The ICD-10 Change-Over: Looking Ahead

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When it comes to ICD-10 planning, the devil is in the details. In our latest slideshow, we highlight the details to consider when looking ahead to the ICD-10 transition. This includes planning, documentation training, the structural differences in the codes, mapping differences, and how your management style could affect the transition.

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The ICD-10 Change-Over: Looking Ahead

  1. 1. The ICD-10 Change-Over: Looking Ahead Adele Allison National Director of Government Affairs, SuccessEHS
  2. 2. ICD-10 Planning
  3. 3. <ul><li>HIPAA 5010 allows technology to accept ICD-10 electronically </li></ul><ul><li>ICD-10 goes well beyond payer-provider transactions </li></ul><ul><li>BCBS Association -> Coding errors to increase 10-25% in first year </li></ul><ul><li>CMS estimates for coder training needs: 179,267 PT / 50,000 FT </li></ul>
  4. 4. <ul><li>ICD-10 Impacts all components of the practice </li></ul><ul><li>AMA estimates cost for 3-MD practice = $83,290 </li></ul><ul><li>Begin Impact Analysis </li></ul><ul><ul><li>What Systems / Workflows does ICD-9 touch today? </li></ul></ul><ul><ul><li>Who needs Training -> Coders, Biller, Physicians for documentation </li></ul></ul>
  5. 5. <ul><li>Begin Impact Analysis </li></ul><ul><ul><li>EHR Adoption and MU have tentacles into ICD-10 change-over </li></ul></ul><ul><ul><li>How will EHR adoption impact practice mgmt., billing, coding, reporting, etc.? </li></ul></ul><ul><ul><li>SuccessEHS will support and continue to provide education </li></ul></ul>
  6. 6. Provider Documentation Training
  7. 7. <ul><li>“ If it’s not documented, it didn’t happen” = Cannot bill </li></ul><ul><li>More codes means more documentation </li></ul><ul><li>Documentation Considerations </li></ul><ul><ul><li>Linking relevant conditions </li></ul></ul><ul><ul><li>Initial Encounter -> 7 th Character Extension “A” for Patient under Active Treatment </li></ul></ul>
  8. 8. <ul><li>Documentation Considerations </li></ul><ul><ul><li>Subsequent Encounter -> 7 th Character Extension “D” for Routine Injury Care during Healing / Recovery </li></ul></ul><ul><ul><li>Sequela -> 7 th Character Extension “S” for Complications / Conditions resulting from an injury (E.g., Scar resulting from a burn) </li></ul></ul>
  9. 9. <ul><li>Impact Analysis: </li></ul><ul><ul><li>Clinical Documentation Assessments -> Do random samples support ICD-10 coding? </li></ul></ul><ul><ul><li>Implement Documentation Improvement Strategies -> E.g., Train, Reassess, Train again </li></ul></ul><ul><ul><li>ICD-10 Implementation/Documentation Champion </li></ul></ul>
  10. 10. Provider Documentation Training
  11. 11. Provider Documentation Training ICD-9-CM 555.2 569.5 <ul><li>Patient : Betty Bea Goode DOB : 07/04/1955 </li></ul><ul><li>Impression : </li></ul><ul><li>Patient has regional enteritis in the small and large intestine </li></ul><ul><li>Patient has an intestinal abcess </li></ul>
  12. 12. Provider Documentation Training ICD-9-CM 555.2 569.5 <ul><li>Patient : Betty Bea Goode DOB : 07/04/1955 </li></ul><ul><li>Impression : </li></ul><ul><li>Patient has regional enteritis in the small and large intestine </li></ul><ul><li>Patient has an intestinal abcess </li></ul>ICD-10-CM K50.814 <ul><li>Patient : Betty Bea Goode DOB : 07/04/1955 </li></ul><ul><li>Impression : </li></ul><ul><li>Crohn’s disease of both the small and large intestine with abscess </li></ul>
  13. 13. Provider Documentation Training ICD-9-CM 555.2 569.5 <ul><li>Patient : Betty Bea Goode DOB : 07/04/1955 </li></ul><ul><li>Impression : </li></ul><ul><li>Patient has regional enteritis in the small and large intestine </li></ul><ul><li>Patient has an intestinal abcess </li></ul>ICD-10-CM K50.814 <ul><li>Patient : Betty Bea Goode DOB : 07/04/1955 </li></ul><ul><li>Impression : </li></ul><ul><li>Crohn’s disease of both the small and large intestine with abscess </li></ul>
  14. 14. Area ICD-9 ICD-10 Comments / Examples Diabetes Mellitus 59 Codes >200 Codes <ul><li>Adds “poorly controlled” in addition to “Controlled” and “Not Controlled” </li></ul><ul><li>Adds multiple combination codes </li></ul><ul><li>Example : E09.11 -> Type 1 Diabetes Mellitus with Ketoacidosis with Coma </li></ul>Injuries No Expanded Categories for Injury Adds 7 th Character Extension to Identify the Encounter Type <ul><li>A = Initial Encounter </li></ul><ul><li>D = Subsequent Encounter for Fracture with Routine Healing </li></ul><ul><li>G = Subsequent Encounter for Fracture with Delayed Healing </li></ul><ul><li>S = Sequela </li></ul><ul><li>Other : Must code the type, cause, size and depth of injury </li></ul>Drug Under-Dosing Absent Codes for when the Patient takes Less Rx than Prescribed <ul><li>First code the Medical Condition </li></ul><ul><li>Secondary Code of Under-dosing </li></ul><ul><li>Tertiary Code of Reason </li></ul><ul><li>Example : Documentation must include “Patient could not afford their medication.” </li></ul>Cerebral Infarctions No differentiation between Type and Late Effects of Stroke Differentiation is made for Late Effects of Stroke by Type <ul><li>Combination codes exist for common etiologies or manifestations </li></ul><ul><li>Example : I63.012 -> Cerebral Infarction due to Thrombosis of Left Vertebral Artery </li></ul>
  15. 15. Area ICD-9 ICD-10 Comments / Examples Acute Myocardial Infarction Age definition is 8 weeks Age definition is 4 weeks <ul><li>New categories for subsequent AMI and for complications within 4 weeks (28 days) of event </li></ul><ul><li>Difference in terminology </li></ul><ul><li>Laterality is included </li></ul><ul><li>Example : I21.02 -> ST Segment Elevation Myocardial Infarction involving the Left Anterior Descending Coronary Artery </li></ul>Musculoskeletal Limited Diagnosis Codes Expanded Diagnosis Codes <ul><li>Example : There are 8 codes for pathologic fracture in ICD-9; 150 codes in ICD-10 </li></ul>Pregnancy Trimester Not Required, uses episodes of care Documentation of Trimester Required <ul><li>Counted from 1 st day of last period </li></ul><ul><li>Must document number of weeks </li></ul><ul><li>Episodes of care deleted </li></ul><ul><li>Obstructed Labor incorporates reason </li></ul><ul><li>Code extensions use to ID baby (1-5) affected by OB condition </li></ul><ul><li>Example : (Trimester) O15.03 -> Eclampsia in Pregnancy in the 3 rd Trimester </li></ul><ul><li>Example : (Obstruction/Baby ID) O64.1xx2 -> Obstructed Labor due to Breech Presentation, Fetus 2 </li></ul>
  16. 16. What about dentists?
  17. 17. <ul><li>Fact: Dental Office Systems should be compatible with Medical Office Systems </li></ul><ul><li>ADA Codes on Dental Procedures and Nomenclature used today </li></ul><ul><li>All electronic dental claims MUST be 5010 compliant </li></ul>
  18. 18. <ul><li>No coding change for the ADA Codes due to ICD-10 </li></ul><ul><li>Exception -> Dentists perform a medically warranted procedure billed on a medical claim </li></ul>
  19. 19. How do you embrace change management?
  20. 20. <ul><li>Pragmatist </li></ul><ul><ul><li>60% aim for minimum </li></ul></ul><ul><ul><li>Only core processes for administration/revenue cycle management </li></ul></ul><ul><ul><li>Aiming for Average = Potential Risk </li></ul></ul>
  21. 21. <ul><li>Collaborator </li></ul><ul><ul><li>20-25% aim for opportunity </li></ul></ul><ul><ul><li>Improve processes </li></ul></ul><ul><ul><li>Advanced analytics, internal reporting </li></ul></ul><ul><ul><li>Aiming for Improvement = Potential Value for Costs </li></ul></ul>
  22. 22. <ul><li>Innovator </li></ul><ul><ul><li>15-20% aim for transformation </li></ul></ul><ul><ul><li>Change agent </li></ul></ul><ul><ul><li>Contracting, training, outcomes management </li></ul></ul><ul><ul><li>Aiming for Excellence = Competitive Advantage & Strategic Positioning </li></ul></ul>
  23. 23. Structural differences in ICD-9 and ICD-10
  24. 24. Structures <ul><li>ICD-9 </li></ul><ul><li>ICD-10 </li></ul>
  25. 25. Structures <ul><li>ICD-9 </li></ul><ul><li>ICD-10 </li></ul>Category Category, Anatomic Site, Severity Alpha/Numeric (E or V) Numeric
  26. 26. Structures <ul><li>ICD-9 </li></ul><ul><li>ICD-10 </li></ul>Category Category, Anatomic Site, Severity Alpha/Numeric (E or V) Numeric Category Category, Anatomic Site, Severity Category Numeric Alpha (Every Letter but U) Numeric or Alpha (Every Letter but U)
  27. 27. Mapping differences in ICD-9 and ICD-10
  28. 28. <ul><li>One–to–One Mapping </li></ul>ICD-9-CM ICD-10-CM 733.6 (Tietze’s Syndrome) M94.0 (Tietze’s Syndrome)
  29. 29. <ul><li>One–to–One Mapping </li></ul><ul><li>One–to–Many Mapping </li></ul>ICD-9-CM ICD-10-CM 733.6 (Tietze’s Syndrome) M94.0 (Tietze’s Syndrome) ICD-9-CM 649.51 (Spotting during Pregnancy) ICD-10-CM O26.851 (Spotting 1 st Trimester) O26.852 (Spotting 2 nd Trimester) O26.853 (Spotting 3 rd Trimester) -OR- 962.9 (Hormone Poisoning) T38.801A T38.901A T38.802A T38.902A T28.803A T38.903A T38.804A T38.904A T38.891A T38.991A T38.892A T38.992A T38.893A T38.993A T38.894A T38.994A 733.82 (Other Cartilage Disorders) T38.801AT38.901A T38.901AT38.901A38.901AT38.801AT38.901A T38.901AT38.901A T38.901AT38.802AT38.902A28.803AT38.903A T38.804AT38.904A T38.891A T38.991A 38.992A38.893AT38.993A T38.901T38.901AT38.892A T38.992A T38.893AT38.993A T38.90T38.90T38.901A T38.894A T38.992A T38.893AT38.993A T38.90T38.90T38.901AT38.994T38.901A38.901AT38.801AT38.901A T38.901AT38.901AT38.90102AT38.902AT28.803AT38.903A T38.804AT38.904A T38.891A T38.991A T38.901AT38.901A T38.892A T38.992A T38.893AT38.993A T38.901A T38.894A T38.901A T38.994A T38.901A38.901A T38.89 T38.801AT38.901A T38.901AT38.901A T38.901A 802AT38.902AT28.803AT38.903A T38.804AT38.904A T38.891A T38.991A T38.901AT38.901A T38.892A T38.992A T38.893AT38.993A T38.901A T38.894A T38.901A T38.994A T38.901A38.901A T38.89 T38.802AT38.902A T28.803AT38.903A T38.804A T38.992A T38.893AT38.993A T38.904A T38.891A T38.991A T38.901A T38.901A T38.90 T38.892A T38.992A T38.893AT38.993A T38.901AT38.90 T38.894A T38.901A T38.994A T38.901A38.901A T38.90 T38.90T38.801AT38.901A T38.901AT38.901A T38.901A 802AT38.902AT28.803AT38.903A T38.804AT38.904A T38.891A T One-to-Sixteen One-to-2,530
  30. 30. Which of the following statements apply to implementation of ICD-10?
  31. 31. <ul><ul><li>ICD-10 is effective October 1, 2013 </li></ul></ul><ul><ul><li>CMS and other payers cannot process ICD-10 claims prior to Oct. 1, 2013 </li></ul></ul><ul><ul><li>ICD-10 applies to all providers and payers </li></ul></ul><ul><ul><li>Providers, clinics and vendors will need to be prepared to support ICD-9 and ICD-10 based on the claim DOS </li></ul></ul><ul><ul><li>All of the above </li></ul></ul>
  32. 32. <ul><ul><li>ICD-10 is effective October 1, 2013 </li></ul></ul><ul><ul><li>CMS and other payers cannot process ICD-10 claims prior to Oct. 1, 2013 </li></ul></ul><ul><ul><li>ICD-10 applies to all providers and payers </li></ul></ul><ul><ul><li>Providers, clinics and vendors will need to be prepared to support ICD-9 and ICD-10 based on the claim DOS </li></ul></ul><ul><ul><li>All of the above </li></ul></ul>
  33. 33. Provider documentation will be a significant factor in succeeding with ICD-10 because:
  34. 34. <ul><ul><li>More codes means more documentation </li></ul></ul><ul><ul><li>Providers must link relevant conditions in their documentation </li></ul></ul><ul><ul><li>Providers must document whether the visit is an initial encounter, subsequent encounter or sequela </li></ul></ul><ul><ul><li>Providers must capture expanded information on the visit </li></ul></ul><ul><ul><li>All of the above </li></ul></ul>
  35. 35. <ul><ul><li>More codes means more documentation </li></ul></ul><ul><ul><li>Providers must link relevant conditions in their documentation </li></ul></ul><ul><ul><li>Providers must document whether the visit is an initial encounter, subsequent encounter or sequela </li></ul></ul><ul><ul><li>Providers must capture expanded information on the visit </li></ul></ul><ul><ul><li>All of the above </li></ul></ul>
  36. 36. 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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