codes  =  30   Source:    Health  Data  Consul�ng   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 12. Defini�on  and  Terminology  Changes   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   ICD-9 Procedure Term ICD-10 Procedure Term Amputation Detachment Amniocentesis Drainage Arthroscopy, Cystoscopy… Inspection… Endoscopic Approach Closed Reduction Reposition Debridement Excision, Extraction, Irrigation, Extirpation Radical Mastectomy Resection (right, left or bilateral) Subtotal Mastectomy Excision Tracheostomy, Bypass Cesarean section Extraction of Products of Conception Incision No ICD-10 term Source:    Health  Data  Consul�ng   Source:    Health  Data  Consul�ng   For  a  complete  copy  of  this  presenta�on  contact   us:   ICD-­‐10@noworldborders.com  
  • 13. “There  are  too  many  Codes”     There  are  lots  of  words  in  the  dic�onary,  but  that  doesn’t   seem  to  trouble  authors…     34,250  (50%)  of  all  ICD-­‐10CM  codes  are  related  to  the   musculoskeletal  system     17,045  (25%)  of  all  ICD-­‐10CM  codes  are  related  to  fractures     10,582  (62%)  of  fracture  codes  to  dis�nguish  ‘right’  vs.  ‘le�’     There  are  over  1800  codes  for  fractures  of  the  radius   (forearm)  but  only  ~  50  concepts  used  repeatedly  in  different   pa�erns     Only  a  very  small  percentage  of  the  codes  will  be  used  most   providers   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 14. “ICD-­‐10  is  much  too  complicated”     Physicians  have  as  much  educa�on  as  rocket   scien�sts…  this  isn’t  rocket  science.     ICD-­‐10  is  actually  more  consistent  and  pa�erns  are   reasonably  understandable     There  are  great  evolving  tools  that  will  help  clinicians   iden�fy  the  right  codes  (assuming  they  accurately   document  the  facts)   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 15. “We  should  wait  for  ICD-­‐11”     ICD-­‐9  (WHO)  Published  in  1978     ICD-­‐10  (WHO)  –  Endorsed  in  1990     ICD-­‐10-­‐CM  dra�  released  in  1995     Proposed  rule  for  ICD-­‐10  adop�on  in  2008     ICD-­‐10  used  for  Mortality  in  the  US  since  1999     ICD-­‐11(WHO)  not  slated  for  release  un�l  2015     Based  on  historical  implementa�ons  by  the  �me  we  get   to  ICD-­‐11-­‐CM  and  from  there  to  implementa�on,  it  will   be  2039.     The  gap  between  ICD-­‐9  and  ICD-­‐10  is    not  nearly  as   drama�c  as  the  gap  between  ICD-­‐9  and  ICD-­‐11   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 16. “Documenta�on  for  ICD-­‐10  is  an  unnecessary  burden.”     The  number  and  type  of  new  concepts  required  for   ICD-­‐10  are  not  foreign  to  clinicians     The  focus  of  documenta�on  is  good  pa�ent  care     Pa�ents  deserve  to  have  accurate  and  complete   documenta�on  of  their  condi�ons     If  other  industries  understand  the  value  of  accurate   and  complete  documenta�on  of  data  about   encounters;  shouldn’t  we?   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 17. “We  should  just  go  to  SNOMED.”     If  you  like  lot’s  of  codes,  you’ll  love  SNOMED  (over   300,000  codes)     Most  stakeholders  in  the  industry  have  no  familiarity   with  SNOMED     Most  physicians  cannot  describe  the  nature  of   SNOMED     Coding  in  SNOMED  is  more  complex  than  ICD-­‐10     SNOMED  is  not  an  adopted  interna�onal  standard   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 18. “ICD-­‐10  won’t  help  me  take  care  of  my  pa�ents.”     Difficult  to  make  the  case  about  how  ICD-­‐10  will  help   Dr.  Smith  with  his  encounter  with  Mary  Jones     Healthcare  crosses  the  boundary  of  �me  and   providers     Improving  healthcare  requires  a  broad   understanding  of  what  works  and  what  doesn't  work     Clinicians  should  be  leaders  in  the  healthcare   industry  by  providing  accurate  data,  accurate   analysis  of  the  data  and  change  in  healthcare  to   con�nuously  improve  the  value  their  pa�ents  receive   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 19. “ICD  diagnosis  codes  are  irrelevant  to  my  business.”     ICD-­‐9  codes  factor  into:   ü  Payer  processing  rules   ü  The  determina�on  of  appropriateness   ü  Measures  of  quality  (pay  for  performance)   ü  Compliance  (meaningful  use)   ü  Contrac�ng  decisions   ü  Risk  adjustments   ü  Fraud  waste  and  abuse   ü  Audits   ü  Authoriza�ons   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 20. “ICD  diagnosis  codes  are  irrelevant  to  my  business.”   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com     ICD-­‐10  codes  are  likely  to  factor  into:   ü  Changes  in  reimbursement  based  on  both  “what”  was   done  and  “why”   ü  Managing  financial  risks  for  contracted  popula�ons   ü  Changes  in  reimbursement  based  on  more  robust   models  of  payment  adjusted  for  risk  and  severity   ü  More  sophis�cated  weigh�ng  of  payments  based  on   DRGs,  episodes  or  other  groupers  of  care.   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 21. “It’s  unreasonable  for  administra�ve  bureaucrats  to   interfere  with  how  I  take  care  of  pa�ents.”     The  success  or  failure  of  healthcare    goes  well  beyond  Dr.   Smith  and  his  visit  with  Mary  Jones.     Purchasers  of  healthcare,  including  government  and   private  en��es  have  a  responsibility  to  assure  that  the   popula�on  they  are  responsible  for  gets  the  best  value   for  services  delivered.     Providers  are  receiving  payment  for  services,  it  is   reasonable  to  believe  that  they  should  be  just  as   accountable  for  what  they  do  as  other  organiza�ons  that   provide  services  and  goods.     Healthcare  has  clearly  moved  into  a  marketed  industry   and  “professionalism”  alone  cannot  assure  quality  and   limit  abuse.   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 22. “There  are  a  bunch  of  dumb  codes  that  make  no  sense.”     Clinician  organiza�ons  have  used  codes  like;  “Hit  by  a   spacecra�”  or  “Suicide  by  paintball  gun”  as  examples   of  the  “stupidity”  of  the  ICD-­‐10  codes.     Interes�ng  to  note  however  is  that  the  codes  noted   above  are  ICD-­‐9  codes  and  have  been  around  for  a   long  �me.     The  bo�om  line;  don’t  use  the  codes  that  don’t  make   sense  or  don’t  accurately  represent  your  pa�ent’s   condi�on.    They  may  mean  something  to  someone,   but  shouldn’t  bother  you.   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 23. “More  �me  is  needed  to  implement.”   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 24. “There  are  too  many  new  ini�a�ves  and  mandates.”     Now  there’s  a  statement  we  can  all  relate  to…     Without  accurate  standardized  data  about  the   pa�ents  health  condi�on:   ü  Meaningful  use  isn’t  very  meaningful     ü  Accountable  care  can’t  be  accountable   ü  It  will  be  difficult  to  reach  the  goal  of  affordable  care   ü  Health  informa�on  exchanges  may  not  be  interoperable   ü  Quality  measures  will  lack  quality  data   ü  Outcomes  can’t  be  independently  verified   ü  Pa�ent  Safety  can’t  be  assured   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 25. ICD-­‐10?   “Top  Ten  Reasons”   1.  The  value  of  good  data  for  be�er  care   2.  Audits  -­‐  Fraud,  waste  and  abuse,  RAC,   and  other  annoyances…   3.  Impact  on  denials  and  payment  delays   4.  Impact  on  quality  measurement   5.  Improving  pa�ent  safety   6.  Improving  healthcare  for  all  pa�ents   7.  Impact  on  pa�ents  directly   8.  Be�er  popula�on  based  research   9.  The  goal  of  interoperability   10.  Changing  models  of  reimbursement   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Why  should  I  care?   Source:    Health  Data  Consul�ng   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 26. Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Why  is  good  documenta�on  important?   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 27. Documenta�on   1889   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 28. Documenta�on   1889   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 29. Documenta�on   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   1889   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 30. Documenta�on   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   1889   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 31. Documenta�on   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   2013   Progress?   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 32. Documenta�on     Supports  proper  payment  reduced  denials     Assures  accurate  measures  of  quality  and  efficiency     Assures  accountability  and  transparency     Captures  the  level  of  risk  and  severity     Provides  be�er  business  intelligence     Supports  clinical  research     Enhances  communica�on  with  hospital  and  other   providers     It’s  just  good  care!   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Why  is  it  important?   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 33. Documenta�on  Quality     Poor  quality  documenta�on  is  bad  for  Providers,   Payers  and  Pa�ents   ü  Billing  accuracy   ü  Quality  measures   ü  Popula�on  management   ü  Risk  management   ü  Healthcare  analy�cs   ü  Pa�ent  history   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Everyone  loses…   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 34. Coding  –  The  Pa�ent  Interface   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Where  it  all  begins   History   Physical  Exam   Internal  Record  Review   External  Record  Review   Assessment/Diagnosis   Studies   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 35. Ge�ng  to  the  Code   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   A  Necessary  Evil?   Back-­‐office  Coding   The  “Super  Bill”   Back  to  the  Doctor?   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 36. The  Super  Bill   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Not  That  Super  Really…   [Note]  For  all  codes  related  to  fractures  of  the  radius:   • ICD-­‐9  codes  =  33   • ICD-­‐10  codes  =  1818     For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 37. Medical  Concepts   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Medical  Scenario:    A  [27  year  old]  [male]  pa�ent  is  seen  in  [follow-­‐up]  for  a  [Smith’s   fracture]  on  the  [right]  that  was  exposed  through  an  [open   wound]  with  [minimal  opening  and  minimal  �ssue  damage].    The   fracture  has  [not  healed  a�er  6  months].   Though  not  explicitly  stated  in  this  scenario  certain  expressions   imply  other  concepts:   “Smith’s  fracture”  >>  [fracture],  [radius],  [distal],  [dorsal  angula�on],  [extra-­‐ ar�cular],  [displaced]   “minimal  opening  and  minimal  �ssue  damage”  >>  [Gus�lo  classifica�on  I]   “not  healed  a�er  6  months”  >>  [nonunion]     Expressing  the  pa�ent  condi�on  in  codes.   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 38. Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 39. New  Concepts   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Parameters  of  Severity  and  risk     Co-­‐morbidi�es     Manifesta�ons     E�ology/causa�on     Complica�ons     Detailed  anatomical  loca�on     Sequelae     Degree  of  func�onal  impairment     Biologic  and  chemical  agents     Phase/stage     Lymph  node  involvement     Lateraliza�on  and  localiza�on     Procedure  or  implant  related   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 40. New  Concepts   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com     Open  Fracture  Classifica�on   ü  Gus�llo  Classifica�on    I,II,IIIa,IIIb,IIIc     Growth  Plate  Injury  Classifica�ons   ü  Sal�er  Harris  I  –IV     Fracture  Displacement   ü  Displaced,  non-­‐displaced     Joint  Involvement   ü  Intraar�cular,  extrar�cular     Healing  Level   ü  Rou�ne  healing,  delayed  healing,  nonunion,  malunion     Fracture  type   ü  Segmental,  oblique,  pathologic,  stress,  stability,  avulsion,  torus   Severity  (Fracture  Example)   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 41. Documenta�on  Requirements   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Recurring  Concepts   Concept   Number  of  Codes   Right   12,704   Le�   12,393   Unilateral   127   Bilateral   821   Laterality   Concept   Number  of  Codes   Rou�ne  Healing   2,913   Delayed  Healing   2,913   Nonunion   2,895   Malunion   2,595   Healing   Concept   Number  of  Codes   Ini�al  Encounter   13,932   Subsequent  Encounter   21,389   Sequela   11,974   Encounter   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 42. Documenta�on  Requirements   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Recurring  Concepts   Concept   Number  of  Codes   Transverse   690   Oblique   522   Spiral   522   Torus   198   Greens�ck   54   Displaced   5,298   Nondisplaced   5,253   Comminuted   660   Simple   42   2-­‐part   42   3-­‐part  or  4-­‐part   21   Segmental   522   Open   Fracture  Pa�erns   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 43. Coding  ICD-­‐10  CM   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Diabetes  Concepts   Diabetes  =  276  ICD-­‐10  Codes  /  83  ICD-­‐9  Codes   Unique  concepts  within  in  ICD-­‐10  codes  =  62     Diabetes  Type   Pregnancy   Neurologic  complica�ons   Type  1  diabetes   First  trimester   Neurological  complica�on   Type  2  diabetes   Second  trimester   Neuropathy   Underlying  condi�on   Third  trimester   Mononeuropathy   Drug  or  chemical  induced   Childbirth   Polyneuropathy   Pre-­‐exis�ng   Puerperium   Autonomic  (poly)neuropathy   Gesta�onal   Antepartum   Amyotrophy   Poisoning  by  insulin  and  oral  hypoglycemic   Postpartum   Coma   Adverse  effect  of  insulin  and  oral  hypoglycemic   Underdosing  of  insulin  and  oral  hypoglycemic   Neonatal   Secondary   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 44. Coding  ICD-­‐10  CM   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Diabetes  Concepts   Lab  Findings   Renal  complica�ons   Ophthalmologic  Complica�ons   Ketoacidosis   Nephropathy   Re�nopathy   Hyperosmolarity   Chronic  kidney  disease   Macular  edema   Hypoglycemia   Kidney  complica�on   Cataract   Hyperglycemia   Ophthalmic  complica�on   Mild  nonprolifera�ve  re�nopathy   Moderate  nonprolifera�ve  re�nopathy   Severe  nonprolifera�ve  re�nopathy   Prolifera�ve  re�nopathy   Background    re�nopathy   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 45. Coding  ICD-­‐10  CM   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Diabetes  Concepts   Vascular  Complica�ons   Skin  Complica�ons   Joint  Complica�ons   Circulatory  complica�ons   Derma��s   Neuropathic  arthropathy   Peripheral  angiopathy   Foot  Ulcer   Arthropathy   Gangrene   Skin  complica�ons   Skin  ulcer   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 46. Coding  ICD-­‐10  CM   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Diabetes  Concepts   Oral  Complica�ons   Diabe�c  Control   Encounter   Other  Concepts   Oral  complica�ons   Diet-­‐controlled   Ini�al  encounter   Complica�ons   Periodontal  disease   Insulin  controlled   Subsequent  encounter   Right   Uncontrolled   Sequela   Le�   Controlled   Accidental   Inten�onal  self-­‐harm   Assault   Family  history   Personal  history   Screening   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 47. Good  pa�ent  data   1.  Complete  observa�on  of  all  objec�ve  and   subjec�ve  facts  relevant  to  the  pa�ent   condi�on   2. Documenta�on  of  all  of  the  key  medical   concepts  relevant  to  pa�ent  care  currently   and  in  the  future   3. Coding  that  includes  all  of  the  key  medical   concepts  supported  by  the  coding  standard   and  guidelines   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   It’s  all  about  good  pa�ent  care…   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 48. Ge�ng  Specific   When  is  unspecified  OK?   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 49. Good  pa�ent  data   1.  Complete  observa�on  of  all  objec�ve  and   subjec�ve  facts  relevant  to  the  pa�ent   condi�on   2. Documenta�on  of  all  of  the  key  medical   concepts  relevant  to  pa�ent  care  currently   and  in  the  future   3. Coding  that  includes  all  of  the  key  medical   concepts  supported  by  the  coding  standard   and  guidelines   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   It’s  all  about  good  pa�ent  care…   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 50. Coding  specificity     What  makes  a  code  unspecified?     Is  “not  elsewhere  classified”  unspecified?     Does  the  use  of  codes  with  3-­‐4  characters  mean  that   they  are  less  specified  than  codes  with  7  characters?         Does  the  use  of  the  term  “unspecified”  mean  that   the  code  is  not  specific  to  the  nature  of  the  condi�on   as  observed?   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   What’s  an  unspecified  code?   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 51. Coding  specificity     Does  specificity  require  more  than  one  code?     When  is  unspecified  the  right  choice?     When  should  unspecified  change  to  specified?   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   What’s  an  unspecified  code?   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 52. Poorly  Specified  Coding     “Coding  that  does  not  fully  define  important   parameters  of  the  pa�ent  condi�on  that  could   otherwise  be  defined  given  informa�on  available  to  the   observer  (clinician)  and  the  coder.”   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   A  proposed  defini�on   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 53. Coding  specificity     NOS  (Not    Otherwise  Specified)  means  that  the  code   selected  does  not  specify  some  level  of  detail  that   may  be  available  for  similar  condi�ons.   ü  In  ICD-­‐10  NOS  is  referred  to  as  “Unspecified”     NEC  (Not    Elsewhere  Classified)  means  that  the  code   selected  does  is  not  defined  in  any  ICD  classifica�on.   ü  In  ICD-­‐10  NEC  is  referred  to  as  “Other”  or  “Other   Specified”     While  in  theory  there  is  a  difference  between  the   two,  from  data  perspec�ve  either  code  is  not   specific.   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   NEC  or  NOS?   For  a  complete  copy  of  this  presenta�on  contact   us:   ICD-­‐10@noworldborders.com  
  • 54. Coding  specificity     3  characters  ,but  specific:   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   More  characters  –  be�er?   J60  -­‐  Coalworker's  pneumoconiosis     7  characters  ,but  less  specific:   S069X9A  -­‐  Unspecified  intracranial  injury  with  loss  of   consciousness  of  unspecified  dura�on,  ini�al  encounter   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 55. Coding  specificity     The  use  of  the  term  “unspecified”  may  simply  refer   to  one  concept  of  several  concepts  about  a   condi�on.  For  example:   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Does  the  term  “unspecified”  mean  less  specific.   S82202J  –  Unspecified  [fracture]  of  [sha�]  of  [le�  �bia  ],   [subsequent  encounter  ]  for  [open  fracture  ]  [type  IIIA,   IIIB,  or  IIIC  ]  with  [delayed  healing  ]     In  this  case,  mul�ple  details  in  [red]  about  this  fracture   are  specified  and  the  only  thing  not  specified  is  the  type   of  fracture  (displaced,  non-­‐displaced,  spiral,  oblique  …)   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 56. Coding  specificity     The  fact  that  the  descrip�on  does  not  use  the  term   unspecified,  does  not  mean  the  code  is  specific.   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   No  term  “Unspecified”?   C7641  -­‐  Malignant  neoplasm  of  right  upper  limb   M4837-­‐  Trauma�c  spondylopathy,  lumbar  region   R6889  -­‐  Other  general  symptoms  and  signs   R45.2  -­‐  Unhappines   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 57. Coding  specificity     Beyond  the  primary  code,  accurate  representa�on  of  the   pa�ent’s  health  condi�on  may  require  other  codes  to   represent:   ü  Causa�on   ü  Infec�ous,  chemical,  physical  or  other  agents   ü  Loca�on  of  Injury   ü  External  causes  of  injury   ü  Manifesta�ons   ü  Comorbid  condi�on  or  contribu�ng  factors   ü  Sequela   ü  Findings   ü  Mul�ple  other  factors  associated  with  the  primary  condi�on   being  treated  or  evaluated   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   More  than  one  code.   For  a  complete  copy  of  this  presenta�on  contact   us:   ICD-­‐10@noworldborders.com  
  • 58. Coding  specificity     Some�mes  unspecified  makes  sense…   ü  The  pa�ent  may  be  early  in  the  course  of  evalua�on   ü  The  claim  may  be  coming  from  a  provider  who  is  not   directly  related  to  diagnosis  of  the  pa�ents  condi�on   ü  The  clinician  seeing  the  pa�ent  may  be  more  of  a   generalist  and  not  able  to  define  the  condi�on  at  a  level   of  detail  expected  by  a  specialist     Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   A  place  for  “unspecified”  codes   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 59. Coding  specificity     If  there  is  sufficient  informa�on  available  to  more  accurately   define  the  condi�on     For  basic  concepts  such  as:   ü  Laterality  (Right,  Le�,  Bilateral,  Unilateral)   ü  Anatomical  loca�ons   ü  Trimester   ü  Type  of  diabetes   ü  Known  complica�ons  or  comorbidi�es     ü  Descrip�on  of  severity,  acute  or  chronic  or  other  known   parameters…     Where  care  is  implemented  that  demands  a  more  specific   level  of  detail     At  specialty  level  that  should  be  able  to  define  the  detail   required     Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   No  place  for  “unspecified”  codes   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 60. Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Analy�cs   Issues  with  transi�on   Ge�ng  the  most  of  ICD-­‐10   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 61. Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Repor�ng  and  Analy�cs   Historical  Data  During  the  Transi�on   ICD-­‐9   ICD-­‐10   ICD-­‐9   ICD-­‐10   ICD-­‐9   ICD-­‐10   Early 2015 Late 2015 Early 2014 For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 62. Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Coding  Quality   Accurate  and  Consistent   Assuring  accuracy  and  consistency    in  repor�ng  and   decision  making.   Consistent   Accurate   Accurate  &  Consistent   For  a  complete  copy  of  this  presenta�on  contact   us:   ICD-­‐10@noworldborders.com  
  • 63. Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Quality  Measures   Challenges  to  measuring  performance   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 64. Quality  Measures  Impacts   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   AMI  example     Defini�on  of  acute  myocardial  infarc�on  (MI)  has   changed   ü  ICD-­‐9  –  Eight  weeks  from  ini�al  onset   ü  ICD-­‐10  –  Four  weeks  from  ini�al  onset     Subsequent  vs.  Ini�al  episode  of  care   ü  ICD-­‐9  –  Fi�h  character  defines  ini�al  vs.  subsequent  episode  of   care   ü  ICD-­‐10  –  No  ability  to  dis�nguish  ini�al  vs.  subsequent  episode   of  care     Subsequent  (MI)   ü  ICD-­‐9  –  No  ability  to  relate  a  subsequent  MI  to  an  ini�al  MI   ü  ICD-­‐10  –  Separate  category  to  define  a  subsequent  MI  occurring   within  4  weeks  of  an  ini�al  MI   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 65. Fraud  Waste  and  Abuse   If  you  can’t  stop  expenditures  upfront  …   Source:   $60,000,000,000/Year   Fraud,  Waste  and  Abuse   Enough  money  to  take  care  of  a   lot  of  need.   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 66. Fraud,  Waste  and  Abuse   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Medicare  Defini�on   Source:    CMS   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 67. Fraud,  Waste  and  Abuse   With  increasing  challenges  to  control  cost,  the  intensity   of  audits  related  to  fraud,  waste  and  abuse  is   increasing.    In    the  “Jus�fica�on  of  Es�mates  for   Appropria�ons  Commi�ees”  CMS  states:   “Although  the  ICD-­‐10  code  set  will  not  eliminate  all   fraud,  waste,  and  abuse,  CMS  believes  that  its   increased  specificity  will  make  it  much  more  difficult   for  fraud,  waste  and  abuse  to  occur.”   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Don’t  get  caught  in  the  trap…   Source:    CMS   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 68. Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   4  Billion   Recovered   in  2010   Fraud,  Waste  and  Abuse   Don’t  get  caught  in  the  trap…   Source:    CMS   For  a  complete  copy  of  this  presenta�on  contact   us:   ICD-­‐10@noworldborders.com  
  • 69. Healthcare  on  the  “RAC”   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Ge�ng  �ghter…   FY  -­‐2010   FY  -­‐2011   FY  -­‐2012   Fy-­‐2013  (Q1)    (Q1)X4   Series1   $75     $797     $2,291     $745     $2,979      $-­‐          $500      $1,000      $1,500      $2,000      $2,500      $3,000      $3,500     Correc�ons  in  Millions   Collected  Overpayments   Source:    CMS   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 70. Advantage  of  Moving  to  ICD-­‐10     More  consistent  with  the  rest  of  the  world     ICD-­‐9  is  30  years  old     We  are  already  using  ICD-­‐10  for  mortality  repor�ng     Considerably  more  informa�on  per  code     More  clinically  relevant     Greater  expandability  in  and  flexibility  of  coding   structure   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 71. Advantage  of  Moving  to  ICD-­‐10     Be�er  clarity  in  coding  guidelines     More  logical  tabular  structure     Be�er  defini�on  of  co-­‐morbidi�es,  complica�ons   and  disease  manifesta�ons     Improved  support  for  analysis  related  to:     ü  Predic�ve  modeling   ü  Quality  and  cost  efficiency  analysis   ü  Popula�on  based  research   ü  Stra�fica�on  of  illness   ü  Public  health  trending   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 72. Summary     ICD-­‐10  will  be  a  substan�al  change  in  the  standard  for   defining  the  pa�ent’s  health  state  and  the  ins�tu�onal   procedures  performed  to  maintain  or  improve  that  health   state.     There  are  significant  impacts  to  both  the  clinical  and  business   side  of  the  prac�ce.     There  are  poten�al  impacts  to  Quality  and  Cost  metrics.     Documenta�on  is  a  cri�cal  requirement  for  proper  coding  and   billing     There  is  value  in  be�er  informa�on  based  on  be�er  coding   based  on  be�er  documenta�on   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Key  Points   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 73. Summary     Focus  clinicians  on  the  need  for  good  documenta�on     Champion  the  value  of  ICD-­‐10  in  a  new  environment  and   demonstrate  the  pi�alls  of  inadequate  documenta�on   and  coding     Provide  tools  and  templates  to  assist  in  documenta�on   and  coding     Collaborate  with  coding  professionals     Take  a  leadership  role  in  the  success  of  the  organiza�on   through  this  transi�on     Iden�fy  opportuni�es  to  collect  and  use  be�er  data     Get  started  now!!   Source:  Health  Data  Consul�ng  and  h�p:// www.noworldborders.com   Ac�on  Items   For  a  complete  copy  of  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com