ICD10

Are You Prepared?Presented by Cheri Welk, RHIT

Manager, Physician Billing

April 6, 2013

ICD10

• A new Date!!• CMS Announces ICD10 will be delayed 1 year –

Implementation is now October 1, 2014

ICD10• Where do you start?

• Depends on your role• Office/Practice Manager – IT Departments

• Work with your software vendors• Work with your payers• Educate your providers

• Coder• Assess if you need additional training on Anatomy/Pathophysiology• AAPC is requiring certified coders to take a proficiency assessment to

maintain their CPC credential

• Providers• Work with your coders to assure your documentation supports the level of

specificity required for ICD10

ICD10• Software Venders and Payers• End-to-End Testing Pilots

• Example; Qualedix QA and the North Carolina Healthcare Information and Communications Alliance (NCHICA) are piloting a trading partner certification program and an ICD-10 testing framework for end-to-end testing.• Step 1: sharing of dual-coded clinical scenarios with two participating health plans, United

Healthcare and Blue Cross Blue Shield of North Carolina• Once the coding has been solidified, the transactions and associated file formats will be

transferred to encoder products from 3M and Optum for internal testing to ensure that these products find the right codes, which already have been determined in the initial analysis based on the medical records

• The health plans will receive compliant 5010 transactions based on the exact clinical scenarios that were reviewed in order to ensure complete traceability to the original test cases. The health plans also will have the ability to test the transactions internally once their systems have been remediated, allowing them to produce accurate ICD-10-based adjudication and remittances.

• The reason this pilot sets the standard for key end-to-end testing methods is that it delivers the ability to show vendors, clearinghouses and health plans what actually will be sent and shared in a live environment – as opposed to basing an entire testing effort on internal payer mappings only. Providers will gain crucial insights into various mapping rules and the contracts they have with each health plan, based on the developed clinical scenarios.

ICD10• Coder Training

• As quoted by the Centers for Medicare & Medicaid Services (CMS), the Robert E. Nolan Company performed a study on challenges of ICD-10 implementation and estimated that each full time coder will need up to 40 hours of ICD-10 training. Physicians and other clinicians will need additional training, ranging between 12 and 80 hours each• Due to the clinical nature of ICD-10-CM a strong understanding of, or

experience in anatomy and/or physiology will be required

ICD10• What does ICD10 look like?

• Guideline changes from ICD9---- assumptions made for causal relationships• Hypertension and Chronic Kidney Disease• Diabetes

• Laterality• For bilateral site, the final character indicates laterality.

• Injury / Fracture Care• Episodes of care 7th Character

• Initial encounter• Subsequent encounter

• Sequela

ICD10• What does ICD10 Look Like? (continued)

• Greater level of detail with its seven (7) alphanumeric characters instead of the 5-digit ICD-9 code set..

• Going from roughly 17,000 codes to about 140,000• ICD10-CM consists of 21 chapters compared to 17 chapters in

ICD9-CM• Contrasts to ICD9 where injuries are classified by injury; in ICD10,

they are grouped first by specific site (head, arm, leg, etc.)• In ICD10, there are code extensions (seventh character) for

obstetrics, injuries and external causes of injuries.• Addition of a place holder (x).

ICD10

ICD-9-CM Code Format

Category Etiology, Anatomic site, manifestation

ICD-10-CM Code Format

Category Etiology, site, Extension

Manifestation

ICD10Combination codes for conditions and common symptoms

ICD-10-CM

• E10.21, Type I diabetes Mellitus with diabetic nephropathy

• I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris

• Crohn’s Disease of large intestine with intestinal obstruction

ICD-9-CM

• 250.41 Diabetes w/ renal manifestations, type I.

• 583.81 Diabetic nephropathy, NOS

• 414.01 Atherosclerotic heart disease of native coronary artery

• 413.9 Angina Pectoris

• 555.1 Regional Enteritis Large Intestine• 560.89 Other specified intestinal obstruction

ICD10

ICD-10-CM

• S06.0x1A Concussion with loss of consciousness of 30 minutes or less, initial encounter

Rational

• Dummy placeholder which is always the letter ‘x’ and it has two uses:

• As the fifth character for certain six character codes. The ‘x’ provides for future expansion without disturbing the sixth character structure

• When a code has less than six characters and a seventh character extension is required. The ‘x’ is assigned for all characters less than six in order to meet the requirement of coding to the highest level of specificity.

• Seventh-character extension for episode of care

• A – Initial encounter• D – Subsequent encounter• S - Sequela

ICD10• General Equivalence Mappings (GEMS)

• Mappings between ICD-9-CM and ICD-10-CM classification systems have been developed to facilitate the transition from one code set to another. Public domain diagnosis code reference mapping files referred to as Diagnosis Code Set General Equivalence Mappings (GEMs) have been released by HCHS. There are to files available allowing for bidirectional mappings.

• http://www.cdc.gov/nchs/icd/icd10cm.htm• http://www.cms.hhs.gov/ICD10

ICD10• GEM File

ICD10• Crosswalk in EncoderPro

ICD10

ICD10

Questions?

ICD10• Resources

THERE IS HELP OUT THERE!!!

• Surgical Management Professionals• CMS Website http://

www.cms.gov/Medicare/Coding/ICD10/index.html• AHIMA Website http://www.ahima.org/icd10/• AAPC Website http://www.aapc.com/icd-10/