Create an awareness of ICD-10-CM. Start to consider the impact the conversion to ICD-10 will have on your operations.

Participants can help spread the “word” throughout the University.

ICD is the World Health Organization's International Classification of Diseases and Related Health Problems and is the international standard diagnostic classification system.

ICD-10 is the abbreviated term used to refer to the 10th revision of the ICD.

ICD-10-CM: The U.S. clinical modification (CM) of the

WHO’s ICD-10, maintained by the NCHS. Includes diagnoses which will be used by all

providers in every health care setting. ICD-10-PCS:

The procedural coding system developed under contract by the CMS.

Includes procedure codes which will only by used for hospitals claims for inpatient hospital procedures.

On January 16, 2009, the Department of Health and Human Services published a Final Rule for the adoption of ICD-10-CM and ICD-10-PCS code sets.

All HIPAA covered entities must be ICD-10 compliant on October 1, 2013.

The compliance date is firm and not subject to change: There will be no delay. There will be no grace period for implementation.

There will be no impact on CPT and HCPCS codes.

1) ICD-9-CM is out of date and running out of space for new codes.

Lacks specificity and detail No longer reflects current medical practice

2) ICD-10 is the international standard to report and monitor diseases and mortality, making it important for the U.S. to adopt ICD-10 based classifications for reporting and surveillance.

3) ICD codes are the core elements of HIT systems, conversion to ICD-10 is necessary to fully realize benefits of HIT adoption.

ICD-10-CM code book retains the same traditional format Index

Tabular Process of coding is similar

Look up a condition in the Index

Confirm the code in the Tabular

ICD – 9-CM ICD – 10-CM

13,600 codes 69,000 codes

Code book contains 17 chapters Code book contains 21 chapters

Consists of 3 to 5 characters Consists of 3 to 7 characters

1st character is alpha or numeric 1st character is alpha

Only utilizes letters E and V Utilizes all letters (except U)

Second, third, fourth, and fifth characters are always numeric

Second characteris always numeric

Third, fourth, fifth, sixth, and seventh

characters can be alpha or numeric

Shorter code descriptions because of lack of specificity and abbreviated code titles

Longer code descriptions because of greater clinical detail and

specificity and full code titles

ICD-9-CM CODE

A - Category of code

B - Etiology, anatomical site, and manifestation

ICD-10-CM CODE

A - Category of code

B - Etiology, anatomical site, and/or severity

C - Extension 7th character for

obstetrics, injuries, and external causes of injury

A B

A B C

ICD-9-CM Codes ICD-10-CM Codes

Pressure ulcer codes 9 codes

707.00 – 707.09

Pressure ulcer codes 125 codes

L89.0-L89.94

Codes:707.0 Pressure ulcer 707.00 - unspecified site 707.01 - elbow 707.02 - upper back 707.03 - lower back 707.04 - hip 707.05 - buttock 707.06 - ankle 707.07 - heel 707.09 - other site

Code Examples:L89.131 – Pressure ulcer of right lower back, stage IL89.132 – Pressure ulcer of right lower back, stage IIL89.133 – Pressure ulcer of right lower back, stage IIIL89.134 – Pressure ulcer of right lower back, stage IVL89.139 – Pressure ulcer of right lower back, unspecified stageL89.141 – Pressure ulcer of left lower back, stage IL89.142 – Pressure ulcer of left lower back, stage IIL89.143 – Pressure ulcer of left lower back, stage IIIL89.144 – Pressure ulcer of left lower back, stage IVL89.149 – Pressure ulcer of left lower back, unspecified stageL89.151 – Pressure ulcer of sacral region, stage IL89.152 – Pressure ulcer of sacral region, stage II…L89.90 – Pressure ulcer of unspecified site, unspecified stage

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

Added extensions for episode of care Inclusion of trimester in obstetrics codes

and elimination of fifth digits for episode of care

Expanded detail relevant to ambulatory and managed care encounters

Inclusion of clinical concepts that do not exist in ICD-9-CM

Changes in timeframes specified in certain codes

I10, Essential (primary) hypertension

A69.21, Meningitis due to Lyme Disease

O9A.311, Physical abuse complicating

pregnancy, first trimester

S52.131A, Displaced fracture of neck of

right radius, initial encounter for closed

fracture

Combination codes for conditions and common associated symptoms and manifestations I25.110, Arteriosclerotic heart disease of native

coronary artery with unstable angina pectoris K50.013, Crohn’s disease of small intestine

with fistula Combination codes for poisonings and their

associated external cause T42.3X2S, Poisoning by barbiturates,

intentional self –harm, sequela

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_038084.hcsp?dDocName=bok1_038084

Diabetes Codes in ICD-9 Diabetes Codes in ICD-10

249.70 - Secondary diabetes mellitus with peripheral circulatory disorders, not stated as uncontrolled785.4 - Diabetic gangrene443.81 - Diabetic peripheral angiopathy

E09.52 - Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene

250.31 - Diabetes with other coma, type I, not stated as uncontrolled

E10.11 - Type 1 diabetes mellitus with ketoacidosis with coma

250.60 - Diabetes with neurological manifestations, type II or unspecified, not stated as uncontrolled355.9 - Mononeuritis of unspecified site

E11.41 - Type 2 diabetes mellitus with diabetic mononeuropathy

249.40 - Secondary diabetes mellitus with renal manifestations , not stated as uncontrolled585.9 - Chronic kidney disease, unspecified

E08.22 - Diabetes mellitus due to an underlying condition with diabetic chronic kidney disease

C50.212, Malignant neoplasm of upper-inner quadrant of left female breast

H16.013, Central corneal ulcer, bilateral

L89.213, Pressure ulcer of right hip, stage III

H61.20, Impacted cerumen, unspecified, ear

H61.21, Impacted cerumen, right ear

H61.22, Impacted cerumen, left ear

H61.23, Impacted cerumen, bilateral

Obstetric codes identify trimester instead of episode of care O26.02, Excessive weight gain in

pregnancy, second trimester Inclusion of clinical concepts that do

not exist in ICD-9-CM T45.526D, Underdosing of antithrombotic

drugs, subsequent encounter Z67.40, Type O blood, Rh positive

The AHA Central Office serves as the clearinghouse for issues related to the use of ICD-9-CM.

With the transfer to ICD-10, a new office will be developed called AHA Central Office on ICD-10-CM Creation of new official guidelines Development of the AHA Coding Clinic for

ICD-10 (similar to the Coding Clinic for ICD-9 but will require a major overhaul)

“GEMs” stands for General Equivalence Mappings

The CMS and the CDC created GEMs to ensure consistent national data when the U.S. adopts ICD-10.

The GEMs will act as a translation dictionary to bridge the “language gap” between the two code sets and can be used to map an ICD-9 code to an ICD-10 code and vice versa.

Designed to give all sectors of the healthcare industry that use coded data the tools to: Convert large databases and test system

applications Link data in long-term clinical studies Develop application-specific mappings Analyze data collected before and after

the transition to ICD-10-CM

The GEMs should not be used as a substitute for learning how to use the ICD-10-CM code sets. “GEMs are not a substitute for learning ICD-10-

PCS and ICD-10-CM coding. They’ll help you convert large data sets.”

Mapping simply links concepts in the two code sets, without consideration of context of specific patient information, whereas coding involves assigning the most appropriate code based on documentation and applicable coding guidelines.

A clear one-to-one correspondence between an ICD-9 or ICD-10 code is the exception rather than the rule. ICD-9 codes: 414.01 Coronary atherosclerosis of

native coronary artery and 411.1 Intermediate coronary syndrome (unstable angina)

ICD-10 code :I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina

There are situations when a code in the target system does not exist T503x6A Underdosing of electrolytic, caloric and

water-balance agents, initial encounter

ICD-9 Code

Description (Source)

820.8 Fracture of unspecified part of neck of femur, closed

ICD-9 Code

Description(Target)

820.8 Fracture of unspecified part of neck of femur, closed

Forward Mapping

Backward Mapping

Checklist: http://www.ahima.org/icd10/ICD-10PreparationChecklist.mht

2009/ 2010 2011 2012 2013

Awareness and Impact

Assessment Preparing for Implementation

Go Live Preparati

on

Post – Implementation

Phase I

Phase II

Phase III

Phase IV

Year

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1. Create awareness among faculty and staff.

2. Identify your current systems and work processes, whether electronic or manual, in which you use ICD-9.

3. Identify potential changes to existing practice workflow and business processes.

4. Assess status of business associates and vendors ICD-10 readiness.

5. Budget for implementation costs.

6. Conduct a detailed assessment of education needs.

Identify who will require education: Coding

professionals Providers Billing personnel Clinical personnel Administrative staff

and Management Researchers

Determine what type and level of education they will need. Assess the current level

of coder education and experience.

Assess the level of knowledge necessary per person/role based on job responsibilities.

Determine the best method of education.

1. Build awareness to understand the impact of the code set change and the differences between the code sets

2. Develop pre-requisite skills where needed, for example, in the biomedical sciences

3. Educate on the foundational concepts on the structure and organization of the code sets

4. Role-based application “just in time” 3 – 9 months prior to implementation

The DHHS recommends inpatient/hospital coders receive 50 hours of training and outpatient coders receive 10 hours of training.

AHA/AHIMA anticipates that a maximum of 16 hours of training may be sufficient for experienced coding professionals on ICD-10-CM only. 6 hours learning the fundamentals (structure, coding

conventions, guidelines and how ICD-10 is different) 6 hours in more intensive training applying the

conventions and guidelines 4 hours practicing applying codes to typical encounters

AHIMA Certified Professionals are required to participate in a predetermined number of mandatory baseline educational experiences specific to ICD-10-CM. RHIT – 6 CEUs RHIA – 6 CEUs CCS-P – 12 CEUs CCS – 18 CEUs CCA – 18 CEUs

AAPC members holding a credential will have two years to pass a proficiency test: You will be given two (2) years to pass the exam,

beginning October 1, 2012 (one year before implementation of ICD-10) and ending September 30, 2014 (one year after implementation)

The test will consist of 75 questions The test will be open-book, online and un-

proctored Coders will be allowed two (2) attempts to pass

for the $60 administration fee

The increased specificity of the ICD-10 codes requires more detailed clinical documentation in order to code some diagnoses to the highest level of specificity.

There are “unspecified” codes in ICD-10-CM for those instances when medical record documentation is not available to support more specific codes.

The benefits of ICD-10 can not be realized if non-specific codes are used rather than taking advantage of the specificity ICD-10 offers.

Conduct medical record documentation assessments Evaluate records to determine adequacy of

documentation to support the required level of detail in new coding systems

Implement a documentation improvement program to address deficiencies identified during the review process Educate providers about documentation

requirements for the new coding system through specific examples

Emphasize the value of more concise data capture for optimal results and better data quality

DHHS agrees that some physicians will want intensive training on ICD-10 but some will seek “awareness training”. Nolan study estimates 8 hours of intensive

physician training Nachimson Advisors, LLC study predicts

12 hours of physician training in both the code set and documentation procedures.

AHIMA believes most physicians would want no more than 4 hours of training.

AHIMA/AHA study found the process of converting fee tickets to ICD-10-CM is not difficult, time consuming, or expensive. Most can be converted to ICD-10 in just a few hours and they are no longer in length than existing fee tickets.

Making the “fee ticket” more manageable: Electronic fee ticket Hybrid coding Context-specific fee tickets Limit specificity/code options List 7th character separate

AHA/AHIMA field test demonstrated that people with previous ICD-9-CM experience can learn ICD-10-CM easily.

Proficiency in use of the system will be dependent on a number of factors, including level of coder education and experience.

It is anticipated that most coders will have a high level of proficiency within 6 months of use.

2010 versions of ICD-10-CM, GEMs and the

Official Guidelines are all available on-line.

CMS, AHA, AHIMA and NCHS/CDC all have

ICD-10 resource centers.

AHIMA has a free monthly ICD-10

Newsletter http://www.ahima.org/images/newsletters/ICDT

en/subscribe.html

While it is too early to start learning how to code utilizing the ICD-10-CM code set, it is never to early to start planning/preparing for the transition.