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Current ICD-9 Code Set is:Outdated: 30 years oldCurrent code structure limits amount of new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?