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ICD-10 101

CHIA

Coding and Data Quality Committee

2011

Developed October 2011

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Presenter Instructions The following ICD-10 slides and content was

prepared by the CHIA Coding and Data Quality

Committee as a tool and resource for the CHIAmembership.

The use of this ICD-10 101 material can bebeyond that of HIM and Coding and this isencouraged.

Having an ICD-10 101 information tool anddocument will help to promote awareness ofimplementation as well as promote consistencywith messaging. (This slide would be deleted

from the actual presentation)

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Introduction

WHO (World Health Organization) owns & publishes ICD(International Classification of Diseases).

WHO endorsed ICD-10 in 1990; members began usingICD-10 or modifications in 1994.

U.S. is only industrialized country not using ICD-10, formorbidity reporting (coding diseases, illnesses, injuries ina healthcare setting).

The U.S. has used ICD-10 for mortality reporting (codingof death certificates by Vital Statistics offices) since

1999. International Classification of Diseases, 10th Revision,Clinical Modification (ICD-10-CM) is a clinicalmodification of the World Health Organizations (WHO)ICD-10, which consists of a diagnostic classificationsystem.

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Introduction

The Final Rule for ICD-10 implementation in the UnitesStates was published in January 2009, giving a five yearreadiness timeline.

ICD-10-CM (Diagnosis code set) includes the level ofdetail needed for morbidity classification and diagnosticspecificity in the United States. It also provides codetitles and language that complement accepted clinicalpractice in the United States.

The Centers for Medicare & Medicaid Services (CMS) isdriving the industry to upgrade core HIPAA transactions(5010) as well as diagnosis and procedure codingstandards (ICD-10-CM/PCS) PCS represents the procedural coding system to be used for

hospital inpatient records

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Introduction: Version 5010

New version of the HIPAA standards - Version 5010

includes:

Technical

Data content improvements

The updated version is more specific in requiring the data that isneeded, collected, and transmitted in a transaction; its adoption

will reduce ambiguities

Version 5010 addresses currently unmet business needs,

including, for example, providing on institutional claims an

indicator for conditions that were present on admission Most important:

Version 5010 also accommodates the use of the ICD-10 code

sets, which are not supported by Version 4010/4010A1

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Todays Uses of ICD-9-CM In addition to HIM and Coding the ICD-9 code set todayis used in and for many others: Reimbursement by payers

Medical necessity screening

Quality of care indicators Outcome measurements

Medical care review

Method to index medical records

Storage and retrieval of dx data

Utilization patterns and review by payers

Research data Statistics

Reasons for Denials

Monitoring and analyzing the incidence of disease and otherhealth problems

Identify health care trends and Future health care needs

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Benefits to ICD-10

Enhanced system

flexibility

Better reflection of current

medical terminology Expanded detail relevant

to ambulatory and

managed care

encounters

Incorporation of

recommended revisions

to ICD-9-CM that could

not be accommodated

HIPAA criteria forcode set standardsare met

Improved collectionand tracking of newdiseases andtechnologies

Space toaccommodate futureexpansion

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Important ICD-10 Compliance

Timeline January 1, 2010 Payers and providers should begin internal

testing of Version 5010 standards forelectronic claims

December 31, 2010 Internal testing of Version 5010 must be

complete to achieve Level I Version 5010compliance

January 1,2011 Payers and providers should begin externaltesting of Version 5010 for electronic claims

CMS begins accepting Version5010 claims

Version 4010 claims continue to be accepted

December 31, 2011 External testing of Version 5010 must becomplete to achieve Level II compliance

January 1, 2012 All electronic claims must use Version 5010Version 4010 claims are no longeraccepted

October 1, 2013 Claims for services provided on or after thisdate must use ICD-10-CM/PCS codes for medical

diagnoses and inpatient procedures

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ICD-9-CM & ICD-10 Code Freeze

Vendors, system maintainers, payers, and educators requested acode freeze

Last regular, annual updates to both ICD-9-CM and ICD-10 will bemade on October 1, 2011

On October 1, 2012 there will be only limited code updates to bothICD-9-CM & ICD-10 code sets to capture new technology and newdiseases.

On October 1, 2013 there will be only limited code updates to ICD-10 code sets to capture new technology and new diseases.

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ICD-10 Code Freeze (cont) There will be no updates to ICD-9-CM on October 1, 2013 as the

system will no longer be a HIPAA standard.

On October 1, 2014 regular updates to ICD-10 will begin

The ICD-9-CM Coordination & Maintenance Committee will continueto meet twice a year during the freeze

The public will comment on whether new codes should be createdduring the freeze

Any codes that do not meet the criteria of being a new technology ornew disease will be held for consideration of inclusion in ICD-10after the freeze ends

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0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

ICD-9-CM ICD-10-CM ICD-10 (WHO) ICD-9-CM ICD-10-PCS ICD-10 (WHO)

Diagnosis

Procedure

ICD-10 Growth

Diagnosis Procedure

11

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Some Differences:

Diagnosis Coding & Data

ICD-9-CM* ICD-10-CM*

35 characters in length 37 characters in length

14,315 diagnosis codes 69,101 diagnosis codes

Only V codes and E codes ALL codes start with a letter

start with a letter

Limited space for adding new codes Flexible for adding new

codes

Cannot identify laterality Can identify laterality

* Based on the 2010 versions of ICD-9-CM and ICD-10-CM.

ICD-10-CM will be used in all healthcare settings

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ICD-10 CM Format

X X X X X X X

ExtensionEtiology, Anatomical site, SeverityCategory

ICD-10-CM code structure differs from ICD-9-CM in that it consists of three to

seven characters, the first digit being an alpha character and second and third

digits are numeric; the fourth and fifth digits may be alpha (not case sensitive) or

numeric with a decimal after the third character.

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Why so Many Codes?

Greater specificity and detail in alldiagnosis codes:

34,250 (50%) of all ICD-10-CM codes arerelated to the musculoskeletal system

17,045 (25%) of all ICD-10-CM codes arerelated to fractures

10,582 (62%) of fracture codes to distinguishright vs. left

25,000 (36%) of all ICD-10-CM codes todistinguish right vs. left

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Some Differences:

P

rocedure Coding & Data

ICD-9-CM* ICD-10-PCS*

34 digits 7 alphanumeric characters

3,838 procedure codes 71,957 procedure codesLacks detail Very specific

Limited space for adding new codes Flexible for adding newcodes

Generic terms for body parts Specific terms for body

parts

Based on the 2010 versions of ICD-9-CM and ICD-10-PCS.

To be used only for hospital inpatient medical records.

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Format of ICD-10P

CS

The procedure coding system for ICD-10-PCS will be used only on inpatient

hospital stays. Outpatient surgery and physician outpatient coding will continue

to use Current Procedural Terminology (CPT) for procedure coding.

There are seven characters in each ICD-10-PCS (Procedural Coding System).

In each section ofPCS, the characters have slightly different meanings to

relate to that particular section.

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Why so Many Codes? Seven Character Alphanumeric Code:

All procedure codes will be seven characters long

I and O (letters) are never used

34 possible values for each character Digits 0 9

Letters A-H, J-N, P-Z

A character is a stable, standardized code component Holds a fixed place in the code

Retains its meaning across a range of codes

A value is an individual unit defined for each character: Section Body Root Body Approach

Device Qualifier System Operation Part

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ICD-10 Impact

People and Business

Communications with bothinternal and external keystakeholders

Regarding preparationactivities

Human resource strategy,change management,

organizational research andcommunication should cometogether.

Process and Technology Address and align technology

and employee behavior withbusiness needs.

Monitor vendor readiness andcompliance

Analyze end-to-end informationand data flow

Impact all aspects of healthcarebusiness and all settings:

Assessed Changed

Tested and made ready

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Implementation and Planning for

ICD-10 Establish an ICD-10 Steering Committee

Members should be multidisciplinary andare key stakeholders

Establish a leader for implementation. HIMand IT may want to co-lead the Steering

Committee The plan should have a charter with goals,

objectives, deliverables and timelines.

Preparation is key!

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Key Stakeholders

HIM

IT

PFS/Billing

Case Mgmt. and UR

Decision Support

Contracting

Educators

Compliance

Physicians

Clinical

Documentation

Improvement (CDI)staff

Payers

Vendors Revenue

Cycle/Finance

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ICD-10 System Readiness

Making sure that ALL systems that touch or useICD-9-CM codes today are ready for ICD-10 iscritical.

Have an inventory of all systems

IT will lead the communicate with external users,vendors and payers in assessing their readiness

Testing of systems prior to 10/1/2013 should be

built into the implementation plan. Inventory of reports (digital and analog),

and reporting to outside agencies andregistries.

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Education and Training

Education and Training is large component to ICD-10implementation.

Although HIM and Coding staff are the main target forEducation and training due to the impact of ICD-10 totheir work, others will also need education and training.

Use role based education and training

Consider conducting an assessment in the core areasfor preparation of ICD-10. This should have occurred by now (2011)

The four core health science competency areas for ICD-10 are: Medical Terminology

Anatomy & Physiology

Pathophys or Disease Process

Pharmacology

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Education and Training

Provide education in the four core competency

areas based upon the assessment findings.

Actual ICD-10 training should be delivery in2013.

AHIMA estimates approximately 16 hours of coding

training is needed for outpatient coders and 50 hours

for inpatient coders. Go-live and post go-live plans should also be in

place as education and training will be needed.

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AHIMA AHIMA CertifiedProfessionals are required by CCHIIM (Commission on

Certification for Health Informatics and Information Management) to participate ina predetermined number of mandatory baseline educational experiences specificto ICD-10-CM/PCS. These ICD-10-CM/PCS specific CEUs will count as part ofall AHIMA certificants total CEU requirements for the purpose of recertification.Stated differently, the following CEU requirements will be included as part ofeach certificants total, required CEUs, by credential, per CEU Cycle.

The total number of ICD-10-CM/PCS continuing education units (CEUs) required,by AHIMA credential, is as follows:

CHPS 1 CEU CHDA 6 CEUs

RHIT 6 CEUs RHIA 6 CEUs

CCS-P 12 CEUs CCS 18 CEUs

CCA 18 CEUs

Certificants who hold more than one AHIMA credential will onlyreport thehighest number of CEUs from among all credentials held. For example, if acertificant has both an RHIA and CCS, the certificant would normally report 40(30 CEUs for RHIA and an additional 10 CEUs for CCS) CEUs per recertificationcycle, and 18 of these CEUs will be required to cover ICD-10-CM/PCS.

Source: AHIMA ICD-10 website

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Documentation Assessment Clinical documentation is critical today and will continuewith ICD-10, thus engage Physicians and other cliniciansis important to successful implementation

A documentation assessment will be helpful

Conduct a review of actual medical records Identify gaps (ie nonspecific diagnostic or procedure terms)

Remember: Coders are required to code to the highestdegree of specificity, butthe quality of the physiciandocumentation HASto be there in the medical recordbefore coding can be achieved.

Expect an increase in the # of physician queries that willbe generated from ICD-10.

Existing physician queries will most likely have to beupdated as you will be asking for different documentationto capture specificity.

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Budgeting

Consider the following:

Coding/HIM Assessment

Coding/HIM Prerequisite coursework

ICD-10 coding education/training

Coverage for coding staff while ineducation/training

Productivity decrease and coverage

IT assessment

Documentation assessment

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Use the CMS ICD-10 Website

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Appendix

ICD-10 Myths & Facts

Myth: The Oct. 1, 2013 date for implementation shouldbe considered a flexible date.

Fact: All HIPAA covered entities MUST implement

the new code sets with dates of service, or date ofdischarge for inpatients, that occur on or after Oct. 1,2013.

Myth: Implementation planning should be undertakenwith the assumption that HHS will grant an extension.

F

act: HHS has no plans to extend compliance datefor implementation of ICD-10-CM/PCS; coveredentities should plan to complete steps required toimplement on Oct. 1, 2013.

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Appendix

ICD-10 Myths & Facts (cont)

Myth: There will be no hard-copy code

books and all coding will need to be

performed electronically.

Fact: ICD-10-CM and ICD-10-PCS code

books are already available and are a

manageable size. The use of ICD-10-CM

is not predicated on the use ofelectronic hardware and software.

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Appendix

ICD-10 Myths & Facts (cont) Myth: The increased number of codes will make ICD-10-

CM/PCS impossible to use.

Fact: Just as the size of a dictionary doesnt make itmore difficult to use, a higher number of codes

doesnt necessarily increase the complexity of thecoding system in fact, it makes it easier to find theright code.

Fact: Greater specificity and clinical accuracy makeICD-10 easier to use than ICD-9-CM.

Fact: Because ICD-10-CM/PCS is much morespecific, is more clinically accurate, and uses a morelogical structure, it is much easier to use than ICD-9-CM.

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Appendix

ICD-10 Myths & Facts (cont) Myth: The increased number of codes will make ICD-10-

CM/PCS impossible to use (cont).

Fact: Just as it isnt necessary to search the entirelist of ICD-9-CM codes for the proper code, it is also

not necessary to conduct searches of the entire listof ICD-10 codes.

Fact: The Alphabetic Index and electronic codingtools will continue to facilitate proper code selection.

Fact: It is anticipated that the improved structure andspecificity of ICD-10-CM/PCS will facilitate thedevelopment of increasingly sophisticated electroniccoding tools that will assist in faster code selection.

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Appendix

ICD-10 Myths & Facts (cont)

Myth: ICD-10-CM/PCS was developed

without clinical input.

F

act: The development of ICD-10-CM/PCS involved significant clinical

input. A number of medical specialty

societies contributed to the

development of the coding systems.

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Appendix

ICD-10 Myths & Facts (cont)

Myth: ICD-10-CM-based super bills will be toolong or too complex to be of much use.

Fact: Practices may continue to create super

bills that contain the most commondiagnosis codes used in their practice. ICD-10-CM-based super bills will not necessarilybe longer or more complex than ICD-9-CM-based super bills. Neither currently-usedsuper bills nor ICD-10-CM-based super bills

provide all possible code options for manyconditions.

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ICD-10 WEB RESOURCES http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf

http://www.cms.hhs.gov/apps/media/fact_sheets.asp

http://www.cms.hhs.gov/ICD10/01_Overview.asp

http://www.cms.hhs.gov/ICD10/03_ICD_10_CM.asp# http://www.hhs.gov/news/press/2008pres/2008.html

http://www.cdc.gov/nchs/about/major/dvs/icd10des.htm

http://www.cdc.gov/nchs/about/otheract/icd9/abticd10.htm

http://www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm

http://www.ahacentraloffice.org/ICD-10

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Other Resources

AHIMA.org

CHIA.org

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Acknowledgement

We wish to acknowledge and thank the

California Health Information Management

Association Coding and Data Quality

Committee. Especially Monica Leisch,

Chantel Susztar, Gloryanne Bryant and

Elaine Lips for their input and assistance

in developing this ICD-10 101presentation.