Basic Introduction to ICD10 CMPCS ICD10 Implementation October

Basic Introduction to ICD-10 CM/PCS

ICD-10 Implementation � October 1, 2015 – Compliance date for implementation of ICD-10 -CM (diagnoses) and ICD -10 -PCS (procedures) � ICD-10 -CM (diagnoses) will be used by all providers in every health care setting � ICD-10 -PCS (procedures) will be used only for hospital claims for inpatient hospital procedures ◦ ICD-10 -PCS will not be used on physician claims, even those for inpatient visits

CPT and HCPCs Codes � No impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes � CPT and HCPCS will continue to be used for physician and ambulatory services including physician visits to inpatients

ICD-10 Implementation �Single implementation date of October 1, 2015 for all users �Ambulatory and physician services provided on or after October 1, 2015 will use ICD-10 -CM diagnosis codes �Inpatient discharges occurring on or after October 1, 2015 will use ICD-10 -CM and ICD-10 -PCS codes

Why ICD-10 Current ICD-9 Code Set is: � Outdated: 30 years old � Current code structure limits amount of new codes that can be created � Has obsolete groupings of disease families � Lacks specificity and detail to support: ◦ Accurate anatomical positions ◦ Differentiation of risk & severity ◦ Key parameters to differentiate disease manifestations

Diagnosis Code Structure Comparison ICD-9 -CM (Volume 1 & 2) ICD-10 -CM 3 -5 characters in length 3 -7 characters in length Approximately 14, 000 codes Approximately 68, 000 codes First digit may be alpha (E or V) or Digit 1 is alpha (to indicate the numeric; digits 2 -5 are numeric category); Digit 2 is numeric (in the future, alpha characters may be used if code expansion is needed); Digits 3 -7 can be alpha or numeric Limited space for adding new codes Flexible for adding new codes Lacks detail Very specific Lacks laterality Includes laterality (i. e. , codes identifying right vs. left)

ICD-10 -CM (diagnosis) Code Format Alpha (except U) 2 nd – Always Numeric 3 rd-7 th Alpha or Numeric S 3 2 Category 3 -7 Characters Additional Characters 0 1 0 A Etiology, Anatomic Site, Severity Added code extensions (7 th Character) for obstetrics, injuries and external causes of injuries

Comparison: ICD-9 to ICD-10 434. 11 Cerebral embolism with infarction Code represents embolism of cerebral arteries with infarction With specificity and laterality, one ICD-9 code translates into 14 possible ICD-10 codes I 63. 40 Cerebral infarction dew to embolism of unspecified cerebral artery I 63. 49 Of other cerebral artery I 63. 411 Of right middle cerebral artery I 63. 412 Of left middle cerebral artery I 63. 419 Of unspecified middle cerebral artery I 63. 421 Of right anterior cerebral artery I 63. 422 Of left anterior cerebral artery I 63. 429 Of unspecified anterior cerebral artery I 63. 431 Of left posterior cerebral artery I 63. 432 Of right posterior cerebral artery I 63. 439 Of unspecified posterior cerebral artery I 63. 441 Of right cerebellar artery I 63. 442 Of left cerebellar artery I 63. 449 Of unspecified cerebellar artery

Procedure Code Structure Comparison ICD-9 -CM (Volume 3) ICD-10 -PCS 3 -4 numbers in length 7 alpha-numeric characters in length Approximately 3, 000 codes Approximately 87, 000 available codes Based on outdated technology Reflects current usage of medical terminology and devices Limited space for adding new codes Flexible for adding new codes Lacks detail Very specific Lacks laterality Has laterality Generic terms for body parts Detailed descriptions for body parts Lacks descriptions of methodology Provides detailed descriptions of and approach for procedures methodology and approach for procedures

ICD-10 -PCS Code Format S 3 2 0 1 0 A Section Root Operation Body System Approac h Body Part Qualifier Device

Comparison: ICD-9 to ICD 10 ICD-9 Procedure Code 39. 50 Angioplasty 39. 31 Suture of artery 47. 01 Laparoscopic appendectomy ICD-10 Procedure Code 0 DN 90 ZZ Release of duodenum, open approach 0 FB 03 ZX Excision of liver, percutaneous approach, diagnostic 02 PS 0 CZ Removal, extraluminal device from pulmonary vein, right, open

ICD-10 Provider Impacts � Clinical documentation is the foundation of successful ICD-10 Implementation � Golden Rule of Documentation ◦ ◦ � The purpose in documentation is to tell the story of what was performed and what is diagnosed accurately and thoroughly reflecting the condition of the patient ◦ ◦ � what services were rendered and what is the severity of the illness The key word is SPECIFICITY ◦ ◦ � If it isn’t documented by the physician, it didn’t happen If it didn’t happen, it can’t be billed Granularity Laterality Complete and concise documentation allows for accurate coding which leads to maximized reimbursement

ICD-10 Changes Everything! � ICD-10 is a Business Function Change, not just another code set change. � ICD-10 Implementation will impact everyone: ◦ Registration, Nurses, Managers, Lab, Clinical Area, Billing, Physicians, and Coding. � Know your role – How is ICD-10 going to change what you do?

ICD-10 Next Steps � Assess & track vendor compatibility � UHS Master Education Plan ◦ Identify all employees and medical staff who need training by April 15, 2015. ◦ Assign all Precyse Courses in Healthstream by April 30, 2015. �Be mindful of assigned staff training hours � Dual coding / practicing with ICD-10 -CM/PCS

ICD-10 Facility Resources � Cost centers have been established specifically for the resources needed to implement ICD-10 successfully. This covers both the training of employees and any necessary back-fill of staff during training. ◦ ICD -10 Training: coded to account #xxx-86100 -687923 � Two ICD-10 translation tools: ◦ Code Translation Tool (CTT) � Translates ICD-9 to ICD-10 utilizing description, specific code, code ranges or list of codes. � Training and Roll-out of the CTT tool has been completed and end users are actively using the tool for Code translation needs. ◦ Financial Impact Tool (FIT) � Analyzes historical DRG data to predict the financial impact of ICD-10, both positive and negative. Variance reports can be utilized to identify avoidable DRG shifts in order to reduce financial risk through physician documentation education. � Training and Roll-out of the FIT tool is in progress.

ICD-10 Resources � CMS Resources ◦ MS-DRG Conversion Report http: //www. cms. hhs. gov/ICD 10/Downloads/Msdrg. Conversio n. pdf ◦ ICD-10 General Information http: //www. cms. hhs. gov/ICD 10 � The following organizations offer providers and others ICD-10 resources ◦ AHIMA (American Health Information Management Association) http: //www. ahima. org/icd 10/default. aspx ◦ WEDI (Workgroup for Electronic Data Interchange) http: //www. wedi. org ◦ HIMSS (Health Information and Management Systems Society) http: //www. himss. org/icd 10

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