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©2017 AHIMA’s Intellectual Property. All rights reserved.
ICD-10-CM Post Implementation in theUAE: Benefits and Challenges
Sunil Raj, N.K M.Sc., CIC, COCSunil Raj, N.K M.Sc., CIC, COCCorporate Insurance Manager, Revenue Cycle ManagementCorporate Insurance Manager, Revenue Cycle ManagementMediclinic Middle EastMediclinic Middle East
Learning objectives
To understand ICD-10-CM post implementationchallenges in UAE To understand other regulatory/payer changes in
2017 which impacted ICD-10-CM implementation
Disclosure :• I hereby sign and guarantee that my participation/presentation has the
sole purpose of education/training and that it is not influenced bydirect or indirect commercial interests of any supporters.
©2017 AHIMA’s Intellectual Property. All rights reserved.
To understand ICD-10-CM post implementationchallenges in UAE To understand other regulatory/payer changes in
2017 which impacted ICD-10-CM implementation
Disclosure :• I hereby sign and guarantee that my participation/presentation has the
sole purpose of education/training and that it is not influenced bydirect or indirect commercial interests of any supporters.
Introduction
Pre implementation readiness Post-implementation challenges Other challenges
©2017 AHIMA’s Intellectual Property. All rights reserved.
Pre implementation readiness Post-implementation challenges Other challenges
Pre ImplementationReadiness
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Pre ImplementationReadiness
Software and Hardware updates Physician training Coders training Impact study
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Software and Hardware updates Physician training Coders training Impact study
Software and Hardware updates
Update the HIS to accommodate ICD-10-CM code sets Development in HIS for more accurate
documentation Testing and new version 3M software
installation Additional hardware's for increased
number of coders Edits to avoid unspecified codes
©2017 AHIMA’s Intellectual Property. All rights reserved.
Update the HIS to accommodate ICD-10-CM code sets Development in HIS for more accurate
documentation Testing and new version 3M software
installation Additional hardware's for increased
number of coders Edits to avoid unspecified codes
Physician training and impacts
• CDI training – HAAD & In house• Coding training – Online program
©2017 AHIMA’s Intellectual Property. All rights reserved.
• CDI training – HAAD & In house• Coding training – Online program
Physician training and impacts
Diagnoses associated with orders & forPBM
Why coding training for Doctors ?
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Diagnoses associated with orders & forPBM
Impact study
1. Financial – 3 M Grouper updates &case mix
2. Additional cost on hardware &software
©2017 AHIMA’s Intellectual Property. All rights reserved.
1. Financial – 3 M Grouper updates &case mix
2. Additional cost on hardware &software
Coders training
Coding training – Online program & Inhouse
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Coding training – Online program & Inhouse
Post implementationChallenges
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Post implementationChallenges
Challenges
1. Impact on productivity2. Impact based on unspecified/Other
specified codes3. Documentation challenges4. Severity changes in IR-DRG5. Bugs in grouper6. Increased Denials – Un accepted
principal diagnosis7. CPT version 2011
©2017 AHIMA’s Intellectual Property. All rights reserved.
1. Impact on productivity2. Impact based on unspecified/Other
specified codes3. Documentation challenges4. Severity changes in IR-DRG5. Bugs in grouper6. Increased Denials – Un accepted
principal diagnosis7. CPT version 2011
Impact on productivity
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Impact on productivity
13
ICD 10 Impact on productivity
ICD-10-CM was impacting coder’sproductivity in terms of the following: Lack of experience Complexity in codes Detailed Lack of specificity in
documentation Focusing on coding quality
©2017 AHIMA’s Intellectual Property. All rights reserved.
ICD-10-CM was impacting coder’sproductivity in terms of the following: Lack of experience Complexity in codes Detailed Lack of specificity in
documentation Focusing on coding quality
Productivity Impact
©2017 AHIMA’s Intellectual Property. All rights reserved.
Impact based on unspecified &Other specified codes
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Impact based on unspecified &Other specified codes
16
ICD 10 Impact on unspecified codes
ICD-10-CM unspecified codes has impacts on the followingsituations: Quality monitoring by regulatory authority Claims denials Diagnosis accuracy for statistics purposes Improvement in reimbursements
Some of the common unspecified codes : Atrial Fibrillation, unspecified CKD stage severity, unspecified Ventricular Tachycardia, unspecified Bronchitis, unspecified CAD of Native or graft unspecified Epilepsy status unspecified
©2017 AHIMA’s Intellectual Property. All rights reserved.
ICD-10-CM unspecified codes has impacts on the followingsituations: Quality monitoring by regulatory authority Claims denials Diagnosis accuracy for statistics purposes Improvement in reimbursements
Some of the common unspecified codes : Atrial Fibrillation, unspecified CKD stage severity, unspecified Ventricular Tachycardia, unspecified Bronchitis, unspecified CAD of Native or graft unspecified Epilepsy status unspecified
Documentation challenges
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Documentation challenges
18
Documentation challenges in ICD-10
ICD-10-CM contains multiple combinationcodes so the documentation must reflectthe association between conditions.
LateralityLaterality needs to be documented. ICD-10-CM features an expanded
category for injuries. A seventh characterseventh characterextension identifies the encounter type.
Broad classification on Musculoskeletaland pregnancy codes.
©2017 AHIMA’s Intellectual Property. All rights reserved.
ICD-10-CM contains multiple combinationcodes so the documentation must reflectthe association between conditions.
LateralityLaterality needs to be documented. ICD-10-CM features an expanded
category for injuries. A seventh characterseventh characterextension identifies the encounter type.
Broad classification on Musculoskeletaland pregnancy codes.
Severity changes in IR-DRG
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Severity changes in IR-DRG
20
Severity changes in IR-DRG
Many to One Mapping
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Severity changes in IR-DRG
One to one Mapping
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Severity changes in IR-DRG
Unspecified Codes
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Bugs in IR-DRG Grouper
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Bugs in IR-DRG Grouper
24
Bugs in IR-DRG Grouper
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Impacts billing and Denials
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Impacts billing and Denials
26
LACK OF CLINICAL KNOWLEDGE INCODERS Impacts billing and Denials
Combination code errors Coding condition with symptoms Coding edits errors Fail to query physician for any underlying
relationship with any coded disorder Un accepted Principal diagnosis
©2017 AHIMA’s Intellectual Property. All rights reserved.
Combination code errors Coding condition with symptoms Coding edits errors Fail to query physician for any underlying
relationship with any coded disorder Un accepted Principal diagnosis
CPT version 2011
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CPT version 2011
28
ICD-10 2015 and CPT 2011 version
CPT codes can be multiple and ICD codeswill be limited to justify the wholeprocedures which can lead to adjudicationerrors from insurance company.ICD can be available for newer invented
diagnoses but with lack of latest CPTprocedure code sets.
©2017 AHIMA’s Intellectual Property. All rights reserved.
CPT codes can be multiple and ICD codeswill be limited to justify the wholeprocedures which can lead to adjudicationerrors from insurance company.ICD can be available for newer invented
diagnoses but with lack of latest CPTprocedure code sets.
Other PostImplementationChallenges
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Other PostImplementationChallenges
Tasneef audits
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Errors due to “symptoms coding”.Symptoms were added mainly for pharmacies as the payers Rule Enginedeny medicines if the codes are missing. Removing symptoms will be affectpatient care as we will not be able to dispense the medication.
E.g.: Cough, Fever
Antibiotic denied for HelicobacterPylori since no infection code beenadded . Payer Rule engine denymainly antibiotics if infection codenot in pre-approval request
Tasneef audits
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Resources
3M DRG grouper manual HAAD circulars
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3M DRG grouper manual HAAD circulars
Questions?
©2017 AHIMA’s Intellectual Property. All rights reserved.
Questions?
Thank You!
©2017 AHIMA’s Intellectual Property. All rights reserved.
Thank You!
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