ICD-10: Are Your Reports Ready?

Transcription

1 ICD-10: Are Your Reports Ready? Barbara Craig Midas+ SaaS Advisor TJ McGreevy Midas+ Solutions Advisor ICD-10 Reality Check 4 months and 12 days to go 135 days 19 weeks and 2 days 3,240 hours 194,400 minutes 11,663,999 11,663,998 11,663,996 11,663,995 11,663,993 11,664,000 11,663,990 11,663,997 11,663,992 11,663,994 11,663,991 seconds 2014 Midas+ Symposium May Tucson, AZ 1

2 Basics: Why the move to ICD-10? Has been federally mandated to begin Oct. 1, Much better specificity Better sensitivity regarding appropriate reimbursement Allows for international comparisons of diseases Better ability to trend issues related to public health Contains updated medical terminology Allows for the logical addition of new diagnoses and procedures Better measurement related to quality of care outcomes Differences between ICD-9 and ICD Midas+ Symposium May Tucson, AZ 2

3 Two different ICD-10 Code Schemes ICD-10 CM International Classification of Diseases, 10th Revision, Clinical Modification ICD-10 PCS International Classification of Diseases, 10th Revision, Procedure Coding System DIAGNOSES PROCEDURES ICD-10 CM (Clinical Modification) Diagnoses 2014 Midas+ Symposium May Tucson, AZ 3

4 The ICD-10 CM Codes are 3 to 7 characters in length Contains CATEGORIES, SUBCATEGORIES, and CODES The first three characters describe the CATEGORY, if there are no further characters, this equals a CODE SUBCATEGORIES are either 4 or 5 characters CODES may be 3, 4, 5, 6 or 7 characters All CM codes start with a letter as the first character The second and third characters are always numeric There is a. after the third character An X is used as a placeholder The side of the body affected by injury or disease is included in the diagnosis codes (laterality) Structure of the ICD-10 CM Codes Decimal Extension Category Subcategories Etiology, Anatomic Site, Severity 2014 Midas+ Symposium May Tucson, AZ 4

5 ICD-10 CM Category Codes (first character) A - Communicable diseases B - Viral diseases C - Malignant Neoplasms D - In situ neoplasms, diseases of the blood E - Endocrine, nutritional, and metabolic diseases F - Mental and behavioral disorders G - Nervous system and sensory H - Eye, ear and mastoid I - Circulatory diseases J - Respiratory diseases K - Digestive diseases L - Skin and subcutaneous tissue N - Genitourinary O - Pregnancy, childbirth, and puerperium P - Newborn Q - Congenital malformations and chromosomal R - Symptoms, signs and abnormal clinical finding not elsewhere classified S - Injury, fractures T - Burns, corrosions, poisoning toxic effects neglect, maltreatment V - External cause of morbidity W - External cause of morbidity X - External cause of morbidity Y - External cause of morbidity location Z - Contacts, exposures M - Musculoskeletal and connective tissues ICD-10 CM Category Codes (first 3 characters) A00-B99 C00-D49 D50-D89 E00-E89 F01-F99 G00-G99 H00-H95 I00-I99 J00-J99 K00-K94 L00-L99 Infectious and Parasitic Diseases Neoplasms Diseases of Blood, Blood forming organs, immune mechanisms Endocrine, nutritional, and metabolic diseases Mental and behavioral disorders Nervous system and sensory organs Eye, ear and mastoid Circulatory diseases Respiratory diseases Digestive diseases Skin and subcutaneous tissue 2014 Midas+ Symposium May Tucson, AZ 5

6 ICD-10 CM Category Codes (first 3 characters) M00-M99 N00-N99 O00-O9A P00-P96 Q00-Q99 R00-R99 S00-T88 V01-Y99 Z00-Z99 Musculoskeletal and connective tissues Genitourinary Pregnancy, childbirth, and puerperium Newborn Congenital malformations and chromosomal abnormalities Symptoms, signs abnormal clinical finding NEC Injury, poisoning, and certain other external causes External cause of morbidity Factors influencing health status and contact with health services (e.g. preventive health, immunizations) Examples of ICD-10 CM Codes J11.1 Influenza, bronchial, epidemic, respiratory, upper, with pharyngitis H Central Corneal Ulcer, bilateral L Pressure Ulcer of right elbow, stage II T14.90 Injury T14.8 Injury, blood vessel NEC S65.50 Injury, blood vessel, finger S65.51 Injury, blood vessel, little finger laceration S Injury, large intestine S Injury, large intestine, ascending (right) S Injury, large intestine, ascending (right), blast injury (primary) V95.9 Occupant injured in powered craft accident V95.40 Occupant injured in powered craft accident, spacecraft V95.43 Occupant injured in powered craft accident, spacecraft collision 2014 Midas+ Symposium May Tucson, AZ 6

7 Which one is not a real ICD-10 Code? T Asphyxiation due to being trapped in bed linens T Aspiration of a fortune cookie T75.82 Effects of Weightlessness T Mechanical Complication of umbrella device W Jumping into a fountain striking bottom causing injury ICD-10 PCS (Procedure Coding System) Procedures 2014 Midas+ Symposium May Tucson, AZ 7

8 ICD-10 PCS (Procedure Coding System) PCS codes are 7 characters in length They DO NOT contain a decimal point X is used as a place holder when another character or number does not apply. Z means not applicable, and is only used in the 6 th and 7 th Segments (Device and Qualifier) 15 PCS Axial Components: Segment Component 1 Section 2 Body System 3 Root Operation 4 Body Part 5 Approach 6 Device Used 7 Qualifier Midas+ Symposium May Tucson, AZ 8

9 ICD-10 PCS Axial Components Section Body System Root Operation Body Part Approach Device Used Qualifier Example 1: Total Right Hip Replacement, Metal 0 S R A Med-Surg Lower Joints Replacement Right Hip Joint Example 2: Total Left Hip Replacement, Ceramic, Cemented Open Synthetic substitute, metal Uncemented 0 S R B Med-Surg Lower Joints Replacement Example 3: Transfusion of FFP via Central Vein Left Hip Joint Open Synthetic substitute, ceramic Cemented Z 4 Administration Circulatory Transfusion Central Percutaneous Frozen Nonautologous Vein Plasma Axial Component 1 Section (Procedures) 0 Med-Surg 1 Obstetrics 2 Placement 3 Administration 4 Measurement and monitoring 5 Extracorporeal Assistance 6 Extracorporeal Therapies 7 Osteopathic 8 Other Procedures 9 Chiropractic B C D F G H Imaging Nuclear Medicine Radiation Oncology Physical Rehab and Diagnostic Audiology Mental Health Substance Abuse Treatment 2014 Midas+ Symposium May Tucson, AZ 9

10 Axial Component 1 Section Section Body System Root Operation Body Part Approach Device Used Qualifier Example 1: Total Right Hip Replacement, Metal 0 S R A Med-Surg Lower Joints Replacement Right Hip Joint Open Synthetic substitute, metal Uncemented Example 2: Total Left Hip Replacement, Ceramic, Cemented 0 S R B Med-Surg Lower Joints Replacement Left Hip Joint Open Synthetic substitute, ceramic Cemented Example 3: Transfusion of FFP via Central Vein Z 4 Administration Circulatory Transfusion Central Vein Percutaneous Frozen Plasma Nonautologous Volumes 2014 Midas+ Symposium May Tucson, AZ 10

11 Axial Component 2 Body System 0. Central Nervous 1. Peripheral Nervous 2. Heart and Great Vessels 3. Upper Arteries 4. Lower Arteries 5. Upper Veins 6. Lower Veins 7. Lymphatic and Hemic 8. Eye 9. Ear, Nose, Sinus B. Respiratory C. Mouth and Throat D. Gastrointestinal F. Hepatobiliary and Pancreas G. Endocrine H. Skin and Breast J. Subcutaneous Tissue and Fascia K. Muscles L. Tendons M. Bursa and Ligaments N. Head and Facial Bones P. Upper Bones Q. Lower Bones R. Upper Joints S. Lower Joints T. Urinary U. Female Reproductive V. Male Reproductive W. Anatomical Regions, General X. Anatomical Regions, Upper Extremities Y. Anatomical Regions, Lower Extremities Axial Component 2 Body System Section Body System Root Operation Body Part Approach Device Used Qualifier Example 1: Total Right Hip Replacement, Metal 0 S R A Med-Surg Lower Joints Replacement Right Hip Joint Example 2: Total Left Hip Replacement, Ceramic, Cemented Open Synthetic substitute, metal Uncemented 0 S R B Med-Surg Lower Joints Replacement Example 3: Transfusion of FFP via Central Vein Left Hip Joint Open Synthetic substitute, ceramic Cemented Z 4 Administration Circulatory Transfusion Central Percutaneous Frozen Nonautologous Vein Plasma 2014 Midas+ Symposium May Tucson, AZ 11

12 Axial Component 3 Root Operation (This example goes only with Med-Surg from Segment 1) 0. Alteration 1. Bypass 2. Change 3. Control 4. Creation 5. Destruction 6. Detachment 7. Dilation 8. Division 9. Drainage B. Excision C. Extirpation D. Extraction F. Fragmentation G. Fusion H. Insertion J. Inspection K. Map L. Occlusion M. Reattachment N. Release P. Removal Q. Repair R. Replacement S. Reposition T. Resection V. Restriction W. Revision U. Supplement X. Transfer Y. Transplantation Axial Component 3 Root Body Root Approach Operation Section System Operation Body Part Device Used Qualifier Example 1: Total Right Hip Replacement, Metal 0 S R A Med-Surg Lower Joints Replacement Right Hip Joint Example 2: Total Left Hip Replacement, Ceramic, Cemented Open Synthetic substitute, metal Uncemented 0 S R B Med-Surg Lower Joints Replacement Example 3: Transfusion of FFP via Central Vein Left Hip Joint Open Synthetic substitute, ceramic Cemented Z 4 Administration Circulatory Transfusion Central Percutaneous Frozen Nonautologous Vein Plasma 2014 Midas+ Symposium May Tucson, AZ 12

13 Axial Component 4 Body Part This varies with each Body System chosen Axial Component 2- Body System Axial Component 4- Body Part 1 G L 2-Cardiac Coronary Artery, 2 Sites Mitral Valve Ventricle, Left W-Anatomic Region Thumb, Right Lower Back B-Respiratory Trachea Upper Lung Lobe, Left Lung, Left Axial Component 4 Body Part This varies with each Body System chosen Section Body System Root Operation Body Part Approach Device Used Qualifier Example 1: Total Right Hip Replacement, Metal 0 S R A Med-Surg Lower Joints Replacement Right Hip Joint Example 2: Total Left Hip Replacement, Ceramic, Cemented Open Synthetic substitute, metal Uncemented 0 S R B Med-Surg Lower Joints Replacement Example 3: Transfusion of FFP via Central Vein Left Hip Joint Open Synthetic substitute, ceramic Cemented Z 4 Administration Circulatory Transfusion Central Percutaneous Frozen Nonautologous Vein Plasma 2014 Midas+ Symposium May Tucson, AZ 13

14 Axial Component 5 - Approach Approach 0 Open 3 Percutaneous 4 Percutaneous endoscopic 7 Via natural or artificial opening 8 Via natural or artificial opening endoscopic X Closed/External Axial Component 5 - Approach Section Body System Root Operation Body Part Approach Device Used Qualifier Example 1: Total Right Hip Replacement, Metal 0 S R A Med-Surg Lower Joints Replacement Right Hip Joint Example 2: Total Left Hip Replacement, Ceramic, Cemented Open Synthetic substitute, metal Uncemented 0 S R B Med-Surg Lower Joints Replacement Example 3: Transfusion of FFP via Central Vein Left Hip Joint Open Synthetic substitute, ceramic Cemented Z 4 Administration Circulatory Transfusion Central Percutaneous Frozen Nonautologous Vein Plasma 2014 Midas+ Symposium May Tucson, AZ 14

15 Axial Component 6 Device Used (depends on System and Body Part) Example 1- Total Hip Replacement Example 3- FFP Transfusion Med-Surg Lower Joints Administration - Circulatory 1 Synthetic Substitute, Metal A Stem Cells, Embryonic 2 Synthetic Substitute, Metal on Polyethylene G Bone Marrow 3 Synthetic Substitute, Ceramic H Whole Blood 4 Synthetics Substitute, Ceramic on Polyethylene K Frozen Plasma 7 Autologous Tissue Substitute N Red Blood Cells J Synthetic Substitute Q White Cells K Nonautologous Tissue Substitute R Platelets T Fibrinogen V Antihemophilic Factors WFactor IX Axial Component 7 Qualifier Section Body System Root Operation Body Part Approach Device Used Qualifier Example 1: Total Right Hip Replacement, Metal 0 S R A Med-Surg Lower Joints Replacement Right Hip Joint Example 2: Total Left Hip Replacement, Ceramic, Cemented Open Synthetic substitute metal Uncemented 0 S R B Med-Surg Lower Joints Replacement Example 3: Transfusion of FFP via Central Vein Left Hip Joint Open Synthetic substitute ceramic Cemented Z 4 Administratio Circulator Transfusion Central Percutaneous Frozen Nonautologous n y Vein Plasma 2014 Midas+ Symposium May Tucson, AZ 15

16 Which is not a real ICD-10 CM Code? W55.22 Struck by a cow W56.21 Bitten by an orca W61.33 Pecked by a chicken W61.39 Sprayed by a skunk W61.62 Struck by a duck Of course, W Sprayed by a skunk is not an actual ICD-10 code 2014 Midas+ Symposium May Tucson, AZ 16

17 But W Bitten by an orca is an actual code. Go figure Midas+ Symposium May Tucson, AZ 17

18 Midas+ and ICD-10 Transition Strategy ICD-10 codes can be loaded into the existing Diagnosis and Procedure Dictionaries. (#43 and #44) This allows seamless historical reporting and longitudinal data integrity No application version upgrade is required to accommodate ICD-10 codes in our products. A software modification to existing versions is needed to properly process interface transactions containing ICD-10 codes. This no-cost overlay package can be delivered to versions 7.2 and higher. Midas+ and ICD-10 Transition Strategy Midas+ CPMS and DataVision enhancements that incorporate ICD-10 codes: Modifications to national measure sets based on requirements (Core Measures, AHRQ) Add ICD-10 codes to existing applicable pre-defined indicators to reflect analogous populations Retirement of metrics for which it is impossible to accurately reflect the same population using ICD-10 Creation of new metrics reflecting the higher level of specificity made possible by the use of ICD Midas+ Symposium May Tucson, AZ 18

19 Changes in Midas+ Version 2011 to Accommodate ICD-10s Standard Reports Modified The following reports have been modified to accommodate selection criteria for ICD-10 codes: ENC PROCEDURE SUMMARY ICD-9 PROCEDURE SUMMARY report has been renamed ENC PROCEDURE SUMMARY The From ICD-9 code: field in the report has been relabeled ICD-9/CPT Code From: The To ICD-9 code: field now simply reads To: An added field labeled ICD Code Is Like: allows pattern-matching search capability The following two reports have also been updated to use Is Like for ICD-10: QM ADM/ATT PHYS PROFILE QM DISEASE PROFILE The content of the generated reports has not changed, with the exception of renaming ICD-9 column headers to ICD Midas+ Symposium May Tucson, AZ 19

20 SmarTrack Changes in Version 2011 to Accommodate ICD-10s SmarTrack Variables Added to Support ICD-10 Dx and Px Codes: ENCOUNTER:DIAGNOSES:Diagnosis:Category ENCOUNTER:DIAGNOSES:Diagnosis:Code Is Like ENCOUNTER:Principal Diagnosis:Code Is Like ENCOUNTER:PROCEDURE:Procedure:Section/Body System ENCOUNTER:PROCEDURES:Procedure:Code Is Like ENCOUNTER:Principal Procedure:Code Is Like These variables can be used in any rule or indicator that identifies encounters. The pattern search capability applies to codes only, not to descriptions. Building SmarTrack Rules If you know the exact code you are building a rule on, you can continue to use existing fields: Encounter:Diagnosis:Diagnosis Encounter:Principal Diagnosis Encounter:Procedures:Procedure Encounter:Principal Procedure and All corresponding Previous or Next Diagnosis or Procedure fields Exact Code entered = V98.3XXS 2014 Midas+ Symposium May Tucson, AZ 20

21 Building Rules on ICD-10 Diagnoses ENCOUNTER:DIAGNOSES:Diagnosis:Category ENCOUNTER:DIAGNOSES:Diagnosis:Code Is Like ENCOUNTER:Principal Diagnosis:Code Is Like ICD-10 CM Category Codes (first 3 characters) Infectious & Parasitic Neoplasms Blood, Blood forming organs, immune mechanisms Endocrine, nutritional, & metabolic Mental & behavioral disorders Nervous system & sensory organs Eye, ear and mastoid Circulatory diseases Respiratory diseases Digestive diseases Skin and subcutaneous tissue Musculoskeletal and connective tissues Genitourinary Pregnancy, childbirth, and puerperium Newborn Congenital malformations and chromosomal abnormalities Symptoms, signs abnormal clinical finding NEC Injury, poisoning, and certain other external causes External cause of morbidity Factors influencing health status and contact with health services A00-B99 C00-D49 D50-D89 E00-E89 F01-F99 G00-G99 H00-H95 I00-I99 J00-J99 K00-K94 L00-L99 M00-M99 N00-N99 O00-O9A P00-P96 Q00-Q99 R00-R99 S00-T88 V01-Y99 Z00-Z Midas+ Symposium May Tucson, AZ 21

22 ICD-10 CM Categories: J09 J30 J09 J10 J11 J12 J13 J14 J15 J16 J17 J18 J20 J21 J22 J30 Influenza due to certain identified influenza viruses Influenza due to other identified influenza virus Influenza due to unidentified influenza virus Viral pneumonia, not elsewhere classified Pneumonia due to Streptococcus pneumoniae Pneumonia due to Hemophilus influenzae Bacterial pneumonia, not elsewhere classified Pneumonia due to other infectious organisms, not elsewhere clsfd Pneumonia in diseases classified elsewhere Pneumonia, unspecified organism Acute bronchitis Acute bronchiolitis Unspecified acute lower respiratory infection Vasomotor and allergic rhinitis 1908 Total CM (Diagnosis) Categories ICD-10 CM Category: B26 B26 Mumps B26.0 Mumps orchitis B26.1 Mumps meningitis B26.2 Mumps encephalitis B26.3 Mumps pancreatitis B26.8 Mumps with other complications B26.81 Mumps hepatitis B26.82 Mumps myocarditis B26.83 Mumps nephritis B26.84 Mumps polyneuropathy B26.85 Mumps arthritis B26.89 Other mumps complications B26.9 Mumps without complication 2014 Midas+ Symposium May Tucson, AZ 22

23 ICD-10 CM Category: G90 G90 Disorders of autonomic nervous system G90.0 Idiopathic peripheral autonomic neuropathy G90.01 Carotid sinus syncope G90.09 Other idiopathic peripheral autonomic neuropathy G90.1 Familial dysautonomia [Riley-Day] G90.2 Horner's syndrome (Bernard-Horner) syndrome G90.3 Multi-system degeneration of the autonomic nervous system G90.4 Autonomic dysreflexia G90.5 Complex regional pain syndrome I (CRPS I) / Reflex sympathetic dystrophy G90.51 Complex regional pain syndrome I of upper limb G Complex regional pain syndrome I of right upper limb G Complex regional pain syndrome I of left upper limb G Complex regional pain syndrome I of upper limb, bilateral G Complex regional pain syndrome I of unspecified upper limb G90.52 Complex regional pain syndrome I of lower limb G Complex regional pain syndrome I of right lower limb G Complex regional pain syndrome I of left lower limb G Complex regional pain syndrome I of lower limb, bilateral G Complex regional pain syndrome I of unspecified lower limb G90.59 Complex regional pain syndrome I of other specified site G90.8 Other disorders of autonomic nervous system G90.9 Disorder of the autonomic nervous system, unspecified Encounter:Diagnosis:Diagnosis:Category 2014 Midas+ Symposium May Tucson, AZ 23

24 Searching Diagnoses and Procedures in SmarTrack You can search by Code or Description, use Begins With, Is Like, and Contains, AND sort your dictionary by either the Code or Description. Searching with Wildcards Use the wildcards % and _ (underscore) to search for diagnosis codes with certain patterns. % is used in a string to indicate inclusion of any characters that follow. _ (underscore) is used as a placeholder to capture any character in that position Midas+ Symposium May Tucson, AZ 24

25 ENCOUNTER:DIAGNOSES:Diagnosis:Code Is Like For example: O64 = Obstructed Labor To capture all obstructed labors due to breech presentation of the fetus, enter O64.1% as a condition variable. ENCOUNTER:DIAGNOSES:Diagnosis:Code Is Like Wildcard _ (underscore) Use underscore to capture all characters in a specified position. Because of the structure of ICD-10 s, there must be an exact match in the other positions in the code. To capture all closed fractures of the left humerus: 2014 Midas+ Symposium May Tucson, AZ 25

26 All of the diagnoses indicated represent an initial encounter for a closed fracture of the left humerus. Those codes all start with S42.2 and end with A. To ignore the two characters between the second 2 and the A, use two underscores, and search for S42.2 A Diagnosis:Code Is Like The same logic applies when building rules for: ENCOUNTER:Diagnosis:Diagnosis:Code Is Like ENCOUNTER:Principal Diagnosis:Code Is Like 2014 Midas+ Symposium May Tucson, AZ 26

27 Building Rules on ICD-10 Procedures ENCOUNTER:PROCEDURE:Procedure:Section/Body System ENCOUNTER:PROCEDURES:Procedure:Code Is Like ENCOUNTER:Principal Procedure:Code Is Like ENCOUNTER:Principal Procedure:Section/Body System When building rules on Procedures, this new condition evaluates the first two segments in the PCS Codes Midas+ Symposium May Tucson, AZ 27

28 ENCOUNTER:PROCEDURE:Procedure:Section/Body System ENCOUNTER:Principal Procedure:Section/Body System In this case 02 was entered (there are 2148 procedure codes that start with 02) ENCOUNTER:PROCEDURES:Procedure:Code Is Like ENCOUNTER:Principal Procedure:Code Is Like Section Body System Root Operation Body Part Approach Device Used Qualifier 0 Med/Surg 2 Cardiac 1 Bypass 1 Coronary Artery, Two sites 0 Open 9 Autologous Venous Tissue 1 Coronary Artery 0 Med/Surg 2 Cardiac 1 Bypass 2 Coronary Artery, Three sites 0 Open Z No Device C Thoracic Artery 0 Med/Surg 2 Cardiac 7 Dilation 1 Coronary Artery, Two sites 3 Percutaneous D Intraluminal 6 Bifurcation 0 Med/Surg 2 Cardiac 1 Bypass K Ventricle, right 0 Open Z No Device F Abdominal Artery 0 Med/Surg 2 Cardiac Q Repair K Ventricle, right 3 Percutaneous Z No Device Z No Qualifier 2014 Midas+ Symposium May Tucson, AZ 28

29 Procedures Section:Body System (samples) 0T 0U 0V 0W 0X 0Y 2W 2Y 3C 3E 4A 4B 5A 6A 7W 8C 8E 9W Medical and Surgical:Urinary System Medical and Surgical:Female Reproductive System Medical and Surgical:Male Reproductive System Medical and Surgical:Anatomical Regions, General Medical and Surgical:Anatomical Regions, Upper Extremities Medical and Surgical:Anatomical Regions, Lower Extremities Placement:Anatomical Regions Placement:Anatomical Orifices Administration:Indwelling Device Administration:Physiological Systems and Anatomical Regions Measurement and Monitoring:Physiological Systems Measurement and Monitoring:Physiological Devices Extracorporeal Assistance and Performance:Physiological Systems Extracorporeal Therapies:Physiological Systems Osteopathic:Anatomical Regions Other Procedures:Indwelling Device Other Procedures:Physiological Systems and Anatomical Regions Chiropractic:Anatomical Regions 102 Total Section/Body System Combinations ENCOUNTER:PROCEDURES:Procedure:Code Is Like ENCOUNTER:Principal Procedure:Code Is Like 027_3D% 2014 Midas+ Symposium May Tucson, AZ 29

30 Search Dictionary Using the Is Like Criteria 027_3D% Search Dictionary Using the Is Like Criteria 2014 Midas+ Symposium May Tucson, AZ 30

31 Reporting ICD-10s in ReporTrack The NEW Midas+ Conversion Utility To optimize reporting on new ICD-10 codes, all Indicators and ReporTrack reports using current ICD-9 dictionaries must be reviewed and modified to include the equivalent ICD-10 terms. This process may take a lot of time and resources to complete, so Midas+ has developed a potentially significant interim solution for Care Management Midas+ Symposium May Tucson, AZ 31

32 What is GEMS? The ICD-10 General Equivalency Mapping tools is a bidirectional crosswalk between ICD-9 and ICD-10 has been developed by: National Center for Health Statistics (NCHS) Centers for Medicare and Medicaid (CMS) American Health Information Management Association (AHIMA) American Hospital Association (AHA) 3M Health Information Systems GEMS Conversion Table The current GEMS table is imbedded in the Midas+ conversion process to allow you to view ICD-9 codes in reports and add the appropriate ICD-10s. Midas+ offers two separate conversion utilities as a package (at no charge); one for SmarTrack, and one for ReporTrack Midas+ Symposium May Tucson, AZ 32

33 Midas+ Conversion Utility The Midas+ Care Management ICD-10 Conversion Utility reviews the conditions of every SmarTrack Indicator and Rule for the presence of conditions pointing to the Diagnoses and Procedures tables. This utility reviews the qualifying ICD-9 terms and creates an equivalent set of qualifying ICD-10 terms which are then added to the Rule conditions. Once converted, these Rules would then be able to display qualifying records with ICD-9 and/or ICD-10 data at the same time. Conversion of Indicators and Reports The conversion of reports to include ICD-10s is a three step process: 1. Midas+ will run an analyzer to review your existing reports, and provide you with a report on what would be included if the utility was actually deployed. You would then have an idea of what you might need to modify to meet your needs. NOTE: Diagnoses and Procedures dictionaries must contain the most current ICD-9 and ICD-10 terms before beginning the conversion! 2014 Midas+ Symposium May Tucson, AZ 33

34 Conversion of Indicators and Reports 2. After your review, you can request a test conversion in your Midas+ test area. You can then practice modifying key converted items to meet your intentions and review the results. Conversion of Indicators and Reports 3. Finally, the actual conversion of your reports and indicators is run in your Midas+ production area. You must then make the appropriate modifications to your reports to have them function as intended. Remember that there will not be actual data in these reports that reflect ICD-10 data until 10/1/2015! 2014 Midas+ Symposium May Tucson, AZ 34

35 Conversion of Indicators and Reports Remember W56.21 Bitten by an Orca? What was that in ICD-9? ICD-10-CM W56.21XA Bitten by orca, initial encounter converts approximately to: ICD-9-CM E906.3 Bite of other animal except arthropod (not bitten by a beetle, scorpion, panda bear, etc.) What if you already have E906.3 in a patient s record as an ICD-9? What will it convert to in ICD-10? ICD-9-CM E906.3 converts approximately to: ICD-10-CM W55.01XA Bitten by cat, initial encounter Where are you with ICD-10? Fewer than 10% of Midas+ facilities have done any kind of ICD-10 conversion testing. Contact your Account Manager ASAP to get started! 2014 Midas+ Symposium May Tucson, AZ 35

36 Documents on the Clients Only Website: How to Search ICD-10s in SmarTrack or ReporTrack ICD10 Conversion Utility Which one is not a real ICD-10 Code? V Fall from heelies V50.2 Person outside of a pick-up truck injured in a collision with an animal W17.82 Fall out of a grocery cart W21.04 Struck by a golf ball W45.1 Paper cut W54.32 Lacerations from handcuffs X98.1 Assault by hot tap water 2014 Midas+ Symposium May Tucson, AZ 36

37 W Fall out of a grocery cart is an actual code! Thanks for attending. Are there any questions? Barbara Craig, SaaS Advisor Barbara.Craig@xerox.com TJ McGreevy, Solutions Advisor TJ.McGreevy@xerox.com 2014 Midas+ Symposium May Tucson, AZ 37