The document provides an introduction to ICD-10 CM/PCS implementation. It states that on October 1, 2015, ICD-10-CM for diagnoses will be used by all providers and ICD-10-PCS for procedures will be used only for hospital inpatient claims. CPT and HCPCS codes will continue to be used for physician services. The current ICD-9 code set is outdated and ICD-10 provides greater specificity. ICD-10 implementation impacts documentation, coding, and reimbursement for all healthcare providers and organizations.

1. Basic
Introduction to
ICD-10 CM/PCS

2. ICD-10 Implementation
 October 1, 2015 – Compliance date for
implementation of ICD-10-CM (diagnoses) and
ICD-10-PCS (procedures)
 ICD-10-CM (diagnoses) will be used by all
providers in every health care setting
 ICD-10-PCS (procedures) will be used only for
hospital claims for inpatient hospital procedures
◦ ICD-10-PCS will not be used on physician claims, even
those for inpatient visits

3. CPT and HCPCs Codes
 No impact on Current Procedural Terminology
(CPT) and Healthcare Common Procedure
Coding System (HCPCS) codes
 CPT and HCPCS will continue to be used for
physician and ambulatory services including
physician visits to inpatients

4. ICD-10 Implementation
 Single implementation date of October 1,
2015 for all users
 Ambulatory and physician services
provided on or after October 1, 2015 will
use ICD-10-CM diagnosis codes
 Inpatient discharges occurring on or after
October 1, 2015 will use ICD-10-CM and
ICD-10-PCS codes

5. Why ICD-10
Current ICD-9 Code Set is:
 Outdated: 30 years old
 Current code structure limits amount of new codes
that can be created
 Has obsolete groupings of disease families
 Lacks specificity and detail to support:
◦ Accurate anatomical positions
◦ Differentiation of risk & severity
◦ Key parameters to differentiate disease manifestations

6. Diagnosis Code Structure
Comparison
ICD-9-CM (Volume 1 & 2) ICD-10-CM
3-5 characters in length 3-7 characters in length
Approximately 14,000 codes Approximately 68,000 codes
First digit may be alpha (E or V) or
numeric; digits 2-5 are numeric
Digit 1 is alpha (to indicate the
category);
Digit 2 is numeric (in the future,
alpha characters may be used if
code expansion is needed);
Digits 3-7 can be alpha or numeric
Limited space for adding new
codes
Flexible for adding new codes
Lacks detail Very specific
Lacks laterality Includes laterality (i.e., codes
identifying right vs. left)

7. ICD-10-CM (diagnosis) Code
Format
S 3 2 0 1 0 A
Alpha
(except U)
2nd – Always Numeric
3rd-7th Alpha or Numeric Additional
Character
s
Category Etiology, Anatomic Site,
Severity
Added code extensions (7th Character) for
obstetrics, injuries and external causes of
injuries
3-7 Characters

8. Comparison: ICD-9 to ICD-10
434.11 Cerebral embolism
with infarction
Code represents embolism of
cerebral arteries with infarction
I63.40 Cerebral infarction dew to embolism
of unspecified cerebral artery
I63.49 Of other cerebral artery
I63.411 Of right middle cerebral artery
I63.412 Of left middle cerebral artery
I63.419 Of unspecified middle cerebral artery
I63.421 Of right anterior cerebral artery
I63.422 Of left anterior cerebral artery
I63.429 Of unspecified anterior cerebral artery
I63.431 Of left posterior cerebral artery
I63.432 Of right posterior cerebral artery
I63.439 Of unspecified posterior cerebral artery
I63.441 Of right cerebellar artery
I63.442 Of left cerebellar artery
I63.449 Of unspecified cerebellar artery
With specificity and
laterality, one ICD-9 code
translates into 14 possible
ICD-10 codes

9. Procedure Code Structure
Comparison
ICD-9-CM (Volume 3) ICD-10-PCS
3-4 numbers in length 7 alpha-numeric characters in
length
Approximately 3,000 codes Approximately 87,000 available
codes
Based on outdated technology Reflects current usage of medical
terminology and devices
Limited space for adding new
codes
Flexible for adding new codes
Lacks detail Very specific
Lacks laterality Has laterality
Generic terms for body parts Detailed descriptions for body
parts
Lacks descriptions of methodology
and approach for procedures
Provides detailed descriptions of
methodology and approach for
procedures

10. ICD-10-PCS Code Format
S 3 2 0 1 0 A
Section
Body
System
Root
Operation
Body
Part
Approac
h
Device
Qualifie
r

11. Comparison: ICD-9 to ICD-
10
ICD-9 Procedure Code
39.50 Angioplasty
39.31 Suture of artery
47.01 Laparoscopic appendectomy
ICD-10 Procedure Code
0DN90ZZ Release of duodenum, open approach
0FB03ZX Excision of liver, percutaneous approach, diagnostic
02PS0CZ Removal, extraluminal device from pulmonary vein, right,
open

12. ICD-10 Provider Impacts
 Clinical documentation is the foundation of successful ICD-10
Implementation
 Golden Rule of Documentation
◦ If it isn’t documented by the physician, it didn’t happen
◦ If it didn’t happen, it can’t be billed
 The purpose in documentation is to tell the story of what was
performed and what is diagnosed accurately and thoroughly
reflecting the condition of the patient
◦ what services were rendered and
◦ what is the severity of the illness
 The key word is SPECIFICITY
◦ Granularity
◦ Laterality
 Complete and concise documentation allows for accurate coding
which leads to maximized reimbursement

13. ICD-10 Changes Everything!
 ICD-10 is a Business Function Change, not just
another code set change.
 ICD-10 Implementation will impact everyone:
◦ Registration, Nurses, Managers, Lab, Clinical Area, Billing,
Physicians, and Coding.
 Know your role – How is ICD-10 going to change
what you do?

14. ICD-10 Next Steps
 Assess & track vendor compatibility
 UHS Master Education Plan
◦ Identify all employees and medical staff who need
training by April 15, 2015.
◦ Assign all Precyse Courses in Healthstream by April
30, 2015.
 Be mindful of assigned staff training hours
 Dual coding / practicing with ICD-10-CM/PCS

15. ICD-10 Facility Resources
 Cost centers have been established specifically for the
resources needed to implement ICD-10 successfully. This
covers both the training of employees and any necessary
back-fill of staff during training.
◦ ICD -10 Training: coded to account #xxx-86100-687923
 Two ICD-10 translation tools:
◦ Code Translation Tool (CTT)
 Translates ICD-9 to ICD-10 utilizing description, specific code, code ranges or list of
codes.
 Training and Roll-out of the CTT tool has been completed and end users are actively
using the tool for Code translation needs.
◦ Financial Impact Tool (FIT)
 Analyzes historical DRG data to predict the financial impact of ICD-10, both positive
and negative. Variance reports can be utilized to identify avoidable DRG shifts in order
to reduce financial risk through physician documentation education.
 Training and Roll-out of the FIT tool is in progress.

16. ICD-10 Resources
 CMS Resources
◦ MS-DRG Conversion Report
http://www.cms.hhs.gov/ICD10/Downloads/MsdrgConversio
n.pdf
◦ ICD-10 General Information
http://www.cms.hhs.gov/ICD10
 The following organizations offer providers and others
ICD-10 resources
◦ AHIMA (American Health Information Management
Association) http://www.ahima.org/icd10/default.aspx
◦ WEDI (Workgroup for Electronic Data Interchange)
http://www.wedi.org
◦ HIMSS (Health Information and Management Systems
Society) http://www.himss.org/icd10

18. QUESTIONS?