The document discusses the transition from ICD-9 to ICD-10 coding systems. It provides an overview of the limitations of ICD-9 and benefits of ICD-10, including increased specificity and ability to track new diagnoses. The implementation process involves planning, training staff, updating processes, testing systems, and collaborating with vendors. Thorough testing is needed to ensure internal and external compliance. The transition to ICD-10 will improve data quality and support initiatives like value-based care despite costs of implementation.

1. ~BY
Jessie Joseph
Jyoshna Kolisetty
Ranveer Tula
Sai Sandeep Boyapati
Shruthi Gajjala

2.  Introduction
 Limitation of ICD-9 & Benefits of ICD-10
 Comparing ICD 9 and ICD 10
 Assessment Phase:
◦ Business Assessment
◦ Scenario based vendor assessment
 Implementation Phase
 Testing Phase
 Conclusions

3. Introduction
Limitations & Benefits
Implementation Testing Phase
Comparison
Study
Conclusion

4.  International classification of diseases (ICD) is a standard
diagnostic tool
 Monitor the incidence and prevalence of diseases and other
health problems.
 The ICD is revised periodically and is currently in its tenth
revision.
 ICD is used for reimbursement and resource allocation
decision-making by countries.
 The code set allows more than 14,400 different codes and
permits the tracking of many new diagnoses.

5.  ICD-10 expands the diagnosis
coding an directory, adding
increased specificity and
detail, which is important to
gaining a better understanding
of a diagnosis and determining
the proper course of
treatment.
 As the ICD-10 codes become
more specific, they also
become more complex.
 With the increased specificity
of ICD-10, codes can be up to
seven digits

6. ICD-9 Code set is no longer
maintained by the WHO
The USA is the only developed nation
still using ICD-9 All other G-7 nations
have transitioned to ICD-10
As of 2002,99 countries have adopted
IC-10 or a clinical modification for
coding and reporting morbidity data
As of 2002,138 countries have
adopted ICD-10 for coding and
reporting mortality data

7.  ICD-10-CM/PCS is a diagnosis classification system
developed by the Centers for Medicare and Medicaid
Services (CMS) and the National Center for Health
Statistics (NCHS), for coding and reporting in the
healthcare environment of the United States.
 It consists of two parts:
1. ICD-10-CM was developed by the Centers for Disease
Control and Prevention for use in all United States of
America health care treatment settings
2. ICD-10-PCS was developed by CMS for use in the U.S.
for inpatient hospital settings ONLY

8. Stakeholders ICD-9 ICD-10
Healthcare
executives:
CEO,CFO,CIO, CMO
CMIO,CNO
 Awareness that billing
and coding process exist
• Become informed about
the changes required
for successful ICD-10
adaption
• Communicate the
clinical values to the
leader
• Influence external
stakeholders
Providers • Document care
• Assign community used
codes (Physician Offices)
• Commit to increased
specialty in clinical
documentation
• Accept responsibility for
front end coding
process
Coders • Assignment of ICD-9
Codes
• Extrapolation from
various levels of
documentation
• Learn the advanced
anatomy
• Learn new code
structure
• Commit to accuracy

10.  Icd-9 has several limitations that prevent complete and
precise coding and billing of health conditions and
treatments, including:
 The 30-year-old code set contains outdated terminology and
is inconsistent with current medical practice.
 Coding may be incomplete if patient records
include a limited number of diagnosis codes. For
example, the Utah Department of Health Hospital
Discharge Database (HDD) captures up to nine diagnosis
codes. However, some Utah hospitals record more than
nine diagnosis codes.
 The HDD includes only the first nine diagnosis codes for
these records. ß only conditions that physicians document in
patient charts can be coded

11.  The codes themselves lack specificity and detail to
support the following:
 Accurate anatomical descriptions
 Differentiation of risk and severity
 Key parameters to differentiate disease manifestations
 Optimal claim reimbursement
 Value-based purchasing methodologies
 ICD9CM codes do not indicate degree of harm
to the patient. ß ICD9CM codes do not capture near
misses.
 Caution should be used when making comparisons
among facilities due to coding variation.

12.  Currently, ICD9CM codes usually
are assigned after the patient is discharged from
the hospital. Hence, ICD9CM codes
provide retrospective, not real-time,
patient information
 The lack of detail limits the ability of payers and others
to analyze information such as health care utilization,
costs and outcomes, resource use and allocation, and
performance measurement.
 The codes do not provide the level of detail necessary
to further streamline automated claim processing,
which would result in fewer payer-physician inquiries
and potential claim payment delays or denials

14.  ICD-9 has approximately 14,000 codes and ICD-10 has
68000 codes.
 New code format allows addition of future codes in
appropriate category and location
 Updated terminology and disease classification
 Determine severity of illness and prove medical
necessity
 Grow compensation and reimbursement.
 Address technology and healthcare reform initiatives
 Ensure your strong reputation
 Reduce the hassle of audits
How can you, your practice and your
patients benefit from ICD-10?

15.  Determine severity of illness and prove medical
necessity
 Grow compensation and reimbursement.
 Address technology and healthcare reform initiatives
 Ensure your strong reputation
 Reduce the hassle of audits
 Improve care

16.  Prevention of fraud and abuse.
 Improved tracking of public health and risk.
 Enhanced and more specific coding to categorize
anatomic site, etiology and severity of disease.
 More detailed data will allow for improved analysis of
disease pattern and the tracking and responding to
public health outbreaks.

17. ICD-9-CM ICD-10-CM
Billable Codes 14,567 69,823
Chapters 19 21
Code Length
(excl.period)
3-5 Characters 3-7 Characters
First Character E, V,or 0-9 A-z, Excel U
Other Characters Numeric See Above
Ability to add new
codes
Very Limited Unrestricted
Ability to provide
detail
Limited Unrestricted

18. ICD-10-CM differs from ICD-9-CM in its organization and structure, code composition, and level of detail.
ICD-9-CM ICD-10-CM
 Consists of three to five characters
 First digit is numeric or alpha (E or V)
 Second, third, fourth, and fifth digits are numeric
 Always at least three digits
 Decimal placed after the first three characters
 Consists of three to seven characters
 First digit is alpha
 All letters are used except for U
 Second and third digits are numeric
 Fourth, fifth, sixth, and seventh digit can be alpha or
numeric
 Decimal placed after the first three characters
Code Structure of the ICD-10-CM versus ICD-9-CM
ICD-10-CM codes may consist of up to seven digits, with the seventh digit extensions representing visit encounter or
sequelae for injuries and external causes.
ICD-9-CM Format ICD-10-CM Format
X X X . X X
 First three digits represents the category
 Fourth and fifth digit represents etiology, anatomic
site, manifestation
X X X . X X X X
 First three digits represents the category
 Fourth, fifth, and sixth digit represents etiology,
anatomic site, severity
 Seventh digit represents the extension

21.  Why?
1. Adopt new technology
2. Change existing workflow
3. Reform care delivery
Steps in implementation:
1.Make a Plan
 Assign target dates for completing steps outlined
here
 Obtain access to ICD-10 codes. The codes are
available from many sources and in many
formats

22.  Decide role(s) your clearinghouse(s)
 will play in your transition. Some providers
who are not ready could benefit from
contracting with a clearinghouse to submit
claims
For ICD-10, clearinghouses can help by:
 1.Identifying problems that lead to claims
being rejected
 2.Providing guidance about how to fix a
rejected claim (e.g., the provider needs to
include more or different data)

23.  Clearinghouses cannot help you code in
ICD-10 unless they offer third-party billing/
coding services .
2.Train Your Staff ̈
 Train staff on ICD-10 fundamentals using the
wealth of free resources from CMS, which include
the ICD-10 website Road to 10, Email Updates,
National Provider Calls, and webinars.
 Free resources are also available from: Medical
societies, health care professional associations.

24. 3.Update Your Processes
 Update hard-copy and electronic forms (e.g.,
super bills, CMS 1500 forms)̈
 Resolve any documentation gaps identified
while coding top diagnoses in ICD-10
 Make sure clinical documentation captures
key new coding concepts:
 Laterality—or left versus right
 Initial or subsequent encounter for injuries
 Trimester of pregnancy

25. 4.Talk to Your Vendors and Health Plans
 Call your vendors to confirm the ICD-10
readiness of your practice’s systems
 Confirm that the health plans,
clearinghouses, and third-party billing
services you work with are ICD-10 ready
 Ask vendors, health plans, clearinghouses,
and third-party billers about testing
opportunities

26. 5.Test Your Systems and Processes :
 Verify that you can use your ICD-10-ready
systems to:
 Generate a claim
 Perform eligibility and benefits verification
 Schedule an office visit
 Schedule an outpatient procedure
 Test your systems with partners like vendors,
clearinghouses, billing services, and health
plans; focus on those partners that you work
with most often.

27. Testing
Phase
Error
Testing
Internal
Testing
External
Testing

28.  The Process of proving that a system or
process meets requirements and produces
consistent and correct results.
 It is critical to successful implementation of
ICD-10
 Testing will ensure ICD -10 compliance
across internal policies, processes and
systems as well as external trading partners
and vendors.

29.  Unit Testing: Confirms that updates meet the
requirements of each individual component in
a system.
 System Testing: Verifies the integrated
system meets requirements for the ICD-10
transition
 Regression Testing: Test modified system
components to ensure that ICD-10 changes
do not cause faults in other system
functionality.

30.  Test plan implications: Test plan to document
the strategy and verify that the business
process system meet future design
specification
 Test case implications: Test cases to ensure
the system update meets the business
requirements
 Test Data Implications: use sample data to
validate the process errors, trigger and
generate a standard environmental model
over time.

31.  All testing will result in errors. Correcting the
errors before they go live is the main
objective for the error testing module
 Methods used to resolve the issues are
◦ Multiple testing layers to support various iterations
of re-testing in parallel tracks
◦ An error tracking system will standard alerts to
report to stakeholders.
◦ Developing a schedule for fixing known issues in
the future.

32.  Internal Testing basically concentrate on the
significant architectural and system logic
changes and focus on testing key business
risks.
 Evaluating each technical area as well as
integration testing across components
◦ DB architecture
◦ User interface
◦ Algorithms

33.  Error testing is performed by creating a
inventory of external entities with whom the
datas are exchange and based on that
scenario has to generated to preform testing
◦ Payers
◦ Hospitals
◦ Health information exchange
◦ Outsourced billing or coding
◦ Government entties

34.  ICD-10 cm and ICD-10pcs must be adopted as soon as possible to
reverse the trend of deteriorating health data.
 ICD-9 cm code set no longer fits with the needs of the 21st century
healthcare system.
 Never in US history we used the same version of ICD for 35 years
 Any changes to do in healthcare industry cost money and ICD-10 is
not exception.
 Benefits: ICD -10 will improve national healthcare initiatives such as
meaningful use, value base purchasing, payment reform and quality
reporting.
 Without ICD-10 data, there will be serious gaps in the ability to
extract important patient health information
 It helps to support the public health reporting and move to a
payment system based on quality and outcomes.

35.  Higher quality information for measuring healthcare service quality safety
and efficiency
 Greater coding accuracy and specificity
 Recognition of advances in clinical practice and technology.
 Improved ability to measure outcomes, efficacy and costs of new medical
technology
 Improved ability to track and respond to public health threats
 Reduced opportunities for fraud and improves fraud detection capabilities
 Global healthcare data comparability space to accommodate future code
expansion
 Reduced need for manual review of health records to perform research and
data mining and adjudicate reimbursement claims

36.  International Classification of Diseases, (2005). Centers for
Disease Control and Prevention (CDC). Retrieved from
http://www.cdc.gov/nchs/data/dvs/icd10fct.pdf
 ICD 10 CM code search, (2014). ICD-10-CM database edition.
Retrieved from http://icd10cmcode.com/abouticd10.php
 International classification of diseases (ICD), 2016. world health
organization (WHO). Retrieved from
http://www.who.int/classifications/icd/en/
 ICD-10 implementation guide for large practices. Centers for
Medicare and Medicaid services. Retrieved from
www.CMS.gov/ICD10

http://www.bcbsm.com/content/dam/public/Providers/Documen
ts/help/faqs/icd10-update-mentalhealth.pdf