ICD-10... What Are You Waiting For? Presented by Jennifer Warfield, BSN, HCS-D, COS-C Education Director, PPS Plus Software
ICD-10... What Are You Waiting For? What is it? International classification for all general epidemiological, many health management purposes, and clinical use Published by the World Health Organization (WHO) & adopted in 1990 US implemented in 1979 with modifications 10 versions of ICD to date Will You Be Ready? Implementation originally set for Oct. 1, 2013 Recently extended to Oct. 1, 2014 Home Health industry will only utilize ICD-10-CM One last revision to be made in 2014 with regular annual updates beginning Oct. 1, 2015. Highlights ICD-10-CM will replace the ICD-9-CM diagnosis codes rendered in all settings ICD-10-PCS will replace the ICD-9-CM procedure codes rendered within the hospital inpatient setting Mapping files that allow the industry to convert from ICD-9-CM to ICD-10-CM & ICD-10-PCS codes and vice versa have been created ICD-10-CM involves 2 components 1. ICD-10-CM for reporting diagnoses 2. ICD-10-PCS for reporting procedures in inpatient hospital facility services Rationale for Change ICD-9-CM lacks specificity and detail for reporting diagnoses laterality combination codes sequelae ICD-9-CM has been in use since 1979, and no longer reflects advances in medical treatment ICD-10 has been in use for most industrialized countries for 20+ years Number of Codes Diagnoses Codes ICD-9-CM 14,315 ICD-10-CM 69,099 Procedure Codes ICD-9-CM 3,838 ICD-10-PCS 71,957 1
Code Set Improvements ICD-10-CM consists of 21 chapters compared to 17 chapters in ICD-9-CM Added info relevant to ambulatory and managed care Expanded injury codes, grouped by anatomical site (e.g. head, arm, leg), then by injury type (e.g. fracture, burn) Creation of combination dx/sx or manifestation codes to reduce the number of codes needed Certain diseases have been reclassified to a more appropriate chapter Addition of placeholder X for future expansion Addition of 6th & 7th characters to represent expansion, sequelae or visit encounter Added laterality V & E codes no longer supplemental codes Post-op complications grouped within a procedure or specific body system chapter Diseases of the eyes and ears have been separated from the nervous system chapter and have their own chapters Similarities & Differences Both use alpha numeric codes ICD-9 is considered alpha numeric because of E & V codes All codes in ICD-10 are alpha numeric Has the same hierarchical structure Both use chapter specifi c codes Major differences in organization, structure, code composition & level of detail Alpha in ICD-10 First character is always alpha Beware of 0 vs O, 5 vs S, 1 vs I Alpha characters are not case-sensitive U is the only letter not used Comparison ICD-9-CM (438.21) 3-5 characters 1st character is numeric or alpha 2nd 5th characters numeric At least 3 characters Decimal after 3rd character ICD-10-CM (I69.951) 3-7 characters 1st character is alpha 2nd character numeric 3rd 7th characters alpha or numeric Use of placeholder x Alpha characters are not case-sensitive 2
ICD-10-CM Format x x x. x x x x CATEGORY ETIOLOGY, ANATOMIC SITE, SEVERITY EXTENSION Sneak Preview ICD-9-CM 250.x Diabetes mellitus - 5th digit 1 type I - 5th digit 0 type II or unspecified - 5th digit 2 & 3 uncontrolled 249.x Secondary diabetes mellitus - 5th digit 0 & 1 uncontrolled 648.8x Abnormal glucose tolerance complicating pregnancy, childbirth, or puerperium (includes gestational diabetes) ICD-10-CM Diabetes codes include type of complication E08 Diabetes mellitus due to underlying condition E09 Drug or chemical induced diabetes mellitus E10 Type 1 diabetes mellitus E11 Type 2 diabetes mellitus E13 Other specified diabetes mellitus O24.4 Gestational diabetes mellitus *Use additional Z79.4 for insulin use Structural Differences ICD-9-CM ICD-10-CM Pneumonia 486 J18.9 Insulin use V58.67 Z79.4 CHF NOS 428.0 I50.9 Open femur fx (neck) 820.9 S72.009B Pressure ulcer of R heel, stage II 707.07 & 707.22 L89.612 Obstructed labor breech presentation 763.x O64.1xx 3
New Features in ICD-10-CM 1. Laterality (left, right, bilateral) Example: Pressure ulcer of R elbow, stage II 707.01 L89.012* 707.22 *6th Character indicates the stage 2. Combination Codes for Symptoms & Manifestations Example: Type 1 diabetes with diabetic nephropathy 250.41 E10.21 583.81 Example: Atherosclerotic heart disease of native coronary artery with unstable angina 414.01 I25110 411.1 3. Combination Codes for Poisonings & Associated Causes Example: Poisoning by barbiturates, intentional self-harm 967.0 T42.3x2S E950.1 *x is placeholder for future expansion *S indicates that condition is a sequela 4. Obstetric Codes for Trimesters Example: Excessive weight gain in 2nd trimester No Code for this O26.02* *2 indicates 2nd trimester 5. Character x to Allow for Future Expansion Example: Foreign body in cornea, left eye, subsequent encounter No Code for this T15.02xD *x is placeholder for future expansion *D indicates subsequent encounter 6. Two Types of Excludes Notes Excludes1 Indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. Excludes1 codes are mutually exclusive. Example: B06 - Rubella Excludes1: P35 - Congenital rubella 4
Excludes2 Indicates that the condition excluded is not part of the condition represented by the code, but patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, if the documentation in the medical records indicates both conditions. Example: J04 Acute laryngitis Excludes2: chronic tonsillitis (J37.0) 7. Inclusion of clinical concepts that do not exist in ICD-9-CM (blood type, underdosing) Example: Underdosing of antithrombotic drug, subsequent encounter No Code for this T45.526D* *D indicates subsequent encounter 8. Significantly expanded codes (injuries, diabetes) Example: Type 2 DM with non-proliferative diabetic retinopathy & macular edema 250.50 E11.341 362.03 362.07 9. Expanded codes for post-operative complications & distinction made for intraoperative or post-procedural complication Example: Accidental puncture and laceration of digestive system during cholecystectomy 998.2 K91.71 863.90 Scenario Patient admitted to home care with a diagnosis of exacerbation of chronic obstructive asthma, senile dementia and diabetes with neuropathy Is on long-term use of insulin Also has a history of HTN ICD-9 Answer 493.22 Exacerbation of asthma 290.0 Senile dementia 250.60 Diabetes with neuro manifestation 357.2 Polyneuropathy 401.9 HTN V58.67 - Long-term use of insulin ICD-10 Answer J44.1 Exacerbation of chronic obstructive asthma F03.90 Senile dementia E11.42 Diabetes I10 HTN Z79.4 Long-term use of Insulin 5
Advice for Planning Other than IT, training & education will take the most resources (time & money). Questions to ask: Who needs training? How much do I budget for? When do I start training? Who will provide training? Decide who needs what level of training (don t forget billers) What training methods do I use? Invite trainer in-house Key staff to attend outside training Train the trainer 2013 Goals Save in favorites: http://www.cms.gov/icd10 & sign up for automatic update e-mails Assign project manager and a team Prepare update meetings and calendar Assess the need for A & P training for coders (especially non-clinician coders) Talk with your software vendor and discuss their plan for transition Discuss in-house system impacts with IT staff Reserve intensive coder training until 6-9 months prior to implementation Familiarize staff with the structure, organization & distinct features of ICD-10-CM Learn about system impacts (staff, software, books) Resources & Links ICD-10 General Information http://www.cms.gov/icd10 MS DRG Conversion Report http://www.cms.gov/icd10/downloads/msdrgconversion.pdf ICD-10 Watch http://www.icd10watch.com/ 6
ICD-10 To-Do List Project Planning Designate a team leader, someone to spearhead all projects. Gather information from useful resources (i.e., professional associations) to provide your agency with knowledge on how to prepare for the changes that will occur with the release of ICD-10. Research and review the ICD-10 code set to gain a better understanding of the upcoming changes. Create a project plan that will focus on main headers below. Impact Assessment Compile a contact list which includes a primary contact name, phone number and email address for: All Vendors Billing Service Company Clearinghouse(s) Payers Contact everyone in your contact list to learn about their plans for the release and implementation of ICD-10. Compile a list of your agency s clinical and administrative electronic systems and various work process systems that utilize ICD-9 codes. Identify which of these processes will need modifying for ICD-10. Identify any and all work flow adjustments that will need to take place for a successful ICD-10 implementation. Identify which of your staff members work with ICD-9 and what their involvement and duties are regarding ICD-9. Implementation Contact your vendor to learn when installation updates will occur. Contact your billing service company to learn when system changes will be installed. Contact clearinghouse(s) to learn when testing can start. Contact various payers to learn when testing can start. Perform various tests: Internal External testing with your billing service company External testing with your clearinghouse(s) External testing with payers Training Who: Identify which staff members need ICD-10 education and which level of education will be needed for each staff member. What: Review the time and costs necessary for training. When: Find out when the training will occur in relation to ICD-10 implementation. Where: Determine training location. How: Determine which training method(s) will be suitable for your staff. Begin staff training 6-9 months prior to implementation. Conversion & Monitoring Purchase ICD-10 coding books. Use ICD-10 codes for all discharges and services occurring on or after October 1, 2014. Examine the ICD-10 code processing. Be aware of things like code rejections, reimbursement changes, etc.
Thanks for Attending! Feel free to contact us with any questions. Jennifer Warfield, BSN, HCS-D, COS-C jennifer@ppsplus.com 1-888-897-9136 Join the PPS Plus Conversation!