basic introduction to icd-10 cm/pcs. icd-10 implementation october 1, 2015 – compliance date for...
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Basic Basic Introduction toIntroduction toICD-10 CM/PCSICD-10 CM/PCS
ICD-10 ImplementationICD-10 ImplementationOctober 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 CodesCPT 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 ImplementationICD-10 ImplementationSingle 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-10Why ICD-10
Current ICD-9 Code Set is:Outdated: 30 years oldCurrent code structure limits amount of new
codes that can be createdHas obsolete groupings of disease familiesLacks specificity and detail to support:
◦ Accurate anatomical positions
◦ Differentiation of risk & severity
◦ Key parameters to differentiate disease manifestations
Diagnosis Code Structure Diagnosis Code Structure ComparisonComparisonICD-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 numeric; digits 2-5 are numeric
Digit 1 is alpha (to indicate the 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 ICD-10-CM (diagnosis) Code FormatFormat
S 3 2 0 1 0 A
Alpha (except
U)
2nd – Always Numeric3rd-7th Alpha or Numeric Additiona
l Characte
rs
Category Etiology, Anatomic Site, Severity
Added code extensions (7th Character) for obstetrics, injuries and
external causes of injuries3-7
Characters
Comparison: ICD-9 to ICD-Comparison: ICD-9 to ICD-1010434.11 Cerebral
embolism with infarction
Code represents embolism of cerebral arteries with infarction
I63.40 Cerebral infarction dew to embolism of unspecified cerebral artery
I63.49 Of other cerebral artery
I63.411 Of right middle cerebral artery
I63.412 Of left middle cerebral artery
I63.419 Of unspecified middle cerebral artery
I63.421 Of right anterior cerebral artery
I63.422 Of left anterior cerebral artery
I63.429 Of unspecified anterior cerebral artery
I63.431 Of left posterior cerebral artery
I63.432 Of right posterior cerebral artery
I63.439 Of unspecified posterior cerebral artery
I63.441 Of right cerebellar artery
I63.442 Of left cerebellar artery
I63.449 Of unspecified cerebellar artery
With specificity and laterality, one ICD-9
code translates into 14 possible ICD-10 codes
Procedure Code Structure Procedure Code Structure ComparisonComparisonICD-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 and approach for procedures
Provides detailed descriptions of methodology and approach for procedures
Lacks precision to adequately define procedures
Precisely defines procedures with detail regarding body part, approach, any device used, and qualifying information
ICD-10-PCS Code FormatICD-10-PCS Code Format
S 3 2 0 1 0 ASectio
n
Body Syste
m
Root Operatio
n
Body Part
Approach
Device
Qualifier
Comparison: ICD-9 to Comparison: ICD-9 to ICD-10ICD-10ICD-9 Procedure Code
39.50 Angioplasty
39.31 Suture of artery
47.01 Laparoscopic appendectomy
ICD-10 Procedure Code
0DN90ZZ Release of duodenum, open approach
0FB03ZX Excision of liver, percutaneous approach, diagnostic
02PS0CZ Removal, extraluminal device from pulmonary vein, right, open
ICD-10 Provider ImpactsICD-10 Provider Impacts Clinical documentation is the foundation of successful
ICD-10 Implementation
Golden Rule of Documentation◦ If it isn’t documented by the physician, it didn’t happen◦ If it didn’t happen, it can’t be billed
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◦ Granularity◦ Laterality
Complete and concise documentation allows for accurate coding which leads to maximized reimbursement
ICD-10 Changes ICD-10 Changes Everything!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 StepsICD-10 Next StepsAssess & 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 ResourcesICD-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 ResourcesICD-10 Resources
CMS Resources ◦ MS-DRG Conversion Report
http://www.cms.hhs.gov/ICD10/Downloads/MsdrgConversion.pdf
◦ ICD-10 General Informationhttp://www.cms.hhs.gov/ICD10
The following organizations offer providers and others ICD-10 resources ◦ AHIMA (American Health Information Management
Association) http://www.ahima.org/icd10/default.aspx◦ WEDI (Workgroup for Electronic Data Interchange)
http://www.wedi.org ◦ HIMSS (Health Information and Management Systems
Society) http://www.himss.org/icd10
OCTOBER 1,
2015!!
QUESTIONS?QUESTIONS?
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