1. INSIGHTS
ICD-10
Wednesday, December 18, 2013
Disclaimer: Nothing that we are sharing is intended as legally binding or prescriptive advice. This
presentation is a synthesis of publically available information and best practices.
3. Quick Overview
October 1, 2014 hard cut-off
Affects all entities covered by HIPAA
14,000 ICD-9 codes grow to 68,000 ICD-10 codes
No impact on CPT codes
Version 5010 standards
Significant changes to clinical and revenue cycle
systems
• Complex conversion to updated codes
• System upgrades to expand data fields for longer codes
• Staff retraining on new versions and codes
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5. ICD-10 Regulatory Mandates
Federal Mandate Department of Health and Human
Services Final Rule CMS-0013-F Published January
2009
HIPAA 5010
Transaction formats for payors
and providers
January 1, 2012
ICD-10
Diagnosis and procedure codes
for clinical transactions
October 1, 2014
6. What are ICD-10 Codes?
• Granular code set developed by WHO for:
– Increased clinical accuracy
– Improved disease tracking
– Disease trending
• More ICD-10 codes compared to ICD-9
ICD-9
14,000 diagnosis codes
4,000 procedure codes
5 digit numeric codes
ICD-10
68,000 diagnosis codes
87,000 procedure codes
7 digit alphanumeric codes
7. Anatomy of ICD-10 Diagnosis Codes
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3–7 digits
Digit 1 is alpha, including O and I but no U
Digit 2 is numeric
Digits 3–7 are alpha (not case sensitive) or numeric
Decimal is after third digit
Examples:
– A78 – Q fever
– A69.21 – Meningitis due to Lyme disease; and
– S52.131a – Displaced fracture of neck of right radius, initial
encounter for closed fracture
9. Anatomy of ICD-10 Procedure Codes
• 7 digits
• Alpha (not case sensitive) or numeric digits
– O and I not used to avoid confusion with 0 and 1
• No decimal
• Examples:
– 0FB03ZX – Excision of liver percutaneous
approach, diagnostic; and
– 0DQ10ZZ – Repair upper esophagus, open
approach
10. Anatomy of ICD-10-PCS
• “Procedure”
– Complete specification of 7 characters
PCS Section
Body System
• Medical and
surgical
• Heart and
great vessels
Root Operation
• Dilation
Body Part
• Coronary
artery, one
site
Approach
• Percutaneous
Device
• Intraluminal
device
Qualifier
• Bifurcation
11. Most Impacted Specialties
• Easy transition
– Hematology
– Oncology
• Hard
– Musculoskeletal
– Injury
– Poisoning
• Most challenging
– Obstetrics
– Psychiatry
– Emergency medicine (poisoning)
• 42% of infectious disease code mappings convoluted, which will
impact most specialties
12. What is SNOMED?
• Acronym for Systematized Nomenclature of
Medicine – Clinical Terminology
• International standard for comprehensive clinical
terminology
• Available at no cost through the National Library
of Medicine
• Enables providers and EHRs to communicate in
common language
– Increased quality of patient care across specialties
– Improved accuracy of patient data analysis
13. What is SNOMED? Continued
• Structured into 19 “hierarchies” which define
the clinical concept
• Broken down into increasing granularity
• Very specific clinical concepts to define patient
condition
• More complex than ICD-10 hierarchy
14. Why is it important?
• MU2 criteria expands upon MU1
requirements to improve and utilize HIT and
EHRs
– Provide consistent, collaborative care
– Interoperability between EHRs and need for
understanding each other
• Use of common language
• Problem list
15. The ICD-10-SNOMED Relationship
• SNOMED CT has better clinical coverage than ICD
• Number of codes:
– SNOMED CT (Clinical finding): 100,000
– ICD-9-CM: 14,000
– ICD-10-CM: 68,000
• ICD focus is statistical
– Less common diseases subsumed under general categories
– After-the-fact codes
• SNOMED CT is clinically-oriented
– Used during care
– Clinical relevance and user-friendliness
• Clinically coded data generates ICD-10 code for billing
17. Effective Implementation Strategy
Impact Analysis
Needs Assessment
Project Plan
Budget
Conversion
•Identify current systems
and work processes that
use ICD-9 codes
•Talk with payers about
effect of ICD-10
implementation on
provider contracts
•Workflow and business
process changes
•Staff training
•Practice management
vendor accommodations
•Implementation plan
with clearing houses,
billing services, and
payers
•Inventory systems and
workflows
•Contingency plan for
failed go-live
•Time and costs related
to implementation
•Training
•IT/IS upgrade
•Assistance from outside
vendor/consultant
•Potential productivity
loss
•Transaction testing
using ICD-10 codes
•Historic data conversion
•Review coded data for
claims reimbursement
consistent with ICD-9
rates
19. Training
• AHIMA recommendation: begin no more than six months
before compliance deadline
• Approximately 16 hours for ambulatory coders and 50
hours for hospital coders
– Physician practice coders need to learn ICD-10 diagnosis coding
only
– Hospital coders need to learn both ICD-10 diagnosis and ICD-10
inpatient procedure coding
• Specialty-specific ICD-10 training
• ICD-10 coding training integrated into credential
maintaining CEUs
• ICD-10 resources and training materials available through
CMS, professional associations and societies
22. What’s Next?
January 8,
2014 –
Meaningful
Use 1
January 15,
2014 –
Meaningful
Use 2
January 22,
2014 –
PatientCentered
Medical
Home
(PCMH)
January 29,
2014 –
Accountable
Care
Organizations
(ACOs)
