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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 It’s 30 years old, terminology is outdated, uses outdated codes that produce inaccurate and limited data and is inconsistent with current medical practice.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 ICD-10-CM/PCS 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 codes 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 condition Addition of a 6th & 7th character The 7th character describes the encounter – A (initial), D (subsequent, & S (sequela) › Example: S06.336A Incorporation of common 4th & 5th-digit subclassifications Updated diabetes codes; providing greater specificity when assigning codes › Code descriptions state Type 1/Type 2 › E11.21 reports Type 2 diabetes with diabetic neuropathy › 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 ICD-9 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 point 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 indented 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 guidelines. 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 condition) › 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 required 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 forms Billing – 5010 electronic procedures with new ANSCI procedures (electronic data interchange) Training – new policies and procedures and ICD-10-CM code set, CMS-1500 changes 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 training The coding systems will continue to be updated until such time that a decision is made to “freeze” the code sets prior to implementation. 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 international? What is the current status of ICD-10? Is the target date still to go into effect 2013? Why should I be concerned with ICD-10?
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