ICD10

Are You Prepared?

Presented by Cheri Welk, RHIT Manager, Physician Billing April 6, 2013

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A new Date!!
CMS Announces ICD10 will be delayed 1 year

Implementation is now October 1, 2014

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Where do you start? Depends on your role
Office/Practice Manager IT Departments Work with your software vendors Work with your payers Educate your providers

Coder Assess if you need additional training on Anatomy/Pathophysiology AAPC is requiring certified coders to take a proficiency assessment to maintain their CPC credential
Providers Work with your coders to assure your documentation supports the level of specificity required for ICD10

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End-to-End Testing Pilots Example; Qualedix QA and the North Carolina Healthcare Information and Communications Alliance (NCHICA) are piloting a trading partner certification program and an ICD-10 testing framework for end-to-end testing. Step 1: sharing of dual-coded clinical scenarios with two participating health plans, United Healthcare and Blue Cross Blue Shield of North Carolina Once the coding has been solidified, the transactions and associated file formats will be transferred to encoder products from 3M and Optum for internal testing to ensure that these products find the right codes, which already have been determined in the initial analysis based on the medical records The health plans will receive compliant 5010 transactions based on the exact clinical scenarios that were reviewed in order to ensure complete traceability to the original test cases. The health plans also will have the ability to test the transactions internally once their systems have been remediated, allowing them to produce accurate ICD-10-based adjudication and remittances. The reason this pilot sets the standard for key end-to-end testing methods is that it delivers the ability to show vendors, clearinghouses and health plans what actually will be sent and shared in a live environment as opposed to basing an entire testing effort on internal payer mappings only. Providers will gain crucial insights into various mapping rules and the contracts they have with each health plan, based on the developed clinical scenarios.

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Coder Training As quoted by the Centers for Medicare & Medicaid Services (CMS), the Robert E. Nolan Company performed a study on challenges of ICD-10 implementation and estimated that each full time coder will need up to 40 hours of ICD-10 training. Physicians and other clinicians will need additional training, ranging between 12 and 80 hours each
Due to the clinical nature of ICD-10-CM a strong understanding of, or

experience in anatomy and/or physiology will be required

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What does ICD10 look like? Guideline changes from ICD9---- assumptions made for causal relationships
Hypertension and Chronic Kidney Disease Diabetes

Laterality
For bilateral site, the final character indicates laterality.

Injury / Fracture Care

Episodes of care 7th Character Initial encounter Subsequent encounter
Sequela

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What does ICD10 Look Like? (continued) Greater level of detail with its seven (7) alphanumeric characters instead of the 5-digit ICD-9 code set.. Going from roughly 17,000 codes to about 140,000 ICD10-CM consists of 21 chapters compared to 17 chapters in ICD9-CM Contrasts to ICD9 where injuries are classified by injury; in ICD10, they are grouped first by specific site (head, arm, leg, etc.) In ICD10, there are code extensions (seventh character) for obstetrics, injuries and external causes of injuries. Addition of a place holder (x).

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ICD-9-CM Code Format ICD-10-CM Code Format

Category
Etiology, Anatomic site, manifestation
Extension

Category

Etiology, site, Manifestation

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Combination codes for conditions and common symptoms

ICD-10-CM
E10.21, Type I diabetes Mellitus

ICD-9-CM
250.41 Diabetes w/ renal manifestations,

with diabetic nephropathy

type I. 583.81 Diabetic nephropathy, NOS

414.01 Atherosclerotic heart disease of

I25.110 Atherosclerotic heart

disease of native coronary artery with unstable angina pectoris

Crohns Disease of large intestine with

native coronary artery 413.9 Angina Pectoris

555.1 Regional Enteritis Large Intestine 560.89 Other specified intestinal obstruction

intestinal obstruction

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ICD-10-CM
S06.0x1A Concussion with loss of

Rational
Dummy placeholder which is always the

consciousness of 30 minutes or less, initial encounter

letter x and it has two uses:

As the fifth character for certain six character codes. The x provides for future expansion without disturbing the sixth character structure When a code has less than six characters and a seventh character extension is required. The x is assigned for all characters less than six in order to meet the requirement of coding to the highest level of specificity.

Seventh-character extension for episode of

care

A Initial encounter D Subsequent encounter S - Sequela

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General Equivalence Mappings (GEMS) Mappings between ICD-9-CM and ICD-10-CM classification systems have been developed to facilitate the transition from one code set to another. Public domain diagnosis code reference mapping files referred to as Diagnosis Code Set General Equivalence Mappings (GEMs) have been released by HCHS. There are to files available allowing for bidirectional mappings.
http://www.cdc.gov/nchs/icd/icd10cm.htm http://www.cms.hhs.gov/ICD10

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GEM File

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Crosswalk in EncoderPro

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Questions?

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Resources THERE IS HELP OUT THERE!!! Surgical Management Professionals CMS Website

http://www.cms.gov/Medicare/Coding/ICD10/index.html AHIMA Website http://www.ahima.org/icd10/ AAPC Website http://www.aapc.com/icd-10/