ICD 10 CMPresentation 1 by 5wuVvO


									   Does not provide the necessary detail for
    patients medical conditions or the
    procedures and services performed on
    hospitalized patients. ICD-9-CM. It’s 30
    years old, terminology is outdated, uses
    outdated codes that produce
    inaccurate and limited data and is
    inconsistent with current medical
    practice. It can’t begin to describe the
    Dx and inpatient procedures of care
    delivered in the 21st century.
 ICD-10-CM: Dx classification system
  developed by NCHS (National Center for
  Health Statistics) for use in all U.S.
  healthcare treatment settings. Dx
  coding under this system uses 3-7 alpha
  and numeric digits and full code titles.
 ICD-10-CM will replace ICD-9-CM,
  Volumes 1 & 2
 ICD-9 currently has 14,000+ codes and
  ICD-10 will have 69,000+ codes
 ICD-10-PCS is a code set designed to
  replace Volume 3 of ICD-9-CM for inpatient
  procedure reporting. It will be used by
  hospitals and by payers. ICD-10-PCS is
  significantly different from Volume 3 and
  will require significant training for users.
 Documentation requirements under ICD-10-
  CM/PCS are quite different, so inpatient
  medical record documentation will be
  affected by this change.
 ICD-10-PCS has nearly 71,000 seven-digit
  alpha-numeric codes
 All HIPAA covered entities MUST
  implement the new code sets with dates
  of service, or date of discharge for
  inpatients, that occur on or after
  October 1, 2013
 HHS has no plans to extend the
  compliance date for implementation of
 Scheduled to replace ICD-9 on October
  1, 2013
 U.S. is one of the only countries that has
  not adopted the ICD-10
 Still on target
 ICD-10 books are currently in DRAFT form
 Certified coders will be required to take
  a proficiency exam through AAPC,
  AHIMA or another certifying body
 Example: CPC – 75 question exam,
  open book, unproctored – 2 year time
  frame to be recertified, cost $60 – 2
  attempts to pass October 1, 2012 (one
  year before implementation of ICD-10)
  and ending September 30, 2014 (one
  year after implementation
 More ambulatory and managed care
 Expansion of injury codes
 Extensive expansion of injury codes allowing
  greater specificity
    › Example: S50.351A is the new code for
      superficial foreign body of right elbow. A 7th
      character designates the encounter: A-initial, D-
      subsequent, S-sequela (ICD-9 code is 913.6)
   Combination diagnosis/symptom codes to
    reduce number of codes to fully describe a
 Addition of a 6th & 7th character
 The 7th character describes the
  encounter – A (initial), D (subsequent, & S
    › Example: S06.336A
   Incorporation of common 4th & 5th-digit
   Updated diabetes codes; providing
    greater specificity when assigning codes
    › Code descriptions state Type 1/Type 2
    › E11.21 reports Type 2 diabetes with diabetic
    › E10.311 reports Type 1 diabetes mellitus with
      unspecified diabetic retinopathy with
      macular edema
   Over 250 diabetes codes with the ICD-10
   Laterality noted – right and left sides are
    designated within the code descriptions
    vs. RT & LT modifiers
    › Example: S51.011, Laceration without
      foreign body of right elbow
   Obstetrics has been reorganized
    › Based on “episode of care” in ICD-9 will be
      based on “trimester” in ICD-10
       Example: O71.02, Rupture of uterus before
        onset of labor, second trimester
 21 Chapters replace the current 17 in
 V & E codes will be incorporated into the
  code set (Chapter 20 – External Causes
  of Morbidity – V01-Y99 & Chapter 21 –
  Factors Influencing Health Status &
  Contact with Health Services – Z00-Z99)
 Addition of chapters for:
    › Eye & Adnexa, Ear & Mastoid Process
    › (Used to be in Nervous System)
 CMS & CDC have developed a
  crosswalk system from ICD-9 to ICD-10
  and ICD-10 to ICD-9
 Mapping will be done Chapter by
  Chapter – codes will not have decimal
 http://www.cms.gov/ICD10
    › Click on 2011 ICD-10-CM & GEMs
 Index and Tabular are set up the same
  as the ICD-9 with the exception of
  Alpha/Numeric numbers vs. just numeric
  numbers (3 to 5 digits changing to 3 to 7)
 Main terms are in BOLD, subterms are
 Each section in the Tabular begins with a
  unique letter and codes are arranged in
  numerical order after the letter assigned
  to the chapter
 ICD-10 guidelines are similar to ICD-9
 Coding conventions are similar
 Instructional notes have added an Excludes
  1 & 2 in ICD-10
    › Includes: diseases primarily recognized as
      communicable or indeterminable
    › Excludes 1 equals Not Coded Here (at same
      time as the code above Excludes 1 note – e.g.,
      can’t code congenital vs. acquired of same
    › Excludes 2 equals Not Included Here
   Code first/Use Additional Code
    › Equals Etiology/Manifestation Paired Codes
    › Underlying condition sequenced 1st followed
     by manifestation 2nd
 Code Also equals More than 1 code
 7th Character and placeholder x (codes
  <6 characters that have a 7th character
  requirement, x is placeholder
 More than just learning a new code set
  & upgrading software. This transition will
  affect every aspect of your practice.
 Labs – changes to documentation,
  forms, reporting
 Physician’s office – DOCUMENTATION,
  code training
 Nurses – prior authorizations – revised
  health plan coverage with updates of
 Billing – 5010 electronic procedures with
  new ANSCI procedures (electronic data
 Training – new policies and procedures
  and ICD-10-CM code set, CMS-1500
 Coding – new codes sets, ICD-9-CM &
  ICD-10-CM will be used concurrently for
  a time, more detailed A & P, help
  physicians with documentation hurdles
 Front desk – HIPAA privacy policies, new
  forms to sign
 System changes – updates will likely be
  required by systems which may require new
  ways of handling patient encounters
 Clinical – patient education on health plan
  policies, new ABN forms with patient
  education on new coverages; payments
  for services rendered, changes to superbills
  – may not be able to house codes on
  paper superbill.
   Managers – New policies & procedures –
    any policy tied to a code, disease
    management, tracking of PQRI will need to
    be changed to be compliant. Vendor
    contracts (hardware & software upgrades)
    › Health Plan Contracts – relationship of Dx to $
    › Budgets – software, hardware, training, new
      contracts – paperwork
    › Training Plan – everyone will need training –
      develop a plan to get that implemented
 Documentation will be HUGE!!!
 Specificity even more detailed
 Superbills & CMS-1500 changes
 Unspecified in ICD-10 will NOT be used as
  much because of more specific codes
 Health plans will be updated
 Training for everyone will be needed
 Coders & providers will need extensive
 The coding systems will continue to be
  updated until such time that a decision is
  made to “freeze” the code sets prior to
 For instance, the health care community
  may request that ICD-9-CM and ICD-10-
  CM/PCS codes not be updated on
  October 1, 2012 and be frozen with the
  October 1, 2011 updates.
 How will my organization be impacted
  with this new coding system? Increased
  cost factor?
 How will it impact the patients?
 How do we prepare for ICD-10? New
  software needed?
 Will those with coding credentials have
  to be re-credentialed?
 Will it be updated every year?
 How is it different from the current
  system? Is it a better system? Is it
 What is the current status of ICD-10? Is
  the target date still to go into effect
 Why should I be concerned with ICD-10?

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