COUNTDOWN TO ICD-10. Transitioning from ICD-9 to ICD-10 4/6/2015. April 7, Suzy Harvey, RN Managing Consultant

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1 COUNTDOWN TO ICD-10 Transitioning from ICD-9 to ICD-10 April 7, 2015 Suzy Harvey, RN Managing Consultant Deborah Lake, RN Senior Managing Consultant 1

2 TO RECEIVE CPE CREDIT Participate in entire webinar Answer polls when they are provided If you are viewing this webinar in a group Complete group attendance form with Title & date of live webinar Your company name Your printed name, signature & address All group attendance sheets must be submitted to within 24 hours of live webinar Answer polls when they are provided If all eligibility requirements are met, each participant will be ed their CPE certificates within 15 business days of live webinar 2 OBJECTIVES Upon completion of this webinar, participants will be able to Discuss reasons for move to ICD-10 Identify how to utilize ICD-10 coding manual Describe how to apply ICD-10 to LTC environment 3 2

3 AGENDA History & ICD-10 Background Implementation Strategies Structure of ICD-10 Diagnosis Code Using ICD-10-CM Manual Final Thoughts 4 COUNTDOWN TO ICD-10 They re going to delay it again! What s the worst that can happen? We ve got lots of time! 5 3

4 HISTORY & ICD-10 BACKGROUND HISTORY Current ICD-9 Developed by World Health Organization (WHO) Adopted by U.S. in 1979 ICD-9 is over 30 years old Outdated & obsolete terminology Technology has changed significantly No room for growth Not sufficiently descriptive (specificity) Reimbursement & quality issues 7 4

5 ICD-10 BACKGROUND First published in 1992 by WHO Used in U.S. since 1999 to code & classify mortality data Final Rule ICD-10 published January 16, 2009 Several false starts Go live! October 1, WHY WE NEED ICD-10? Reimbursement is changing Enhance accurate payment for services rendered Redefine reimbursement methodologies Bundled payments ACOs Pay for performance Improved cash flow 9 5

6 WHY WE NEED ICD-10? Quality Better data performance measurement, outcome analysis, cost analysis, etc. Improved clinical documentation Flexibility To quickly incorporate emerging diagnoses & procedures Decreased administrative burden 10 WHY WE NEED ICD-10? Exact To identify diagnoses & procedures precisely To improve data reporting ICD-9-CM is lacking in all categories 11 6

7 COMPLIANCE DATES Single implementation date for all users Date of discharge for inpatient claims Date of service for outpatient claims ICD-9 codes will not be accepted for services provided on or after October 1, 2015 ICD-10 codes will not be accepted for services prior to October 1, EXPECTED OUTCOMES 1 Improve clinical documentation 2 Assignment of more specific codes 3 Increased specificity will result in more accurate reimbursement & quality data 13 7

8 IMPACT ON LTC PROVIDERS Documentation Coding Reimbursement Internal systems & processes Quality reporting 14 IMPLEMENTATION STRATEGY 8

9 IMPLEMENTATION STRATEGY Support from the top Establish interdisciplinary committee Identify project manager Develop action plans with detailed tasks ICD-9 clean up Review diagnosis histories Add end dates to resolved codes 16 IMPLEMENTATION STRATEGY Dual codes with ICD-10 Time frames Deadlines Responsible parties Identify resources required to complete tasks 17 9

10 IMPLEMENTATION STRATEGY Assess organizational readiness Identify affected individuals & systems Identify reports & forms that will require modification Identify policies & procedures that need to be developed or revised 18 IMPLEMENTATION STRATEGY Provide organization-wide ICD-10 awareness Physicians, department managers, MDS coordinator, senior management Regulatory requirements Value of new code sets Who may be affected How ICD-10 fits into SNF initiatives/procedures 19 10

11 IMPLEMENTATION STRATEGY Determine affected systems Identify data flow of reports that contain ICD-9 codes Determine vendor readiness now What expectations they have of your staff & vice versa Plans & timeframes System interactions 20 IMPLEMENTATION STRATEGY Assess time & costs related to implementation Software modification, education, staff time, hardware upgrades Consulting services, report redesign/reprinting, additional resources Assess training needs Who will need education? What type of education will be needed? How will it be delivered? Identify appropriate & cost-effective means of training 21 11

12 What Does ICD-10 Look Like? ICD-9 & ICD-10 COMPARISON Three to five digits First digit = numeric or alpha (E or V only) All other digits = numeric 23 12

13 ICD-10 COMPARISON Up to seven digits First digit = always alpha, except U Second digit = always numeric All other digits = combination 24 SEVENTH CHARACTER NEW The seventh character of code Adds additional information to describe encounter A = Initial encounter D = Subsequent encounter S = Sequela Must be used if applicable Example S32.9XXD Fracture of unspecified parts of lumbosacral spine and pelvis, subsequent encounter for fracture with routine healing 25 13

14 PLACE HOLDERS NEW Character x is used as a placeholder Allows for future expansion Fills empty characters for codes that require seven characters Examples T46.1x5A Adverse effect of calcium-channel blockers, initial encounter T15.02xD Foreign body in cornea, left eye, subsequent encounter 26 ICD-10-CM SPECIFICITY Detailed information is reflected when characters are added to the main category three-character code Example S52 Main category for Fracture of Forearm S52.5 Subcategory code for unspecified Fracture of the lower (or distal) end of radius S52.52 Sub classification code for Torus fracture of lower (or distal) end of radius 27 14

15 ICD-10-CM SPECIFICITY Examples S S52.521A Sub classification code for Torus fracture of lower (or distal) end of right radius Adding the required seventh character A specifies the type of encounter or stage of healing - Torus fracture of lower end of right radius, initial encounter for closed fracture 28 ICD-10 LATERALITY NEW Laterality Left, right & bilateral Applicable only to those code categories (or chapters) that need to define side or region of body where condition occurs, e.g., musculoskeletal, sense organs, integumentary Laterality is represented by fifth or sixth character & placement is dependent on code subcategory 29 15

16 ICD-10 LATERALITY NEW Fifth or sixth characters are defined as follows Right side = 1 Left side = 2 Bilateral = 3 Unspecified = 0 or 9 Examples L Pressure ulcer of right buttock, stage II L Pressure ulcer of left buttock, stage II 30 COMBINATION CODES NEW Code descriptions are expanded to include manifestations Reduces number of codes needed to describe a condition Example E Type 1 diabetes mellitus with diabetic neuropathic arthropathy Describes type, body system & manifestation 31 16

17 TYPE OF ENCOUNTER DEFINED Initial, subsequent or care of sequelae (i.e., late effects) Active treatment Examples: Surgical treatment, ER encounter, E/M by new physician Subsequent encounter Routine follow-up care, during healing phase Sequelae Complications of conditions that occur as a direct result of an injury or illness 32 WILL I STILL USE V CODES? Codes now located in Chapter 21 of ICD-10 code book Factors Influencing Health Status Codes will begin with Z (Z00 - Z99) Will not use same aftercare codes for fractures & injuries Will be used for circumstances other than disease or injury, i.e., dependence on ventilator (Z99.11) History codes (Z80 - Z87) may also be used if pertinent to care 33 17

18 Using ICD-10 Manual ICD-10 MANUAL ICD-10-CM (Clinical Modification) Table of Contents Introduction/How to Use Official Conventions and Guidelines Index to Diseases and Injuries Table of Neoplasms Table of Drugs and Chemicals Index to External Causes Tabular List of Disease and Injuries Illustrations of Body Systems 35 18

19 ICD-10 MANUAL Tabular list 21 chapters Chronological list of codes based on body systems or condition 36 ICD-10 MANUAL Locating a code Always locate main term first in alphabetic index Then verify code in tabular list Follow instructional notations that appear in both alphabetic index & tabular list Alpha index does not always provide full code Laterality & seventh character assigned in tabular list A dash at end of alpha index code may indicate additional characters are required 37 19

20 OTHER RESOURCES Recommended Medical Dictionary Pharmacy Desk Reference (PDR) Medical Terminology Anatomy & Physiology 38 FINAL THOUGHTS Embrace need for change Evaluate where you are in process Develop & set goals Communicate with vendors & payors Assess education & workflow needs Perform internal audits Test, test, test Be ready to go live 39 20

21 RESOURCES CMS site CMS ICD-10 resources ds/icd10resourcesflyer pdf AHIMA 40 RESOURCES Pathway Health ICD-10-CM Coding Essentials for LTC HealthStream The Impact of ICD-10 on Post-Acute Care Tom Ormondroyd, Louis Vick & Reagan Sanders 41 21

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23 CPE CREDIT CPE credit may be awarded upon verification of participant attendance For questions, concerns or comments regarding CPE credit, please the BKD Learning & Development Department at 44 THANK YOU! FOR MORE INFORMATION 23

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