The ICD-10 Change-Over: Getting Started  Adele Allison National Director of Government Affairs, SuccessEHS
Brief History of ICD
<ul><li>1966 </li></ul><ul><ul><li>American Medical Association classifies the practice of medicine </li></ul></ul><ul><ul...
<ul><li>1990 </li></ul><ul><ul><li>World Health Organization endorses ICD-10 </li></ul></ul><ul><ul><ul><li>ICD is the mos...
<ul><li>2002 </li></ul><ul><ul><li>ICD-10 published in 42 languages </li></ul></ul><ul><ul><ul><li>138 countries for Morta...
<ul><li>U.S. System Today – Standardized Answers to 2 Questions </li></ul><ul><ul><li>What did you do?  > Procedure Code <...
Initial Health Care Reform
<ul><li>Jan. 16, 2009 </li></ul><ul><ul><li>2 Final Rules to update HIPAA standards, aka the  5010 Rules </li></ul></ul><u...
<ul><li>Jan. 20, 2009 </li></ul><ul><ul><li>Obama inaugurated </li></ul></ul><ul><li>Feb. 17, 2009 </li></ul><ul><ul><li>A...
<ul><li>March 23, 2010 </li></ul><ul><ul><li>Patient Protection and Affordable Care Act (PPACA) </li></ul></ul><ul><li>Mar...
<ul><li>PPACA + HCERA = Affordable Care Act (ACA) </li></ul>
What is 5010?
<ul><li>HIPAA: enacted in 1996 </li></ul><ul><li>5010 Rules focus on Administrative Simplification, Privacy and Security <...
<ul><li>Standard Prior to 1.1.2012 -> X12 version  4010A1 </li></ul><ul><ul><li>Eligibility Checking </li></ul></ul><ul><u...
<ul><li>Full Standard Terminology </li></ul><ul><ul><li>“ Accre dited Standards Committee (ASC)  X12 Version  005010  stan...
<ul><li>HIPAA-covered entities </li></ul><ul><ul><li>Physicians and dentists </li></ul></ul><ul><ul><li>Ancillary and beha...
<ul><li>HIPAA-covered entities </li></ul><ul><ul><li>Clearinghouses  </li></ul></ul><ul><ul><li>Pharmacies </li></ul></ul>
<ul><li>Are software vendors covered by HIPAA?  </li></ul><ul><ul><li>No, but it is their duty to keep clients compliant. ...
Why the change?
<ul><li>The U.S. is the only G7 nation not using ICD-10 </li></ul><ul><li>5010 fully supports NPI as intended by Secretary...
<ul><li>5010 lays the foundation for ICD-10 roll-out </li></ul><ul><ul><li>ICD-10 has increased the code field size from 5...
Overview of ICD-10
<ul><li>Effective Date ->  Oct. 1, 2013 </li></ul><ul><li>Transition requires maintenance of both ICD-9 and ICD-10 </li></...
<ul><li>CMS and other payers  CANNOT  process ICD-10 claims before Oct. 1, 2013 </li></ul><ul><li>Does  NOT  affect CPT co...
<ul><li>ICD-10 Benefits: </li></ul><ul><ul><li>↑  Accuracy and specificity of clinical informat ion </li></ul></ul><ul><ul...
<ul><li>ICD-10 codes sets are Public Domain –  free download  on CMS Website at  www.cms.gov/ICD10/12_2010_ICD_10_CM.asp <...
<ul><li>Potential Barriers </li></ul><ul><ul><li>Coders </li></ul></ul><ul><ul><ul><li>Shortage of credentialed profession...
<ul><li>Potential Barriers </li></ul><ul><ul><li>Physicians  and other  Health Care Professionals </li></ul></ul><ul><ul><...
ICD-9 versus ICD-10
<ul><li>ICD-9 </li></ul><ul><ul><li>Maintained by the National Center for Health Statistics </li></ul></ul><ul><ul><li>14,...
<ul><li>ICD-10 </li></ul><ul><ul><li>Maintained by the National Center for Health Statistics </li></ul></ul><ul><ul><li>69...
For more information about  industry trends, visit  www.successehs.com  for white papers, articles, blog posts and more! C...
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The ICD-10 Change-Over: Getting Started

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This presentation contains a brief background of how the health care industry created and adopted the ICD format. The current legislation surrounding health care and how that affects providers using this standard documentation.

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The ICD-10 Change-Over: Getting Started

  1. 1. The ICD-10 Change-Over: Getting Started Adele Allison National Director of Government Affairs, SuccessEHS
  2. 2. Brief History of ICD
  3. 3. <ul><li>1966 </li></ul><ul><ul><li>American Medical Association classifies the practice of medicine </li></ul></ul><ul><ul><ul><li>Current Procedural Terminology (CPT) </li></ul></ul></ul><ul><ul><ul><li>Healthcare Common Procedure Coding System (HCPCS) </li></ul></ul></ul>
  4. 4. <ul><li>1990 </li></ul><ul><ul><li>World Health Organization endorses ICD-10 </li></ul></ul><ul><ul><ul><li>ICD is the most widely-used disease classification in the world. </li></ul></ul></ul>
  5. 5. <ul><li>2002 </li></ul><ul><ul><li>ICD-10 published in 42 languages </li></ul></ul><ul><ul><ul><li>138 countries for Mortality Classification </li></ul></ul></ul><ul><ul><ul><li>99 countries for Morbidity </li></ul></ul></ul>
  6. 6. <ul><li>U.S. System Today – Standardized Answers to 2 Questions </li></ul><ul><ul><li>What did you do? > Procedure Code </li></ul></ul><ul><ul><li>Why did you do it? > Diagnosis Code </li></ul></ul><ul><ul><li>However, the U.S. has yet to adopt ICD-10 </li></ul></ul>
  7. 7. Initial Health Care Reform
  8. 8. <ul><li>Jan. 16, 2009 </li></ul><ul><ul><li>2 Final Rules to update HIPAA standards, aka the 5010 Rules </li></ul></ul><ul><ul><ul><li>Replace ICD-9 with ICD-10 by Oct. 1, 2013 </li></ul></ul></ul>
  9. 9. <ul><li>Jan. 20, 2009 </li></ul><ul><ul><li>Obama inaugurated </li></ul></ul><ul><li>Feb. 17, 2009 </li></ul><ul><ul><li>American Recovery and Reinvestment Act (ARRA) </li></ul></ul>
  10. 10. <ul><li>March 23, 2010 </li></ul><ul><ul><li>Patient Protection and Affordable Care Act (PPACA) </li></ul></ul><ul><li>March 30, 2010 </li></ul><ul><ul><li>American Recovery and Reinvestment Act (ARRA) </li></ul></ul>
  11. 11. <ul><li>PPACA + HCERA = Affordable Care Act (ACA) </li></ul>
  12. 12. What is 5010?
  13. 13. <ul><li>HIPAA: enacted in 1996 </li></ul><ul><li>5010 Rules focus on Administrative Simplification, Privacy and Security </li></ul>
  14. 14. <ul><li>Standard Prior to 1.1.2012 -> X12 version 4010A1 </li></ul><ul><ul><li>Eligibility Checking </li></ul></ul><ul><ul><li>Claims Submission and Remittance </li></ul></ul><ul><ul><li>Claims Status and Referral Management </li></ul></ul>
  15. 15. <ul><li>Full Standard Terminology </li></ul><ul><ul><li>“ Accre dited Standards Committee (ASC) X12 Version 005010 standard Tec hnical Reports Type 3 (TR3s)” </li></ul></ul><ul><li>Nickname = HIPAA 5010 </li></ul>
  16. 16. <ul><li>HIPAA-covered entities </li></ul><ul><ul><li>Physicians and dentists </li></ul></ul><ul><ul><li>Ancillary and behavioral health providers (e.g., nurse practitioners, LPCs, etc.) </li></ul></ul><ul><ul><li>Hospitals </li></ul></ul><ul><ul><li>Payers </li></ul></ul>
  17. 17. <ul><li>HIPAA-covered entities </li></ul><ul><ul><li>Clearinghouses </li></ul></ul><ul><ul><li>Pharmacies </li></ul></ul>
  18. 18. <ul><li>Are software vendors covered by HIPAA? </li></ul><ul><ul><li>No, but it is their duty to keep clients compliant. </li></ul></ul>
  19. 19. Why the change?
  20. 20. <ul><li>The U.S. is the only G7 nation not using ICD-10 </li></ul><ul><li>5010 fully supports NPI as intended by Secretary of HHS </li></ul>
  21. 21. <ul><li>5010 lays the foundation for ICD-10 roll-out </li></ul><ul><ul><li>ICD-10 has increased the code field size from 5 to 7 characters </li></ul></ul><ul><ul><li>Vendors will eventually be able to accommodate up to 12 diagnosis codes vs. the 8 supported by 4010A1 today </li></ul></ul>
  22. 22. Overview of ICD-10
  23. 23. <ul><li>Effective Date -> Oct. 1, 2013 </li></ul><ul><li>Transition requires maintenance of both ICD-9 and ICD-10 </li></ul><ul><ul><li>DOS < October 1, 2013 -> ICD-9 </li></ul></ul><ul><ul><li>DOS = October 1, 2013 or > -> ICD-10 </li></ul></ul>
  24. 24. <ul><li>CMS and other payers CANNOT process ICD-10 claims before Oct. 1, 2013 </li></ul><ul><li>Does NOT affect CPT coding </li></ul><ul><li>Applies to ALL Providers and Payers </li></ul>
  25. 25. <ul><li>ICD-10 Benefits: </li></ul><ul><ul><li>↑ Accuracy and specificity of clinical informat ion </li></ul></ul><ul><ul><li>↑ Reporting for quality research, outcomes, p atient safety, etc. </li></ul></ul><ul><ul><li>↑ Ability to track / respond to bioterrorism </li></ul></ul><ul><ul><li>↑ Comparative effectiveness research with ot her countries </li></ul></ul>
  26. 26. <ul><li>ICD-10 codes sets are Public Domain – free download on CMS Website at www.cms.gov/ICD10/12_2010_ICD_10_CM.asp </li></ul>
  27. 27. <ul><li>Potential Barriers </li></ul><ul><ul><li>Coders </li></ul></ul><ul><ul><ul><li>Shortage of credentialed professional coders (exists today for ICD-9 and CPT) </li></ul></ul></ul><ul><ul><ul><li>Transition to new structure – although many characteristics are the same </li></ul></ul></ul>
  28. 28. <ul><li>Potential Barriers </li></ul><ul><ul><li>Physicians and other Health Care Professionals </li></ul></ul><ul><ul><ul><li>Training </li></ul></ul></ul><ul><ul><ul><li>Documentation, Documentation, Documentation! </li></ul></ul></ul>
  29. 29. ICD-9 versus ICD-10
  30. 30. <ul><li>ICD-9 </li></ul><ul><ul><li>Maintained by the National Center for Health Statistics </li></ul></ul><ul><ul><li>14,315 Codes </li></ul></ul><ul><ul><li>3-5 Characters </li></ul></ul><ul><ul><li>First Character = #, E, V </li></ul></ul>
  31. 31. <ul><li>ICD-10 </li></ul><ul><ul><li>Maintained by the National Center for Health Statistics </li></ul></ul><ul><ul><li>69,099 Codes </li></ul></ul><ul><ul><li>3-7 Characters </li></ul></ul><ul><ul><li>First Character = Alpha – all except U </li></ul></ul><ul><ul><li>7 th Character for injury / external causes by initial, subsequent or sequela </li></ul></ul>
  32. 32. For more information about industry trends, visit www.successehs.com for white papers, articles, blog posts and more! Click here for our industry blog

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