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Taiwan Medical and Health Information Management Association Saturday, July 28, 2012 Nelly Leon-Chisen, RHIA, Director Coding and Classification American Hospital Association Lee H. Hilborne, MD, MPH, The Impact of ICD-10-CM and ICD-10-PCS on Medical Documentation, Patient Safety And Quality Initiatives Medical Director, Care Coordination UCLA Health System Health Services Researcher RAND Corporation Medical Director Quest Diagnostics

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Page 1: The Impact of ICD-10-CM and ICD-10-PCS on Medical ... · ICD-9-CM and ICD-10-CM/PCS Mapping • To facilitate the transition from ICD-9-CM to ICD-10-CM/PCS, mapping between the two

Taiwan Medical and Health Information Management Association

Saturday, July 28, 2012

Nelly Leon-Chisen, RHIA, Director Coding and Classification

American Hospital Association

Lee H. Hilborne, MD, MPH,

The Impact of ICD-10-CM and

ICD-10-PCS on Medical

Documentation, Patient Safety

And Quality Initiatives

Medical Director, Care

Coordination

UCLA Health System

Health Services Researcher

RAND Corporation

Medical Director

Quest Diagnostics

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2

Public Reporting Of Data Is A Driving

Force

• Transparency is a property of a high reliability organization

• Many initiatives are emerging to evaluate and report quality

of care and patient safety

• Reported data serve four common interconnected purposes

– Quality Improvement

– Public Reporting

– Pay-For-Performance

– Research

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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3

Where Does The Pressure Originate?

• Employers

– Reducing costs

– Improving clinical quality

– Comparative performance data available in the public domain (e.g. Leapfrog Group, National Business Coalition on Health)

• Health plans

– Data to describe providers’ and enrollee’s actions, costs, and health outcomes

– Analysis of comparative performance data and pricing

• Consumer concerns

– Medical errors

– Increased cost

– Lack of coverage

– Access to comparative performance

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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4 Copyright (c) 2012 by American Hospital Association. All rights reserved.

Pay For Performance Is On Everybody’s Mind

• Also called value based purchasing

• Differential payment to hospitals

and physicians based on

performance on a set of specified

measures

– Quality

– Efficiency

– Patient experiences

– Structural reforms (e.g.,

information technology)

• Aligns financial incentives with

delivery of high quality care

• Rapidly expanding programs

0

50

100

150

200

P4P Programs

2003 2004 2005

2006 2008

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5

Private Sector Initiates Most Pay for

Performance Programs

• Most link relatively small bonus payments to better performance on specific process measures with outcome correlation

• Focus on costly and relatively common conditions

• Hospital “pay for performance” (P4P) experiments are run either by commercial plans or by employer-payer coalitions

• Most include process and structure measures

– Some include condition specific clinical outcome measures

– But process measures are easiest to identify because what was actually done gets coded

• Wide range of incremental revenue from successful performance—from less than 1% to 15%

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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6

Pay For Performance Is A Centers for

Medicare & Medicaid Priority

• Shift in payment considerations

– Payment traditionally based on the process of care (what was

done)

– P4P: Outcome influences payment (treatment impact); better

outcomes paid more

– Value-based purchasing

• Goal

– Right care for every patient every time

– Conforms to Institute of Medicine (IOM) quality domains

• Safe

• Effective

• Centered on the patient’s needs

• Timely

• Efficient

• Equitable

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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7

Medicare Programs Target Multiple Settings

• Various initiatives to encourage improved quality

of care in all health care settings:

– Hospitals

– Physicians’ offices

– Ambulatory care facilities

– Nursing homes

– Home health care agencies

– Dialysis facilities

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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8

Quality Reporting Programs Working With CMS Are

Dramatically Impacting Hospital Care

• The Hospital Quality Alliance (HQA)

– Created in 2002 as the USA’s first multi-stakeholder

private/public organization dedicated to developing, reporting

and updating information about hospital quality performance,

and encouraging efforts to improve hospital quality.

– Transferred the quality measure review processes to the

Measures Application Partnership (MAP) in 2012.

– Catalyzed adoption of the Hospital Consumer Assessment of

Healthcare Providers and Systems (HCAHPS), the nation’s first

standardized survey for measuring patients’ perceptions of their

hospital care.

– Introduced the nation’s first measures of surgical site infections.

– Virtually all of the 10 core measures that the HQA first put

forward now are above 95 percent compliance.

– Advised CMS on the creation of Hospital Compare

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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9

Quality Reporting Programs Working With CMS Are

Dramatically Impacting Hospital Care (cont.)

• Hospital Compare www.hospitalcompare.hhs.gov

– The nation’s broadest compendium of publicly available,

internet accessible and comparable national hospital

quality measures.

– Currently reports on more than 50 performance

measures for inpatient and outpatient care and allows

the public and health care providers to compare the

performance of more than 4,500 hospitals across the

nation.

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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10

Addressing Quality Creates Data Challenges

• Retrospective chart abstraction

– Burdensome

– Time-consuming

– Mostly manual process

– Able to collect more specific clinical measures

• Administrative claims data

– More efficient

– Quality reporting as a by-product of the administrative

process

– Codes do not provide level of detail necessary

– Concerns over accuracy of coded data

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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11

We Focused On Patient Safety In Taiwan - 2003

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12

We Agreed Safety Is Not New And Surely Not

Unique to the USA

“Grant me the courage to realize my daily mistakes so

that tomorrow I shall be able to see and understand in a

better light what I could not comprehend in the dim light

of yesterday” Maimonides (1135-1204)

“I would give great praise to the physician whose

mistakes are small for perfect accuracy is seldom to be

seen” Hippocrates

“…even admitting to the full extent the great value of the

hospital improvements in recent years, a vast deal of

the suffering, and some at least of the mortality, in these

establishments is avoidable.” Florence Nightingale, 1863

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13

Safety Has Reached Our Patients’ Journals

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14

Errors Made News In Taiwan Too

United Daily News

2 December 2002

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15

We Discussed Changing The Culture In Which

We Practice

• Vague/slippery concept

– “How we get things done around here”

– Unofficial organizing principles; the way problems are solved; organizational glue

– We know it when we see it

– It eats strategy for lunch

• But there are some themes

– Corporate self-esteem

– Organizational structures that are important

– How the organization views itself/outside world

– Degrees of autonomy/collaboration, expectations,

hierarchies of decision making

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16

The Heart Of Culture Change In Medical Care

• The idea that medical errors are caused by bad systems is a transforming concept

• Complex systems have latent errors

– Design of work

– Conditions of work

– Training

– Design and maintenance of equipment

• Must have clear responsibility to make the changes needed

• Safety must trump personal preferences

• Safety is everyone’s responsibility

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17

We Have Made Progress, But Are Reminded

We All Have Much More Work To Do…

• Several high profile quality and patient safety issues have

happened recently

– In the United States

– In Taiwan

• These high profile issues highlight

– The messages regarding safety and quality remain valid

– We have to keep focusing the light on the issues

– It’s not about our good intentions – it’s about what we do

• Better data can help inform decisions and prevent errors

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18

So Can Better Data Help Improve Safety

and Quality?

Clinical Concern Care Variation

Health Services Research

Evidence Based Guidelines

Prioritize the Concern

Decision to Monitor Practice

Select/Define Indicators

Measurement Protocols

Performance Measurement

Identify Best Performers

Evaluate for Best Practices

Disseminate Recs/Findings

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19

ICD-10-CM/PCS Potential

• ICD-10-CM/PCS codes have the potential to reveal much

more about quality of care, which will help clinicians better

understand complications, better designing of clinically

robust algorithms, and better tracking of the outcomes of

care.

• The ability to more finely differentiate diseases may help

analysts spot unusual patterns that would otherwise be lost

in the broader categories.

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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20

Impact of ICD-10 on Quality Measures

• Quality measures will need to be translated

• Issues related to translation

• Clinical intent of the measure

– The specificity of ICD-10 codes may alter the definition

of a quality measure

– ICD-10 coding conventions and guidelines can affect

the patient populations included or excluded from a

measure

– Can the patient population be better identified using

ICD-10?

• Impact on existing trend data

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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21

What If You Already Have Data In ICD-9-

CM?

• Data conversion issues

• Does change reflect a true picture or an artifact of

data conversion?

• What about mapping?

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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22

Hospital Value-based Purchasing

Program

• Quality measures

– Heart attack care

– Heart failure care

– Pneumonia

– Surgical care

– Patient safety

– Hospital acquired conditions

• Centers for Medicare & Medicaid (CMS) will evaluate

hospitals both on their achievement on each measure

during the “performance period” and the improvement in

their performance from a “baseline period” to the

performance period.

• CMS will translate each hospital’s total performance score

into an incentive payment.

Performance measure

populations are defined

using ICD-9-CM. Will need

to be re-specified with the

more specific ICD-10 codes

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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23

Hospital Value-based Purchasing

Program

• The Accountable Care Act (ACA)

requires CMS to make publicly

available hospital-specific

performance information on

individual measures, conditions or

procedures, and overall scores.

• CMS will publish on the Hospital

Compare website hospital-specific

information with respect to

individual measure scores,

condition-specific scores, domain-

specific scores and total

performance scores.

Performance measure

populations are

defined using ICD-9-

CM. Will need to be re-

specified with the

more specific ICD-10

codes

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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24

Quality Reporting Measures are Defined

Using Clinical Codes

• Joint Commission core

measures

• National Quality Forum

endorsed measures

• Physician Consortium for

Performance Improvement

(PCPI) measures

• CMS demonstration projects

• CMS Hospital Acquired

Conditions (HAC) Diagnosis

Related Groups (DRG) impact

• State data reporting

Performance measure

populations are

defined using

ICD-9-CM.

Will need to be re-

specified with the

more specific

ICD-10 codes

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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25

Accountable Care Organizations

• Shared savings

– Encourages groups of providers to

form accountable care organizations

(ACOs) to improve the quality and

efficient delivery of patient care and

to share in the cost savings they

achieve with the Medicare program.

• Quality measures

– 65 quality measures, the majority of

the measures do not overlap with the

56 quality measures (45 inpatient

and 11 outpatient) that hospitals

currently report and require data

collection from medical records or

surveys.

Performance

measure populations

are defined using

ICD-9-CM. Will need

to be re-specified

with the more

specific ICD-10

codes

The more specific ICD-10

codes will help you

better understand the

clinical picture of the

patients you treat and the

treatment you provide.

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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26

ICD-9-CM and ICD-10-CM/PCS Mapping

• To facilitate the transition from ICD-9-CM to ICD-10-CM/PCS,

mapping between the two coding systems has been

developed.

• The General Equivalence Mappings (GEMs) are used to

facilitate linking between the diagnosis codes in ICD-9-CM

and the new ICD-10-CM/PCS code sets.

• The GEMs as well as the documentation and user’s guide are

available online at:

http://www.cms.gov/Medicare/Coding/ICD10/index.html

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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27

General Equivalence Mappings (GEMs)

• The GEMs are a comprehensive

translation dictionary that can be used

to accurately and effectively translate

any ICD-9-CM-based data, including

data for:

– Tracking quality;

– Recording morbidity/mortality;

– Calculating reimbursement; or

– Converting any ICD-9-CM-based

application to ICD-10-CM/PCS.

• The GEMs can be useful for projects to

convert large data sets.

• They are not a substitute for learning

how to use ICD-10-CM or for selecting

ICD-10-CM codes.

GEMs should be

used with care and

require

understanding of

ICD-9-CM as well as

ICD-10, as well as

the intent of the

application or data

being converted.

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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28 Copyright (c) 2012 by American Hospital Association. All rights reserved.

ICD-9-CM and ICD-10-PCS Mapping

• Documentation and user’s guide available online

– Information on structure and relationships contained in

the mappings to facilitate correct usage

– Glossary of terms and conventions used in the mapping

along with their accompanying definitions

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29

General Equivalence Mappings (GEMs)

• They are not a substitute for learning how to use ICD-

10-CM or for selecting ICD-10-CM codes.

• The GEMs as well as the documentation and user’s guide

are available online at:

http://www.cms.gov/Medicare/Coding/ICD10/index.html

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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30

Example of GEMs Translations: Single Code

• Only one alternative in a GEM (“one-to-one” translation)

– Are the codes identical?

Copyright (c) 2012 by American Hospital Association. All rights reserved

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31

Example of GEMs Translations: Multiple

Code Alternatives

• There may be multiple translation alternatives all of which are

equally plausible depending on circumstances (e.g. burns).

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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32

Example of GEMs Translations: ICD-9

Code Clusters

• More than one ICD-9 code is required to equal a complete

translation of one ICD-10 code

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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33

Example of GEMs Translations: ICD-10

Code Clusters

Copyright (c) 2012 by American Hospital Association. All rights reserved.

• More than one I-10 code is required to equal a complete

translation of one I-9 code

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34 Copyright (c) 2012 by American Hospital Association. All rights reserved.

Number of ICD-9 and ICD-10 Codes for Diagnoses and

Procedures

68,000

72,600

3,000

13,000

0

40,000

80,000

Diagnosis codes Procedure codes

ICD-9

ICD-10

What does the additional detail provide for

quality reporting?

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35

NQF Seriously reportable events in healthcare: Patient death or

serious disability associated with the use or function of a device

in patient care in which the device is used or functions other than

as intended.

ICD-9-CM

996.1 Mechanical

complication of

other vascular

device, implant,

and graft

ICD-10-CM

9 codes differentiating aortic graft, carotid arterial

graft, femoral graft from catheters.

Examples:

T82.49xA Other complication of vascular dialysis

catheter, initial encounter

T82.591A Other mechanical complication of surgically

created arteriovenous shunt, initial encounter

T82.593A Other mechanical complication of balloon

(counterpulsation) device, initial encounter

T82.595A Other mechanical complication of umbrella

device, initial encounter

ICD-10-CM Code Examples

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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36

NQF Seriously reportable events in healthcare: Patient death or

serious disability associated with intravascular air embolism that

occurs while being cared for in a healthcare facility

ICD-9-CM

999.1 Complications of medical

care, not elsewhere classified,

air embolism

(includes air embolism to any

site following infusion,

perfusion, or transfusion)

or

996.74 Other complications, due

to vascular device, implant, and

graft

(includes embolism, fibrosis,

hemorrhage, pain, stenosis)

ICD-10-CM

T80.0xxA Air embolism

following infusion,

transfusion and therapeutic

injection, initial encounter

T82.818A Embolism of vascular

prosthetic devices, implants

and grafts, initial encounter

ICD-10-CM Code Examples

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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37

ICD-10-CM Code Examples

ICD-9-CM

998.2 Accidental puncture or

laceration during a

procedure

ICD-10-CM

21 codes indicating accidental puncture

and laceration specifying organ or

body system and type of procedure

Examples:

D78.11 Accidental puncture and

laceration of spleen during a

procedure on the spleen

D78.12 Accidental puncture and

laceration of spleen during other

procedure

National Quality Forum Endorsed Quality Measure: Accidental

Puncture or Laceration

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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38

ICD-9-CM

998.4 Foreign body

accidentally left

during a

procedure

• Includes

adhesions,

obstruction or

perforation due to

foreign body left

accidentally during

surgery

ICD-10-CM

T81.525D Obstruction due to foreign body

accidentally left in body following heart

catheterization, subsequent encounter

T81.532A Perforation due to foreign body

accidentally left in body following kidney

dialysis, initial encounter

Plus 48 more unique codes specifying

complications due to foreign body (splitting

out obstruction, adhesions, perforations,

and other complications) and some

common procedures like surgical

operation, endoscopic procedures, removal

of catheter and infusion.

ACO quality measure, MS-DRG hospital acquired condition, Hospital Value

Based Purchasing Program measure: Foreign Body left after procedure

ICD-10-CM Code Examples

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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39

Local Coverage Determination: Hyperbaric oxygen therapy

includes indication of diabetic ulcer. ACO At-risk population

measure, Diabetes mellitus foot exam

ICD-9-CM

250.8x Diabetes with other

specified manifestations

+

707.x Chronic ulcer of skin

ICD-10-CM

E10.62x or E11.62x Type 1 or type 2

diabetes mellitus with foot ulcer or

other skin ulcer

Indication is captured in a single code

instead of requiring the combination of

2 codes

ICD-10-CM Code Examples

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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40

Local Coverage Determination: Percutaneous transluminal

angioplasty includes indication of vascular graft stenosis

ICD-9-CM

996.74 Other

complications due to

other vascular device,

implant, and graft

• Includes embolism,

thrombosis, fibrosis,

hemorrhage, pain, and

stenosis

ICD-10-CM

T82.858 Stenosis of vascular prosthetic

devices, implants, and grafts

ICD-10-CM Code Examples

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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41

Underdosing by (inadvertently) (deliberately) taking less substance

than prescribed or instructed.

Information may be useful to identify reasons for readmissions and

prevent readmissions

ICD-9-CM

Concept does not exist

Code to condition

ICD-10-CM

• T38.3X6 A Underdosing of insulin and oral

hypoglycemic [antidiabetic] drugs, initial

encounter

• T44.7X6A Underdosing of beta-

adrenoreceptor antagonists

ICD-10-CM Code Examples

Copyright (c) 2012 by American Hospital Association. All rights reserved.

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ICD-10-CM Code Examples

ICD-9-CM

V15.81

Noncompliance

with medical

treatment

ICD-10-CM

Z91.11 Patient's noncompliance with dietary regimen

Z91.120 Patient's intentional underdosing of medication regimen due to financial hardship

Z91.128 Patient's intentional underdosing of medication regimen for other reason

Z91.130 Patient's unintentional underdosing of medication regimen due to age-related debility

Z91.138 Patient's unintentional underdosing of medication regimen for other reason

Z91.14 Patient's other noncompliance with medication regimen

Z91.15 Patient's noncompliance with renal dialysis

Z91.19 Patient's noncompliance with other medical treatment and regimen

Patient noncompliance: Information may be useful to identify

reasons for readmissions and prevent readmissions

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ICD-10-CM Code Examples

ICD-9-CM

518.5 Pulmonary

insufficiency following

trauma and surgery

ICD-10-CM

J95.82 Postprocedural respiratory failure

AHRQ Patient Safety Indicators, Value Based Purchasing

Complication/patient safety indicators: Postoperative respiratory

failure

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Greater Specificity – Laterality Example

ICD-10-CM

• L89.312 Pressure ulcer of

right buttock, stage II

• L89.324 Pressure ulcer of left

buttock, stage IV

• OR

• L89.322 Pressure ulcer of left

buttock, stage II

• L89.314 Pressure ulcer of

right buttock, stage IV

ICD-9-CM

• 707.05 Pressure ulcer buttock

• 707.22 Pressure ulcer stage II

• 707.24 Pressure ulcer stage

IV

• How many ulcers are there?

CMS, Hospital Acquired Condition: Pressure ulcer

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ICD-9-CM vs. ICD-10-CM Sample Codes

ICD-10-CM

I97.410 Intraoperative hemorrhage and

hematoma of a circulatory system organ or

structure complicating a cardiac catheterization

I97.611 Postprocedural hemorrhage and

hematoma of a circulatory system organ or

structure following cardiac bypass

D78.01 Intraoperative hemorrhage and hematoma

of spleen complicating a procedure on the

spleen

D78.02 Intraoperative hemorrhage and hematoma

of spleen complicating other procedure

ICD-9-CM

998.11 Hemorrhage

complicating a

procedure

998.12 Hematoma

complicating a

procedure

Tracking complications, what really happened,

when?

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ICD-10-CM Code Examples

ICD-9-CM

996.57 Mechanical

complication due to

insulin pump

ICD-10-CM

T85.614 Breakdown (mechanical) of insulin pump, or

T85.624 Displacement of insulin pump, or

T85.633 Leakage of insulin pump, or

T85.694 Other mechanical complication of insulin

pump

Plus

T38.3x6- Underdosing of insulin and oral

hypoglycemic [antidiabetic] drugs

or

T38.3x1- Poisoning by insulin and oral

hypoglycemic [antidiabetic] drugs, accidental

(unintentional)

National Quality Forum seriously reportable events in healthcare: Patient

death or serious disability associated with hypoglycemia, the onset of

which occurs while the patient is being cared for in a healthcare facility

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ICD-9-CM vs. ICD-10-PCS Comparison

ICD-9-CM

• 39.31 Suture of artery

ICD-10-PCS

• 02QP0ZZ Repair pulmonary

trunk, open approach

• Plus 195 other codes based on

– Approach

• Open

• Open Endoscopic

• Percutaneous

• Percutaneous

Endoscopic

– Body part

• 67 different arteries

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Tracking procedures, what was done?

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National Quality Forum endorsed quality measure: Number of

admissions for lower-extremity amputation among patients with

diabetes.

ICD-9-CM

84.14 Amputation of

ankle through malleoli

of tibia and fibula

84.15 Other amputation

below knee

84.17 Amputation above

knee

ICD-10-PCS

Distinguishes between

• Right and left foot

• Complete foot only

• Lower leg (low, mid or high)

• Upper leg (low, mid or high)

Examples:

0Y6M0Z0 Detachment at Right Foot,

Complete, Open Approach

0Y6C0Z2 Detachment at Right Upper

Leg, Mid, Open Approach

0Y6J0Z3 Detachment at Left Lower

Leg, Low, Open Approach

ICD-9-CM vs. ICD-10-PCS Comparison

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Number of ICD-9 and ICD-10 Codes for Diagnoses and

Procedures

68,000

72,600

3,000

13,000

0

40,000

80,000

Diagnosis codes Procedure codes

ICD-9

ICD-10

How does it affect documentation needs?

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Documentation Issues

• ICD-10 requires more detailed documentation to specify

aspects of diagnoses and procedures required for more

detailed codes

• Assess current documentation specificity

• Physician education – not necessarily to obtain a more

specific code, but for

• Quality improvement

• Clinical purposes

• Patient safety

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Documentation Improvement Program

• Work with your medical staff

• Audit- what is the quality of your documentation today?

• Are diagnoses and procedures documented in in sufficient detail

for coding?

• Are all significant secondary diagnoses properly documented?

• Refine any existing Clinical Documentation Improvement

programs to include ICD-10-CM/PCS requirements

• Will need support from administration

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Assess Current Workflow

• Assess choices for provider

documentation

– Problem list

– Pick list – templates

– Free text

– Dictation/speech recognition

– Templates

– Combination?

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Case of the Missing Documentation

• Paper vs. electronic

• Hybrid

• Documentation in multiple

locations

– Difficult to find

– Coders may need to

log into multiple

systems or paper

– Easy to miss important

information

– Coders are too

valuable to spend time

playing detectives

• Centralized records

– Scanning

– Electronic health

records

• Technology can be a

coder’s best friend (if done

right)

• Enable remote chart

reviews and audits

• Dealing with shortage of

qualified coders

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Does Your Organization Code Minor

Procedures?

• Review/revise coding policies on what to code

• Consider alternatives for obtaining required information

required for minor procedures and where should the coding

happen?

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Focus Coding and Documentation Gap

Analysis

• Sample records

• Top MS-DRGs

• Most common surgical procedures

• Most active members of the medical staff (high

volume admission/surgeries)

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Consider Solutions and Develop Plan

• Technical solutions

• People solutions

• Identify physician and executive champions

• Consider existing venues for disseminating information

• What’s in it for the physicians?

• It’s not only about getting a code number for the hospital or

the claim

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Query Forms

• Will need to redesign physician queries.

• Coders and documentation specialists most

likely already know where the gaps in

documentation are

– Engage them to watch for gaps and work

on closing those gaps now!

• Review query form inventory

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Dictation/Transcription

• Much more difficult (if not impossible in some instances) to

code without an operative report

• Do you want your coders to wait for the dictation and/or

transcription of the report?

• Filing (if working with paper)

• Address any workflow deficiencies upfront

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Questions?