4. 4
ICD-10: What Should We be Asking Ourselves?
• How will my cash flow be impacted?
• What will be my financial performance?
• How do I keep my coding operation intact?
• What is the best method to train our system?
5. 5
Adoption of ICD-10 Delayed
• On April 1, 2014, a bill was signed into law to delay the
implementation of ICD-10-CM/PCS by at least one year.
– The bill, H.R. 4302, Protecting Access to Medicare Act of 2014, mainly
creates a temporary “fix” to the Medicare sustainable growth rate (SGR).
– A seven-line section of the bill states that the Department of Health and
Human Services (HHS) cannot adopt the ICD–10 code set as the standard
until at least October 1, 2015.
7. 7
Phase 1: Implementation Plan Development and
Impact Assessment
• Consolidated Coding Service Line Across System
• Ensure Consistent Coding Practices Across Facilities
• Balanced Workload Across Facilities
• Coder Assessment of skill sets
• Assign Workload Based on Competencies
• Improve Encoder Software
• Implemented New Hire Testing
• Implemented Coding Productivity & Quality Standards
• Implemented Remote Coding
• Revised Job Descriptions
8. 8
Phase 1: Implementation Plan Development and
Impact Assessment
• Successful Consolidated Coding Service Line Across System
9. 9
Phase 1: Implementation Plan Development and
Impact Assessment
• Implementation of ICD-10 Steering Committee
• Implementation of ICD-10 Team Leaders (Subcommittee)
• Coding
• Clinical Documentation
• Patient Access
• CBO/Contracting
• IT
• Quality and Reporting
10. 10
Phase 1: Implementation Plan Development and
Impact Assessment
• A comprehensive ICD-10 Transition Blueprint was developed, vetted and
shared with each work team to assist with ICD-10 implementation efforts.
11. 11
Phase 1: Implementation Plan Development and
Impact Assessment
• Best Practice Metrics Tracking In Place
14. 14
Phase 1: Implementation Plan Development and
Impact Assessment
• Provide ICD-10 Steering Committee with ICD-10 awareness education
• Coders begin ICD-10 Training – Focus on Anatomy and Physiology
15. 15
Phase 2: Implementation Preparation
• Development of comprehensive internal and external communication
strategy/plan
• Review of payer contracts
• Modify/develop policies and procedures
• Modify ICD-10 project plan as needed
16. 16
Phase 2: Implementation Preparation
• Evaluate potential DRG shifts w/Top 10 Medicare MS DRGs
– Most cases did not shift in MS DRG with the exception of two:
– MS-DRG 885 (Psychosis)
– Under ICD-9, these cases had a principal diagnosis 296.20, Major Depression,
unspecified. This becomes F32.9 in ICD-10, which includes Depression NOS (311 in ICD-
9) so F32.9 shifts the case to the lower weigh MS-DRG 881, Depressive Neuroses.
– MS-DRG 191 (Chronic obstructive pulmonary disease w/cc)
– 82% of the shifts were due to ICD-10 not differentiating sub-types of COPD the way ICD-9
does. No longer two codes but one code in ICD-10.
– Many of the hospital admissions for COPD exacerbation were caused due to pneumonia.
If documented as the cause of the COPD exacerbation, pneumonia can be coded in
addition to COPD exacerbation (J44.0) which is a MCC on the ICD-10 List.
17. 17
Phase 2: Implementation Preparation
• MS DRGs w/ a frequency of shifting when re-coded in ICD-10
– MS-DRG 812 (Red Blood Cell Disorders w/o MCC)
– MS-DRG 981 (Extensive OR procedure unrelated to PDX w/MCC)
– MS-DRG 391 (Esophagitis, Gastroent w/MCC)
– MS-DRG 885 (Psychosis)
– MS-DRG 066 (Intracranial hemorrhage w/o cc/ MCC)
– MS-DRG 191 (Chronic obstructive pulmonary disease w/cc)
– MS-DRG 011 (Tracheostomy for face, mouth, neck w/MCC)
– MS-DRG 292 (Heart Failure and shock w/cc)
– MS-DRG 037 (Extra cranial procedures w/MCC)
18. 18
Phase 2: Implementation Preparation
• Development of ICD-10 Budget for 2014
– Resources For System Build and Testing
– System Wide Education
– Educational Materials
– Coder Market Analysis
– Coder Retention Plan
– External vs. Internal ICD-10 Coding Support
– Overtime
– Consulting
19. 19
Phase 3: “Go- Live” Preparation
• BHS ICD-10 Coding Support Plan
– Internal versus External Coding Support
– Post Grad Internal ICD-10 Coding Program was launched at BHS in
January 2014.
– Post grads were placed on a development plan to have them trained on
ICD-9 and ICD-10 prior to the ICD-10 implementation date.
– Post grads are a 2 year commitment position
20. 20
Phase 3: “Go- Live” Preparation
• BHS Training Plan
– The ICD-10 classification system will increase from a total of 17,849 codes
in ICD-9 to over 140,000
– ICD-10 education must address two major groups of learners:
– Anyone who assigns, analyzes or interacts with codes today or will in ICD-10
– Anyone who documents or supports documents in the medical record
21. 21
Phase 3: “Go- Live” Preparation
• In-depth training January 2014-September 2015
• Training Hours (online) by Specialty:
– Imaging, Lab, Therapy, Wound care (1-2)
– Patient Access (3-4)
– IT, Analysts, contracts (2-5)
– Finance Analysts (5)
– Revenue Cycle (2-12)
– HIM staff (8)
– CDI/CM/QA (2-21)
– Coders (63)
22. 22
Phase 3: “Go- Live” Preparation
• Physician Training (Online)
– Online Training using Precyse University
– Training 3-5 hours
– CME offered
– Three Phases of Training:
– Phase 1: Introduction “What is ICD-10”
– March-May 2014
– Phase 2: Basic Documentation in ICD-10
– June-July 2014
– Phase 3: Specialty Specific
– August-September 2014
23. 23
Phase 3: “Go- Live” Preparation
• ICD-10 Coding in encoder prior to go live
– Double Coding in ICD-10 effective January 2014
– Payer specific
– MS DRG and Diagnosis specific
– Top 10 MS DRGs and Diagnosis & randomly selected
– Dual Coding in ICD-10 effective April 2014
– Payer Specific
– MS DRG and Diagnosis specific
– Top 10 MS DRGs and Diagnosis & randomly selected
25. 25
Phase 3: “Go- Live” Preparation
• ICD-10 Coding Go-Live
– Eliminate coding backlogs prior to ICD-10 implementation
– All coders will be onsite for first two weeks
– Mandatory “no overtime” during first 60 days
– Successful post grad coding support program
26. 26
Phase 3: “Go- Live” Preparation
• BHS Progress in Preparation for ICD-10
27. 27
Phase 4: Post Implementation Follow Up
• Monitor impact on reimbursement, claim denials, rejections
• Monitor coding productivity and accuracy
• Train or re-train staff as necessary
• Assess the reimbursement impact of the ICD-10 transition, monitor
case mix
• Work closely with payers to resolve payment issues
• Analyze data to evaluate the impact of implementing ICD-10 at end
of FY14 to develop a baseline to monitor against in FY15.
28. 28
Despite ICD-10 Delay: Moving forward with ICD-10
Implementation Plan
• Continue with ICD-10 Implementation Plan
• Extend End-to-End Testing
• Continue Staff Education and Training Efforts
• Improve Clinical Documentation Processes
• Build a Strong Foundation for Process Improvement
