HP Enterprise Services International Classification of Diseases, 10th Edition (ICD-10) Presentation

Transcription

1 HP Enterprise Services International Classification of Diseases, 10th Edition (ICD-10) Presentation Presenter: (HP Enterprise Services) 09/ Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice

2 Agenda Objectives HPES/DCH Timeline ICD-10 Requirements What s changing with the ICD-10 Clinical Modification (CM) Format Structure and Examples ICD-10 Procedure Classification System (PCS) code changes 2

3 Agenda (continued) Specific Documentation Myths vs. Facts Resources Session Review Food for Thought Closing and Q&A Glossary of Acronyms 3

4 Objectives Information presented enables participants to: Manage the timeline for DCH/HPES ICD-10 conversion Explain the ICD-10 requirements Explain the changes to the ICD-10-CM format structure Explain the ICD-10-PCS code changes 4

5 ICD-10 Implementation Project Timeline 6

6 ICD-10 Requirements Centers for Medicare & Medicaid Services (CMS) Final Ruling as of August 24, 2012 October 1, 2014 is the compliance date for ICD-10-CM and ICD-10-PCS code sets for all covered entities (no exceptions) Adopts ICD-10-CM and ICD-10-PCS as a new code set under HIPAA replacing ICD-9-CM (Volumes 1, 2, and 3) ICD-10-CM is for diagnosis coding; all covered entities must transition to the new coding requirements 7

7 ICD-10 Requirements (continued) ICD-10-PCS is for all inpatient hospital procedure coding No impact on CPT or HCPCS ICD-9-CM codes will not be accepted for services provided on or after 10/1/14 ICD-10-CM/PCS codes will not be accepted for services provided prior to 10/1/14 Systems must accommodate both ICD-9-CM and ICD-10-CM/PCS 8

8 What s Changing With ICD-10-CM 9

9 ICD-9-CM Three to five characters ICD-10-CM Three to seven characters First digit numeric or alpha Digits two through five are numeric First digit alpha (not case sensitive) Digits two to three are numeric; Digits four through seven can be alpha (not case sensitive) or numeric Example: Essential Venous Hypertension, chronic, idiopathic, unspecified Example: I Essential Venous Hypertension, chronic, idiopathic, unspecified 13,000 codes 68,000 codes 10

10 Structure of ICD-10-CM codes Example S52.521A Torus fracture of lower end of right radius, initial encounter for closed fracture In this example, first three characters (S52) is the Category, fourth and fifth characters ( 5 & 2 ) represent the clinical detail and anatomic site, sixth character ( 1 ) indicates the right or left side, and the seventh character ( A ) provides the additional information such as type of encounter and so on. 11

11 Examples of ICD-10-CM Specificity Diabetes mellitus (ICD-9-CM category ) has been split into different category codes in ICD-10-CM E08 E09 E10 E11 E13 Diabetes mellitus due to underlying condition Drug or chemical induced diabetes mellitus Type 1 diabetes mellitus Type 2 diabetes mellitus Other specified diabetes mellitus 12

12 Examples of ICD-10-CM Specificity (continued) Diabetes mellitus codes are expanded to include the classification of the diabetes and the manifestation E08.22 Diabetes mellitus due to an underlying condition with diabetic chronic kidney disease E09.52 Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene E10.11 Type 1 diabetes mellitus with ketoacidosis with coma E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy 13

13 ICD-10-PCS Inpatient Hospital Code Changes 14

14 ICD-10 PCS Section Coding Totals Medical and Surgical 61,896 Obstetrics 300 Placement 861 Administration 1,386 Measurement and Monitoring 339 Extracorporeal Assistance and Performance 41 Extracorporeal Therapies 42 Osteopathic 100 Other Procedures 60 Chiropractic 90 Imaging 2,934 Nuclear Medicine 463 Radiation Oncology 1,939 Rehabilitation and Diagnostic Audiology 1,380 Mental Health 30 Substance Abuse Treatment 59 Total 71,920 15

15 Structure of ICD-10-PCS 16

16 Structure of an ICD-10-PCS Code 1. Section e.g., Medical and Surgical, Imaging, Obstetrics 2. Body System e.g., Respiratory, Upper Veins, Lower Veins 3. Root Operation e.g., Excision (partial removal), Resection (complete removal), Extraction (removal by force) 4. Body Part Left Inner Ear, Cervix, Right Lesser Saphenous Vein 5. Approach Open, Percutaneous 6. Device Drainage device, Irrigating Substance 7. Qualifier Diagnostic, Bilateral 17

17 What s Different in ICD-10- PCS? Specificity! Especially in the Medical and Surgical Section out of 72k ICD-10-PCS codes, 62k of them are in the Medical and Surgical section. Each code contains much more detailed information What was done (i.e., specific operational definitions)? Where was it done (e.g., which specific tendon, and what side)? How did you do it (e.g., what approach, what device)? 18

18 What s Different in ICD-10- PCS? (continued) Root operations have specific definitions that may be different from how you use those terms in your practice. Physicians are not expected to use the terms as defined in the code set as long as there is enough information to correlate the documented procedure to the defined PCS term. 19

19 What s Different in ICD-10- PCS? (continued) Codes are precise in their definitions, and a much greater level of anatomical detail will be required for correct coding. All seven characters must always be used. Physicians and other providers will have to train themselves to include more specific details about body parts to avoid unnecessary queries. Example: ICD-9-CM - Insertion of one vascular stent ICD-10-CM - Dilation of Right Pulmonary Vein with Drug-eluting Intraluminal Device, Open Approach 20

20 Specific Documentation Documentation of diagnoses and procedures: ICD-10 codes must be supported by medical documentation, medical record documentation should be specific If the documentation is not clear, ask the rendering provider for clarification New ICD-10 coding system will mean new coverage policies and system edits Changes will be made to accommodate increased specificity Note: Contact each vendor, heath plan, device manufacturer, and other trading partner to determine what changes they are making and how they will help support the practice through the transition. 21

21 ICD-10 Myths vs. Facts Myth: There will be no hard-copy ICD-10-CM code books and all coding will need to be performed electronically. Fact: ICD-10-CM code books are already available and are a manageable size. The use of ICD-10-CM is not predicated on the use of electronic hardware and software. Myth: Unnecessarily detailed medical record documentation will be required. Fact: Medical record documentation needs to be more specific (In ICD-10-CM, the codes are much more specific so before a code is assigned, clinical documentation must be present to support the specificity of the code). Myth: The increased number of codes will make ICD-10-CM impossible to use. Fact: DCH/HPES is using the General Equivalence Mapping (GEM) and a clinical team to make sure mapping is optimized. 22

22 Resources HP Enterprise Services will conduct statewide workshops The ICD-10 Final Rule CMS Training 07_ICD-10TrainingSegments.asp Complete list of code sets for ICD-10-CM and ICD-10-PCS; Final Rule and Official ICD-10-CM Guidelines DCH ICD-10 Mailbox 23

23 Resources (continued) CMS ICD-10 References ICD-10 Remediation Project Fact Sheet DCH/HP Enterprise Services will reach out to the other agencies (DJJ, DOC, PH and DBHDD) Centers for Disease Control and Prevention (CDC) ICD-10-CM (USA - modification) Centers for Medicare & Medicaid Services (CMS) ICD-10 Overview CMS Transaction and Code Sets Overview 24

24 Resources (continued) ICD-10 and 5010 Regulations CMS ICD-10 Implementation Planning World Health Organization (WHO) ICD-10 Page CMS ICD-10 Vendor Conference Executive Summary CMS ICD-10 Vendor Conference Video 25

25 Session Review You should now be able to: Understand and adhere to the timeline for DCH/HPES ICD-10 Conversion Explain the ICD-10 Requirements Explain the changes to the ICD-10-CM format structure Explain the ICD-10-PCS Code Changes 26

26 Food for Thought Has your office developed a training plan? Have you started working with your clearinghouse? When will you start working and testing with your clearinghouse/trading partner? Have you considered operational changes: Billing? Forms according to payer? 27

27 Closing and Q&A 28

28 Glossary of Acronyms 29

29 Acronym CMS CPT DBHDD DCH DOC DJJ GEM HCPCS HIPAA HPES ICD-10-CM ICD-10-PCS PH Term Center for Medicare and Medicaid Services Current Procedural Terminology Department of Behavioral Health and Developmental Disabilities Department of Community Health Department of Corrections Department of Juvenile Justice General Equivalence Mapping Healthcare Common Procedure Coding System Health Insurance Portability and Accountability Act Hewlett Packard Enterprise Services International Classification of Diseases10th Clinical Modification International Classification of Diseases10th Procedure Classification System Public Health 30