Transcript ICD-10 International Classification of Diseases – CM “Time

January 29, 2014
ICD-10
ORIENTATION AND SHC
“PLAN”
PRESENTED BY
IN COODINATION WITH SHC
Rhonda Anderson, RHIA, President
Anderson Health Info. Systems, Inc.
940 W. 17th Street, Suite B
Santa Ana, CA 92706
Tel. 714-558-3887 Fax 714-558-1302
[email protected]
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OBJECTIVES
• Participants will identify:
– Dates for New ICD-10
– Administrative Support Needed
– Documentation support
– Some general coding guidelines
– SHC Work plan – Key timelines
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FINAL REGULATION
• Final Regulations were released in
January 2009
• Implementation Date is October 1, 2014
• All billing using ICD-10 begins 10/1/2014
• ICD-10 for billing purposes as far as ability
to accept the code known as “5010” was
required by October, 2012-SHC is in
compliance
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SHC ICD-10 PROJECT TEAM
• Steering Committee- Foothill Resource
Team – ( Aisha, Belen, Russell, Kathy Simpson,
Greg Sewell, Wesla, Karen Florez, Norma Martinez,
Tonya Martinez, Ted Chigaros, Rhonda Anderson)
• VPO’s / VPPS Support Team
• Regional Resource Team
• Facility Level Team
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ICD-10 “HAS TWO PARTS”
• ICD-10 CM – Clinical Modification –
Skilled Nursing will use “CM”
• ICD-10 PCS – Procedural Code System
(used for procedures, operations within
the hospital inpatient setting)
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WHAT DOES ICD-10
COMPLIANCE MEANS?
• ICD-10 compliance means that everyone
covered by HIPAA is able to successfully
conduct health care transactions using
ICD-10 codes
• All Billing Claims will be denied if not ICD10 by OCTOBER 1, 2014.
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WHO IS AFFECTED??
• Freestanding providers
• Ancillary services – “that means all of us
really” who provide services and bill for
them under Medicare, Medicaid/Cal and
private insurances
• Therapy Providers
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WHO IS AFFECTED?? -2
• Developed for the provider and the
coder….(person who may review the
documentation and determine if code is
accurate)
• Consistent, complete documentation
in the medical record is a major
emphasis
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STATE MEDICAID PROG. NEED
TO TRANSITION TO ICD-10
• Like everyone else covered by HIPAA,
state Medicaid programs must comply
with ICD-10
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REVIEW YOUR ROLE
• No you will NOT code!
– Leadership needs some information about
the importance
– To know resources – and resources
needed
– Identify SHC Project Team – initiated now
– Obtain assurance from the computer system
– To know that coding is correct – in future
to have a system to assure accuracy of
coding, billing, documentation
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CODES CHANGE EVERY YEAR
• ICD-10 codes will be updated every year
• Not in 2014 unless new technologies and
new diseases
• IN 2015 – regular updates (affects
training and also purchase of manuals –
computer alone is not enough.
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ICD-10 DIFFERENCES
• Organization – Two volumes
• Structure – Alphanumeric categories
rather than numeric categories.(has
“includes and excludes notes:
– Categories are three digits
– Chapters – re-arranged
– Titles have Changed – examples on
following slides
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ICD-10 DIFFERENCES -2
CHAPTER*
ICD-9-CM
ICD-10-CM*
1
Infectious and
Parasitic Diseases
2
Neoplasms
Certain Infectious and
Parasitic Diseases A00-B99
Malignant Neoplasms
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Diseases of the
Nervous System
and Sense Organs
Diseases of the
Nervous System
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Disease of the
Circulatory System
Diseases of the Eye
and Adnexa
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ICD-10 DIFFERENCES -3
CHAPTER*
ICD-9-CM
ICD-10-CM*
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Diseases of the
Respiratory
System
Diseases of the Ear
and Mastoid Process
H60-H95
9
Diseases of the
Digestive System
Diseases of the
Genitourinary
System
Diseases of the
Circulatory System
Diseases of the
Respiratory System
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ICD-10 DIFFERENCES -4
CHAPTER
ICD-9-CM
ICD-10-CM
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Diseases of the
Musculoskeletal
System and
Connective Tissue
Diseases of the
Musculoskeletal
System and
Connective Tissue
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Congenital
Anomalies
Disease of the
Genitourinary System
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ICD-10
• Code composition – increased specificity
• Level of detail
• May consist of up to 7 digits with the
seventh digit extensions representing
visit encounter or sequelae as stated
above
• Includes full code titles and no reference
back to common 4th and 5th digits)
• V and E codes are no longer supplemental
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ICD-10-CM DIAGNOSIS CODES –
FORMAT & STRUCTURE
• 3-7 characters in length
• Approximately 68,000 codes
• Digit 1 is alpha, digit 2 and 3 are numeric; digit
4-7 are alpha or numeric
• Decimal placed after the first 3 characters,
• All letters used except “U”
• Flexible for adding new codes
• Very specific
• Has laterality
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FIVE-SIX CHARACTER
SUBDIVISION
• Way too much detail…but it looks like
this!!
– J10.8 – Influenza due to other influenza virus
with other manifestations
– J10.81 – Influenza gastroenteritis
– J10.89 – Influenza with other manifestations:
• Influenzal encephalopathy
• Influenzal myocarditis
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FIVE-SIX CHARACTER
SUBDIVISION -2
• Way too much detail…but it looks like
this!!
– ANOTHER EXAMPLE – WITH
SPECIFICITY AND LATERALITY:
• S55.011 Laceration of ulnar artery at forearm
level, right arm
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MAPPING TOOLS
• Mapping from ICD-9 to 10 tools are
available, General Equivalence
Mappings (GEMS) – translation
dictionary for diagnoses
• Called “GEMS” – general equivalence
mappings
• CM – GEMS available
• PCS – GEMS just available last of
September (acute hospital mostly)
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GEM FILES
• Do not despair…you vendor should
prepare as much of a crosswalk as
possible
• NOTE: will require some conversion for
long term resident’s diagnoses by the
effective date of ICD-10
• Later TRAINING and how to use
them…Key to early review!!!
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THE WORKPLAN
TRANSITION TO ICD-10
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Work Plan to Facilities
• Steering Committee – Coordinating Dates
1.
2.
3.
4.
5.
February – Brief Orientation ( Webinar)
Feb 6 and Feb 7
March – 2 hours Webinar – 2 Sessions
March 18 and 20
April /May/June/July – “Live Trainings”
July /August– Each Facility will transition all Long Term
residents to ICD-10.
September 1 - All facilities ready ….Dual Coding ICD 9 and
ICD-10
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ICD-10 PROJECT PLAN -3
• Determine who and how many staff
needs training:
–
–
–
–
–
–
–
–
–
Facility Level ICD- 10 Team/ Attendees:
Administrator
DON
Medical Records
Diagnosis Coder – Nursing Supervisor
Biller
MDS
Admissions
Medical Director/ UR Doctors
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IMPROVE DOCUMENTATION
NOW
• All of the information that is required to
code according to ICD-10 is information
that is necessary to an individual’s care
and is already documented in the medical
record
• What we will ask is “how does your
documentation in your facility compare to
what is needed to code accurately using
ICD-10?
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ICD-10 CODES REQUIRE
• Clear focus to better documentation
• Absolutely critical to the success of ICD-10
• Good resident care –focused on
documentation:
– Affect so many facets of health care
downstream
– Quality measures to analytics, research,
payment and surveillance
– Must be as accurately documented, coded
and billed
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ICD-10 CODES REQUIRE -2
• Good resident care (cont.)
– Requires i.e., physician, nursing, therapy–
efforts to provide good documentation
– ?? To Ask
– What are you documenting today?
– Evaluate documentation “best practices” to
increase quality/quantity as needed
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ICD-10 CODES REQUIRE -3
• Recognition of:
– Impact of ICD-10 (not new but = new focus
– medical, financial, even regulatory
ramifications
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DEVELOP THE RELATIONSHIP
BETWEEN CLINICIANS
• Clinicians Director of Nursing (DON) do
not need to understand all of the
intricacies of coding, and coders do not
need to understand all of the medical –
but the 2 must work together to ensure
optimal accuracy
• Increase questions from coders as there
is a need to understand basic anatomy
and pathophysiology.
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STRATEGIES FOR TRAINING
• Leadership are those individuals who are
responsible for moving things through the
organization:
– Understand what the impact of ICD-10 will be
– What challenges are anticipated
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STRATEGIES FOR TRAINING -2
• Training Medical Record, MDS/PPS,
DON, Business Office, Inquiry Staff,
Medical Director:
– Have training
– Parallel coding taking the same cases and
coding them accurate to ICD-9 and ICD-10
– Parallel training and testing
– Start in early 2014
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STRATEGIES FOR TRAINING -3
• Leadership should understand enough
about the coding changes to understand
the implications:
– Documentation
– Business practices
– MDS / Medicare PPS
– $$ impact for training, implementation and
billing
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RESOURCES
• HIM Consultant – ICD-10 Certified and
Specialized Training
• SHC Team members who have been to
training will be “ Trainer” resource
• DCR’s / Medical Records Consultant will
assist in Training Facilities
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WHY PREPARE NOW?
• Major understanding for providers, payers and
vendors
• Will drive business and systems changes,
hospital, SNF, Physicians, Outpatient, et’l, from
large national health plans to small provider
offices, laboratories, medical testing centers
• Staff time – start looking at who is affected
now and what they need to know
• Financial resources
• Options for ICD-10 transition
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ICD-10 PROJECT PLAN -4
• Evaluate current documentation
• Identify most commonly used diagnoses
by checking out:
– Reports – past coding Medicare coverage
issues “ADR”
– Documentation to support those diagnoses
– Medical staff / Medical Director support
– Clinical documentation improvements
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TOO MUCH INFORMATION
• JUST AN EXAMPLE OR TWO – MORE
THAN YOU NEED TO KNOW!!!
• Impacts your staff from prior to admission
to discharge and beyond – billing finals,
et’l
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SPECIFIC INFO. NEEDED TO
ACCURATELY CODE
• Diabetes Mellitus
– Type of diabetes
– Body system affected
– Complication or manifestation
– If type 2 diabetes, long-term insulin use
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SPECIFIC INFO. NEEDED TO
ACCURATELY CODE -2
• Fractures
– Site
– Laterality
– Type
– Location
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REVIEW CHANGES IN DOC.
REQUIREMENTS
• Injuries
– External cause – cause of the injury, more
applicable to op
– Place of occurrence – home, at work, in the
car, etc.
• More related to op we will have some references
– Resident Activity level code
– External code status – indicate if the injury
was related to military, work, or other
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TRANSITION & TESTING
• Jan/Feb, 2014 – September 15, 2014
– Conduct high level training on ICD-10 for
clinicians
– Codes to prepare for testing
– Clinical documentation review
– Determine dual coding dates and record
reviews
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COMPLETE TRANSITION / FULL
COMPLIANCE
• October 1, 2014
• Complete ICD-10 transition for full
compliance
– ICD-9 codes continue to be used for services
provided before October 1, 2014
– ICD-10 diagnosis and inpatient procedure
codes required for services provided on or
after October 1, 2014
– Monitor systems correct errors if needed
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THANKS FOR ATTENDING
Rhonda Anderson, RHIA
President
Anderson Health Information Systems, Inc.
940 W. 17th Street, Suite B
Santa Ana, CA 92706
Mobile 714-299-0573 Office 714-558-3887
[email protected]
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