ICD-10 -CM PCS What does it mean to us

ICD-10 -CM/PCS What does it mean to us? Lynda Starbuck, MS, RHIA, C-CDI AHIMA Approved ICD-10 -CM/PCS Trainer October, 2012

ICD-10 Timeline October 1, 2011 - Last full update to ICD-9 -CM and ICD-10 (revised with implementation delay) January 1, 2012 - 5010 electronic claims submission October 1, 2014 - ICD-10 codes required on all discharges (NEW DATE) October, 2012

ICD-10 -CM/PCS What is it? ICD-10 -CM US clinical modification of the World Health Organization’s ICD-10 Diagnostic coding system (no procedure codes) ICD-10 -PCS Developed under contract by CMS specifically to replace the ICD-9 -CM procedural coding system October, 2012

ICD-10 -CM Code Structure Alphanumeric Up to 7 characters Place holders of “x” are used when code is 5 characters and needs a seventh character code extension 21 chapters and codes are dispersed differently V and E codes are incorporated into the main code October, 2012

ICD-10 -CM Code Extensions CODE S 73. 011 A– Posterior subluxation, right hip, initial encounter 064. 0 XX 1 - Obstructed labor due to incomplete rotation of fetal head, fetus 1 of multiple October, 2012 MEANING Initial encounter, subsequent encounter, sequela Fetus number

ICD-9 -CM Full Code Titles ICD-9 -CM 802. Fracture malar, maxillary and zygoma bones - 802. 4 Closed - 802. 5 Open October, 2012 ICD-10 -CM S 02. 4 - S 02. 40 – Fracture of malar, maxillary, and zygoma bones, unspecified - S 02. 400 Malar Fracture, unspec. - S 02. 401 Maxillary Fracture, unspecified - S 02. 402 Zygomatic fracture, unspecified - S 02. 41 Le. Fort fracture - S 02. 411 Le. Fort I fracture - S 02. 412 Le. Fort II fracture - S 02. 413 Le. Fort III fracture

New Features Combination codes for conditions and common symptoms or manifestations Combination codes for poisonings and external causes Added laterality Expanded codes (injury, diabetes, alcohol/substance abuse, postoperative complications) Impending/threatening condition codes Injuries grouped by anatomical site rather than injury category October, 2012

Official Coding Guidelines Chapter Specific Infectious Disease - Urosepsis is a non-specific term – no reference in the alpha index - Post-procedural infection by procedure Mental and Behavioral Disorders - Added disorders due to psychoactive substance use Nervous System and Sense Organs - Hemiplegia/hemiparesis – new rule for dominant vs. non-dominant sides October, 2012

Chapter Specific Guidelines continued… Circulatory System - MI timeframes reduced to 4 weeks vs. 8 - Causal relationship assumed between CAD and Angina Obstetrics - Trimester indicated in code (or weeks of gestation) - Fetal extension – used to distinguish to which fetus complication applies October, 2012

Chapter Specific Guidelines continued… Injuries - Code extensions used to indicate what phase of care the patient is receiving (initial, subsequent, or sequela) Adverse effects / Poisonings - Includes under-dosing - Codes indicate how the adverse effect occurred October, 2012

ICD-10 -PCS Code Structure 1 st character is the Section 2 nd character is the Body System 3 rd character is the Root Operation 4 th character is the Body Part 5 th character is the Approach 6 th character is the Device 7 th character is the Qualifier October, 2012

ICD-10 -PCS Code Example PTCA with Stent RCA - Root Term – Dilation = Dilation - Artery >> Coronary >> Four or more sites 0273 >> One site 0270 >> Three sites 0272 >> Two sites 0271 October, 2012

ICD-10 -PCS Code Example… 027 table October, 2012

ICD-10 -PCS Obstetric Delivery- Forceps Extraction –pulling or stripping out or off all or a portion of a body part (10 D) - Products of Conception (10 DO) - Via Natural or Artificial Opening (10 DO 7) - No Device (10 D 07 Z) >> Qualifier – Mid Forceps-4 ICD-10 -PCS Code 10 D 07 Z 4 October, 2012

Impact of ICD-10 -CM/PCS Hospitals Potentially have the most system changes Advantage in added detail (to identify severity and reduced billing paperwork) Large learning curve for coders (no Coding Clinic guidance as of Oct. , 2013) More physician specificity required – thus more queries DRG ‘s / CC’s / MCC’s – have not been formulated for ICD-10 codes. October, 2012

IMPACT Healthcare Providers Non-inpatient facilities including physician offices will only use ICD-10 -CM, not ICD-10 -PCS CPT will continue to be used by Part B providers to describe procedures (all outpatient claims) Physicians will be asked to document specificity and detail Physicians offices will have to learn ICD-10 -CM (diagnosis only) Training and new materials cost Revising Super Bills October, 2012

Staff Training and Preparation Limited knowledge to Business office, Registration staff, Radiology, Lab, Unit secretaries, and IT staff who support coding software. Intermediate knowledge to Hospital Administration, Physicians, Finance, Rehabs, Home Health, Hospice, Case Management, and Outpatient Diagnostic coders High levels of knowledge to Inpatient coders, Outpatient Surgical Coders, Quality, Chief Medical Officer, Educators, Documentation Improvement Managers, and CDI Staff/Nurses. October, 2012

What should we be doing now? Conduct an ICD-10 update once a month in RAC/UR Committee CDI Chart Reviews – early identification of highimpact areas Creation of Queries for ICD-10 in relation to top 10 -15 DRG’s October, 2012

Impact of ICD 10 CM Acute Care Hospitals Required to use ICD-10 -CM and ICD-10 -PCS Potentially have the most system changes Advantage in added detail (to identify severity and reduce billing paperwork) Coder productivity is predicted to decrease by 1/3 for potentially up to 2 years. Medical Staff will be required to document more accurately October, 2012

IMPACT continued… Coding System Changes - Data trending challenges include maintenance of crosswalks among coding systems for longitudinal data analysis and the potential for faulty decisions due to distorted, inaccurate, or misinterpreted data Other Healthcare Providers -Non-inpatient facilities including physician offices will only use ICD-10 -CM, not ICD-10 -PCS -CPT will continue to be used by Part B providers to describe procedures (outpatient claims) October, 2012

Why ICD 10 Is Worth The Trouble Moving to the new code sets will permit improved efficiencies and lower administrative costs due to replacement of a dysfunctional classification system. This in turn allows: Increased use of automated tools to facilitate the coding process Decreased claims submission or claims adjudication costs Fewer rejected and improper reimbursement claims Greater interoperability Decreased need for manual review of health records to meet the information needs of payers, researchers, and other data mining purposes Decreased need for large research organizations to maintain dual classification systems (one for reimbursement and one for research) Reduced coding errors Reduced labor costs and increased productivity Increased ability to prevent and detect healthcare fraud and abuse October, 2012

ICD 10 Training Proposal ICD 10 Introduction Explanation of ICD 10, Benefits/Goals, Expectations, Deadlines (We suggest that All attend) Location: Webinar or on-site. Time expectation: 45 minute to 1 hour plus 15 min for test. Up to 3 separate sessions to allow for time constraints of attendees. October, 2012

Track 1: ICD History; ICD 10 basics; Comparison to ICD 9; ICD 10 structure and format; Conventions and Guidelines. Medical Terminology Basic Anatomy and Physiology Advanced Anatomy and Physiology October, 2012

Track 2: ICD History; ICD 10 basics; Comparison to ICD 9; ICD 10 structure and format; Conventions and Guidelines. Advanced Anatomy and Physiology October, 2012

Track 3: ICD History; ICD 10 basics; Comparison to ICD 9; ICD 10 structure and format; Conventions and Guidelines. CDI: What’s in it for me? Provider and facility profiling; Value based purchasing of Healthcare CDI : What is CDI and the requirements under ICD 10 CDI: OP and IP documentation Tips under ICD 10 CDI: Comparison of documentation of common diagnoses under ICD 19 and ICD 10 October, 2012

Track 4: ICD History; ICD 10 basics; Comparison to ICD 9; ICD 10 structure and format; Conventions and Guidelines. Financial Implications and Reimbursement under ICD 10 Assess ICD 10 impact on claims processing and productivity Identifying front-end edits based on the new ICD 10 code logic Develop action plans for post implementation payment issues (includes cross-walking both coding systems) Assess ICD 10 impact on both the inpatient and outpatient revenue cycles Update medical necessity coverage determination policies October, 2012

Track 5: ICD History; ICD 10 basics; Comparison to ICD 9; ICD 10 structure and format; Conventions and Guidelines. Coding Essentials for ICD 10 Assess ICD 10 impact on both internal and external review criteria Assess impact on Trauma Registries, Tumor Registries, and other clinical research provided to external agencies. Training clinic staff and coders in basic ICD-10 -CM coding (ICD -10 -PCS if necessary) October, 2012

WHO SHOULD ATTEND WHICH TRACK? (Suggestions only) ICD 10 Introduction: Hospital/Clinic Staff wide attendance Track 1: Nurses, coders, Transcriptionists, Radiology, Lab, Case management, Utilization Review Track 2: Nurses, coders, Transcriptionists, Radiology, Lab, Case management, Utilization Review Track 3: Physicians, Nurses, Case Management, Utilization Review Committee , HIM Staff Track 4: HIM Staff, Case Management, Utilization Review, Business office/Finance, Administration Track 5: HIM staff, UR committee, Coders, Business Office Note: There will be a short test after every session for every topic in each track. October, 2012

Webinars and on-site training sessions will be presented by: Terrance Govender MD, MBBCh, CHBC, C-CDI HCCS - Director of Medical Consulting Lynda Starbuck MS, RHIA, C-CDI AHIMA Certified ICD-10 Trainer HCCS -VP Coding Services October, 2012

References ICD-10 -CM/PCS – The Complete Official Draft Code Set, Draft 2011 MLN Matters/CMS CDI: Improve Documentation Now for Effective Transition Later – HCPro, Inc. "Why ICD-10 Is Worth the Trouble. " Journal of AHIMA 79, no. 3 (March 2008): 24 -29. AHIMA ICD-10 -CM/PCS Update (April, 2011) Journal of AHIMA (2011 and 2012) October, 2012