5. Why is ICD-9 Being Replaced?
❖ICD-9-CM is out of date and running out of space for
new codes.
!
❖Lacks specificity and detail
❖No longer reflects current medical practice
!
❖ICD-10 is the international standard to report and monitor diseases and mortality,
making it important for the U.S. to adopt ICD-10 based classifications for reporting
and surveillance.
❖ICD codes are the core elements of HIT systems, conversion to ICD-10 is necessary
to fully realize benefits of HIT adoption.
6. Major Differences Between ICD-9-CM
and ICD-10-CM
ICD – 9-CM
ICD – 10-CM
13,600 codes
69,000 codes
Code book contains 17 chapters
Code book contains 21 chapters
Consists of 3 to 5 characters
Consists of 3 to 7 characters
1st
1st
Only utilizes letters E and V
Utilizes all letters (except U)
Second, third, fourth, and fifth
characters are always numeric
Second character
is always numeric
Shorter code descriptions
because
of lack of specificity and
abbreviated code titles
Third, fourth, fifth, sixth, and
seventh
characters can be alpha or
Longer code descriptions
because of greater clinical detail
and specificity
and full code titles
7. Comparison of ICD-9-CM
and ICD-10-CM
ICD-9-CM Code
• A - Category of code
• B - Etiology, anatomical
site, and manifestation
A
B
ICD-10-CM code
• A - Category of code
• B - Etiology, anatomical
site, and/or severity
• C - Extension
▫ 7th character for obstetrics,
injuries, and external causes of
injury
A
B
C
8. Comparison of ICD-9-CM and
ICD-10-CM
ICD-9-CM Codes
Pressure ulcer codes
9 codes
707.00 – 707.09
Codes:
707.0 Pressure ulcer
707.00 - unspecified site
707.01 - elbow
707.02 - upper back
707.03 - lower back
707.04 - hip
707.05 - buttock
707.06 - ankle
707.07 - heel
707.09 - other site
ICD-10-CM Codes
Pressure ulcer codes
125 codes
Code Examples:L89.0-L89.94
L89.131 – Pressure ulcer of right lower back, stage I
L89.132 – Pressure ulcer of right lower back, stage II
L89.133 – Pressure ulcer of right lower back, stage III
L89.134 – Pressure ulcer of right lower back, stage IV
L89.139 – Pressure ulcer of right lower back,
unspecified stage
L89.141 – Pressure ulcer of left lower back, stage I
L89.142 – Pressure ulcer of left lower back, stage II
L89.143 – Pressure ulcer of left lower back, stage III
L89.144 – Pressure ulcer of left lower back, stage IV
L89.149 – Pressure ulcer of left lower back,
unspecified stage
L89.151 – Pressure ulcer of sacral region, stage I
L89.152 – Pressure ulcer of sacral region, stage II
…
10. Coder Training
❖ Key issues include training courses, but equally ramping up to
productivity standards and confidence
❖ Future needs to meet:
❖ Coders will need to train in real environments with real notes/encounters and see
where skill gaps exist
❖ Multiple passes –at first getting comfortable with coding, then testing productivity.
See where the gaps exist and retrain specifically.
❖ Computer-assisted rules-based coding will greatly assist the
transition
❖ Dual coding environment –specific notes, rules engine suggested codes, coders
code, after-the-fact analyses of generic versus specific codes
❖ The Practice will want to be sure they understand revenue risk from non-specific
coding prior to October.
11. Physician Training
The Problem
❖ Physicians have learned how
to document at the detailed
level over the last 20 years
❖ More detailed information
required to get to the most
specific codes
❖ Organizations have
meaningful revenue risk with
ICD-10 if documentation is
not up to the new standard
❖ No physicians want to worry
about this now, but every
physician will need to adapt
Needed approach
❖Note-by-note and ICD-by-ICD
analysis of the specific changes each
physician needs to make
❖Data-driven training with physicians
– their documentation, their
deficiencies, needed changes
❖ “Small footprint” discussions over
time—topic-by-topic rather than allat-once. Aggregated plan between
now and October
❖Follow-up data analysis to
determine effect of training and to
structure additional interactions
12. Needed Documentation Deficiency
Analysis
❖Step 1: Data Processing
❖Take historical notes and code for ICD10
!
❖Compare—at the note level—specific language in note
with documentation needed for specific ICD10 code
!
❖Determine gaps overall and by doctor
!
❖Group training activity into themes or specific areas so
that effective and granular training can be performed
13. Needed Documentation Deficiency
Analysis
❖Step 2: Data Analysis and Aggregation
❖Determine patterns by physician, modality
!
❖Isolate highest impact deficiencies
❖Frequency
❖Value
❖Based on identified deficiencies, collate examples
of deficient documentation
14. Needed Documentation Deficiency
Analysis
❖Step 3: Reporting and training
❖ Overall patterns
❖ Physician-specific reporting
❖ Work with physicians one on one or in relevant focus groups to
train
!
❖ Analyze and repeat as necessary to ensure the new concepts stick
!
❖ Utilize existing coding management and teams to conduct the
training (they are the ones who do it normally anyway)—but you
have to free up their time to do so
16. Be Prepared for the ICD-10 Migration
❖Are you in good hands??
❖MGMA Research Finds
!
❖More than 52 percent of doctors indicated they had not
heard from their practice management system vendor
regarding when software changes would be available to
the practice.
!
❖Almost 50 percent had not heard from their EHR
vendor.
19. Revenue Cycle: Overview
SCHEDULING
GU
LA
TIO
NS
REGISTRATION
INSURANCE
VERIFICATION
RE
CASH POSTING
POINT OF SERVICE
COLLECTIONS
PROGRAM
ADMINISTRATION
R
ME
STO IONS
CU
AT
CT
PE
EX
POST
PAYMENT REVIEW
SELF PAY
COLLECTIONS
CULTURE
PEOPLE
FINANCIAL
CLEARANCE
CUSTOMER
SERVICE
PROCESS
TOOLS
FINANCIAL
COUNSELING
MEDICAL
RECORDS
CDM/CHARGE
CAPTURE
YO
CDMP
PA
Y
G
LO
O
HN
C
TE
CASE MGMT/QUR
BILLING
RS
DENIALS
MANAGEMENT
THIRD PARTY
FOLLOW- UP
"19
20. Getting Paid for the Services That are
Provided. The first time!
21. Getting Paid for the Services That are
Provided. The first time!
❖Step One: Automate
❖ Automating Coding and Claims
❖ Automating the Clearinghouse
❖ Automating Eligibility
❖ Automating Denial Management
❖ Automating Self-Pay Collections
❖Step Two: Analyze
❖ Business Intelligence Tools
❖ Benchmarking
❖Step Three: Detect and Fix
❖Step Four: Refine and Repeat
23. Importance of Collecting Accurate
Information
!
❖ It starts with the collection of comprehensive and accurate financial
data.
!
❖ Garbage in, garbage out! Collecting accurate demographic and billing
information should not be limited to new patients
!
❖ Another headache for practices is monitoring patients with aged
balances who keep coming in for additional services
!
❖ Untimely submission of insurance claims and poorly designed patient
statements will thwart collection efforts
!
❖ Failure to analyze collection performance can be a major headache
27. Leverage Technology to Ease the Pain!
!
❖Technology is your
friend! Use it wisely.
❖A lonely writer who
develops an unlikely
relationship with his
newly purchased
operating system
that's designed to meet
his every need.
29. If you would like more information on this
topic or other ways to increase your
reimbursements, contact us directly.
!
Call us: 1-877-AVISENA
E-Mail: marketing@avisena.com
Visit us at www.avisena.com
