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The ICD-10 Change-Over: Getting Started
 

The ICD-10 Change-Over: Getting Started

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This presentation contains a brief background of how the health care industry created and adopted the ICD format. The current legislation surrounding health care and how that affects providers using ...

This presentation contains a brief background of how the health care industry created and adopted the ICD format. The current legislation surrounding health care and how that affects providers using this standard documentation.

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    The ICD-10 Change-Over: Getting Started The ICD-10 Change-Over: Getting Started Presentation Transcript

    • The ICD-10 Change-Over: Getting Started Adele Allison National Director of Government Affairs, SuccessEHS
    • Brief History of ICD
      • 1966
        • American Medical Association classifies the practice of medicine
          • Current Procedural Terminology (CPT)
          • Healthcare Common Procedure Coding System (HCPCS)
      • 1990
        • World Health Organization endorses ICD-10
          • ICD is the most widely-used disease classification in the world.
      • 2002
        • ICD-10 published in 42 languages
          • 138 countries for Mortality Classification
          • 99 countries for Morbidity
      • U.S. System Today – Standardized Answers to 2 Questions
        • What did you do? > Procedure Code
        • Why did you do it? > Diagnosis Code
        • However, the U.S. has yet to adopt ICD-10
    • Initial Health Care Reform
      • Jan. 16, 2009
        • 2 Final Rules to update HIPAA standards, aka the 5010 Rules
          • Replace ICD-9 with ICD-10 by Oct. 1, 2013
      • Jan. 20, 2009
        • Obama inaugurated
      • Feb. 17, 2009
        • American Recovery and Reinvestment Act (ARRA)
      • March 23, 2010
        • Patient Protection and Affordable Care Act (PPACA)
      • March 30, 2010
        • American Recovery and Reinvestment Act (ARRA)
      • PPACA + HCERA = Affordable Care Act (ACA)
    • What is 5010?
      • HIPAA: enacted in 1996
      • 5010 Rules focus on Administrative Simplification, Privacy and Security
      • Standard Prior to 1.1.2012 -> X12 version 4010A1
        • Eligibility Checking
        • Claims Submission and Remittance
        • Claims Status and Referral Management
      • Full Standard Terminology
        • “ Accre dited Standards Committee (ASC) X12 Version 005010 standard Tec hnical Reports Type 3 (TR3s)”
      • Nickname = HIPAA 5010
      • HIPAA-covered entities
        • Physicians and dentists
        • Ancillary and behavioral health providers (e.g., nurse practitioners, LPCs, etc.)
        • Hospitals
        • Payers
      • HIPAA-covered entities
        • Clearinghouses
        • Pharmacies
      • Are software vendors covered by HIPAA?
        • No, but it is their duty to keep clients compliant.
    • Why the change?
      • The U.S. is the only G7 nation not using ICD-10
      • 5010 fully supports NPI as intended by Secretary of HHS
      • 5010 lays the foundation for ICD-10 roll-out
        • ICD-10 has increased the code field size from 5 to 7 characters
        • Vendors will eventually be able to accommodate up to 12 diagnosis codes vs. the 8 supported by 4010A1 today
    • Overview of ICD-10
      • Effective Date -> Oct. 1, 2013
      • Transition requires maintenance of both ICD-9 and ICD-10
        • DOS < October 1, 2013 -> ICD-9
        • DOS = October 1, 2013 or > -> ICD-10
      • CMS and other payers CANNOT process ICD-10 claims before Oct. 1, 2013
      • Does NOT affect CPT coding
      • Applies to ALL Providers and Payers
      • ICD-10 Benefits:
        • ↑ Accuracy and specificity of clinical informat ion
        • ↑ Reporting for quality research, outcomes, p atient safety, etc.
        • ↑ Ability to track / respond to bioterrorism
        • ↑ Comparative effectiveness research with ot her countries
      • ICD-10 codes sets are Public Domain – free download on CMS Website at www.cms.gov/ICD10/12_2010_ICD_10_CM.asp
      • Potential Barriers
        • Coders
          • Shortage of credentialed professional coders (exists today for ICD-9 and CPT)
          • Transition to new structure – although many characteristics are the same
      • Potential Barriers
        • Physicians and other Health Care Professionals
          • Training
          • Documentation, Documentation, Documentation!
    • ICD-9 versus ICD-10
      • ICD-9
        • Maintained by the National Center for Health Statistics
        • 14,315 Codes
        • 3-5 Characters
        • First Character = #, E, V
      • ICD-10
        • Maintained by the National Center for Health Statistics
        • 69,099 Codes
        • 3-7 Characters
        • First Character = Alpha – all except U
        • 7 th Character for injury / external causes by initial, subsequent or sequela
    • For more information about industry trends, visit www.successehs.com for white papers, articles, blog posts and more! Click here for our industry blog