rochester health information management icd-10 was almost here !!! amy m. crowfoot, msha, rhia,...
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ROCHESTER HEALTH INFORMATION MANAGEMENT
ICD-10 WAS ALMOST HERE !!!
Amy M. Crowfoot, MSHA, RHIA, C-CDIApril 23, 2014
ICD-10 READINESS: WERE YOU READY?
Days to ICD-10
The number of days remaining to get ready for ICD-10 ??
Was 201, now 524!!
Why the Transition to ICD-10 ?
ICD-10-CM will be used in all U.S. health care settings to allow
for a much more specified and substantially different coding
system
ICD-10 Fun Fact !!
Among the tens of thousands of codes included in the generic ICD-10, there are distinctions for "wounds inflicted by macaws" and "wounds inflicted by parrots."
An important distinction, or a ludicrously extraneous detail?
Why the Transition to ICD-10 ?
The transition to ICD-10 is occurring because ICD-9 data about
patients medical conditions and hospital inpatient procedures are
limited, its inconsistent with current medical practice, and the current
ICD-9 coding system as we know it, is limited in expansion due to the
three digit category structure
Look at the Expansion !
• 14,000 Diagnoses Codes
• Numeric Codes:
-Max of 5 digits• 4,000 Procedure
Codes• Numeric Codes:
-Max of 4 digits
Alphanumeric Codes:Alphanumeric Codes:Always Start with a Letter
(Exc. U) Max of 7 Char.
87,000 Procedure Codes (ICD-10-PCS)
Approximately 68,000 Diagnoses Codes
Alpha/Numeric Codes:Alpha/Numeric Codes:Start with a Number or
Letter (Exc. O or I to avoid confusion with 0/1
ICD-10 Timeline
ICD-10 codes will be required on all claims with dates of service on or after
October 1, 2015
This includes professional and institutional claims as mandated by
HIPAA regulations
General Overview
• ICD-10 documentation requirements will impact physicians, hospitals, and other providers
• ICD-10 diagnosis codes, based upon greater documentation specificity, will be used by all providers in all care settings
• ICD-10 will increase the level of clinical detail • ICD-10 will change in organization and structure• ICD-10 will change in code composition – 14K – 68K
Dx Codes, 4K – 87K Proc. Codes with a combination of alpha and numeric codes
ICD-10 Code Comparison Examples
10
Benefits to ICD-10 ?
The new classification system will provide much better data needed for;
•Measuring the quality and safety of patient care•Improvem the explanation of the patient’s condition•Assist with research, clinical trial studies, disease management•Assist with the redesign of payment systems •Assist with claims processing for reimbursement•Greater flexibility for expansion of new codes
Greater Specificity
Keep in mind…..HIM, Coders, and Documentation Specialists…will continue to play a key role…………..
•Coders have to communicate documentation updates to providers and others in the organization•Work with providers concurrently to meet new documentation demands•Increase coding queries to ensure new documentation specificity
?? Coding Productivity
• How much longer will it take to code each inpatient case ? 10%, 20%, 30%
• How much longer will it take to code each OPT case ? 0%, 5%, 10%
• Will there be more inpatient queries ?• Will there be more medical necessity denials ?• Coding will tie directly back to CMI, SOI, ROM
WILL WE GET PAID ?
All claims will require an ICD-10 code(s) to be paid for the following;
Inpatient
Outpatient
ED, Amb Surgery, Clinic, Ref’s/RCR’s
ICD-10 Areas Being Impacted
Any area that currently utilizes ICD-9 codes;
a.HIM
b.Information Technology
c. Billing
d. Physicians/Providers/CDI
e. Nursing
f. Performance Improvement
Impact to Information Technology
• Interfaces, software upgrades
• Claims Processing
• Testing of interfaces
• Testing to ensure you can produce an
I-10 bill
• Internal reporting
• External reporting
Impact to Billing Systems
Can and will we be able to get a claim out the door ??
Impact to Billing Systems
1. Are your billing systems updated to capture ICD-10 coding system ?
2. Do these systems have edits to ensure ICD-10’s are captured correctly ?
3. Have your systems been updated to capture both I-9’s and I-10’s?
4. Have you begun reviewing and testing your interfaces ?
5. Have your billing system claim forms been updated to be able to output ICD-10’s ?
Impact to Providers
• Physicians documentation – BIG changes• Physician specificity is critical to avoid the
unknown and unspecified coding choices• Physician specificity critical to inpatient and
procedural coding• Training and education should be underway• Modify all queries to begin the ‘behavior
changes’ in documentation practices
Physicians’ Role Vital
• Make sure approach is collaborative vs. punitive
• Physicians should already have been involved in the transition to I-10
• Leverage their natural competitiveness
• Goal always remains on patient care
• Provide physicians data in ‘real time’
• Recognize physician success
Look What We Have to Know !
Fracture of the Radius1. Fracture Type 2. Healing Process 3. Localization 4. Encounter 5. Displacement 6. Classification 7. Laterality 8. Joint Involvement 9. Fracture Pattern10. Named Fractures
10 documentation points when classifying and coding a fracture of the radius !!!!
Providers Documentation Some Tips That Might Help !
• Laterality• Acute/Chronic• Trimester of pregnancy• Episode of care• Stages of healing• Specific location of injury• Mild, moderate, severe• Overweight/Under weight
Internal Provider Impact
• Nursing Performance Improvement: critical areas of documentation and trend reports
• Performance Improvement: should begin to review compiled reports, internal reports, external reports and how these will be rebuilt and ready for ICD-10
• Physician reports: should begin reviewing and transitioning these to I-10
Measure of Readiness
• Do you have the ability to ‘dual code’ now throughout all your systems ?
• If you can answer that question, it will help you know what you need to keep moving ahead, getting
the pieces in
place !
ICD-10 Road Map for Success
• Plan your budget for 2015• Review your impact assessment/gap analysis• Review with your stakeholders/steering committee where you
stand ?• Review your vendor lists, clearinghouse and payers processes• Continue your education efforts with providers and coding staff• Continue your testing and system redesign• Continue your training efforts with your dual coding funtionality
• Lets wait to see what the government is forecasting for ICD-10 for 2015 !
Clinical Documentation Improvement Efforts…
Keep in mind…..
If you have poor documentation/coding today under ICD-9, this will continue with the implementation of ICD-10……
Now is the time to strengthen your program !
Clinical Specificity
• Today versus ‘Tomorrow’
• Today =‘s Tomorrow
• So why wait ????
• Lets not wait !
Integrate ICD-10
• Continue to incorporate clinical specificity into established medical necessity processes
• Make I-10 part of your clinical review and coding practice…….even today, every day
• Require your providers to practice clinical excellence through accurate documentation of their clinical thoughts and decision making
• These are the keys to accurate inpatient coding assignments
Integration Continued….
• Incorporate clinical specificity into medical necessity for your all your service lines
• More specific documentation will improve compliance with medical necessity and will enhance provider’s E/M level assignment
• Enhanced documentation will lead to improved revenue, happy CFO’s !!
Questions ???
Rochester Regional Health Information Management Association
Resources:
The ICD-10-CM Official Guidelines are available at :http://www.cdc.gov/nchs/icd/icd10cm.htm#10update
Amy M. Crowfoot, MSHA, RHIA, C-CDI
(p)315.787.4122
(f) 315.787.4851