Presented by Sithara Satiyadev

Africode Consulting

September 2013

Agenda

ICD-10

Background

MIT

Phase 3

Phase 4

Background to ICD-10

Owned by WHO

Adopted by NDoH in

1997

Adopted by PHISC in

2000

Task Team (NTT)

established in 2004

ICD-10 Implemente

d in July 2005

Background to ICD-10

2000: Private stakeholders complaint to

MoH

2001: MoH request CMS to

investigate

2004-Feb 2011

NTT: auspice of

CMS 2003: CMS

report & recommendation to

MoH

Medical

Schemes Act,

Reg . 5 (f)

May 2011:

DG TT

March 2012:

MoH:

appointed

ICD-10 TT

MoH: Terms of Reference for the ICD-10

Task Team

Structure of ICD-10 Task Team

Chairperson

Communication & Monitoring

sub-committee

Privacy & Security sub-

committee

ICD-10 Morbidity sub-committee

ICD-10 Mortality sub-committee

Training sub-committee

NDoH: Secretariat and support to Task

Team

Participation from all

healthcare stakeholders

Ministerial ICD-10 Task team

Advise and recommend ICD-10 standards: adopted as policy by

the NDoH

ICD-10 MIT: Master Industry Table

Failure to update systems with this file

will lead to rejections of claims by

medical aids and inaccurate health data

collections

Are about 1600 codes changes: added,

deleted or modified

Many more convention changes, e.g.

notes, excludes, includes, etc

Last file update was in 2007

ICD-10 MIT: Master Industry Table

Examples of new codes

J09: Influenza due to certain identified

influenza virus

new code to be used for swine flu &

avian flu

K02.5: Caries with pulp exposure

G90.4: Autonomic dysreflexia

ICD-10 MIT: Master Industry Table

Examples of Modified Codes

Old: O60: Preterm labour and delivery: was

valid for use

New: O60: not valid

O60.0: Preterm labour without delivery

O60.1: Preterm spontaneous labour with

preterm delivery

O60.2: Preterm spontaneous labour with

term delivery

O60.3: Preterm delivery without

spontaneous labour

ICD-10 MIT: Master Industry Table

Old Version

I70: Atherosclerosis

I70.0:

Atherosclerosis of

aorta (was valid for

use)

New version

I70.0:

Atherosclerosis of

aorta (not valid-need

5th characters)

I70.00:Atheroscleros

is of aorta without

gangrene

I70.01:Atheroscleros

is of aorta with

gangrene

ICD-10 MIT: Master Industry Table

Examples of deleted codes

• H54.7: Unspecified visual loss

• K35.0 Acute appendicitis with

generalized peritonitis

• K35.9: Acute appendicitis, unspecified

Above have been replaced with new codes

ICD-10 Coding Tools

ICD-10 Browser

NDoH/TT to go out on tender

Secure SP Development to commence

in 2013

Current version: BHF/DXS 2007 (only valid until 31 May 2013)

Acquire from PMS or Private

companies

SA ICD-10 Coding Standards

Documents

Examples: Z01.6, Z01.7,

Finalise standards Publish NDoH website

Z code (DSN 21) Review

Codes proposed for deletion Default codes (overuse)

ICD-10 Coding Morbidity Coding Standards Document

Policy Document Morbidity ICD-10 standards

ICD-10 Mortality Coding Standards

Document

• Ready for sign off by DG

• Will be posted on NDoH website

Version 1 of Standards Document

• Circulated for comments

• Collated and published in next version

Outstanding standards/ Guidelines

ICD-10 Implementation

Phased Approach:

Phase 1: 01/07/05 to 30/09/05-education

Phase 2: 01/10/05 to 31/12/05-valid ICD-10 code

Phase 3: 01/01/06 to date-validations

Phase 4: to commence in 2014

Current Situation Implementation

Phase 3: current phase: not fully implemented (private & public healthcare sectors)

MoH/NDoH: phase 3 to be fully implemented nationally by 01/07/14 to support NHI and quality disease stats.

The NDoH & CMS: all schemes and administrators to commence full scale phase 3 and phase 4.1. validations on 01/07/14 (CMS accreditation)

Currently: only 3 schemes/administrators are doing primary ICD-10 code validations (Pdx)

Hospitals: header level validation on all codes

Drs and Allied Staff: line level validations on all codes

Full scale ICD-10 phase 3 validations can lead to a great deal of claims rejections if providers are not compliant to phase 3

ICD-10 Technical User Guide

Non-compliance will result in claims rejections

Implementation: 01/07/14

Phase 3 and 4.1

NDoH website

Funder messages : 01/06/13 Funder messages : 01/06/13

ICD-10 Technical User Guide for Phase 3

Phase 3 Phase 4.1

ICD-10: Phase 3 Requirement Implementation date: 01 July 2014

ICD-10

Correct 3, 4, 5 character Codes (all

codes-pdx & sdx)

Appropriate Pdx codes as

Per MIT

MIT: Version 2007 (BHF)

Update: June 2013

SA Coding Standards Version 5

Sequelae Codes

Dagger &

Asterisk

S & T codes: Must have V,W,X,Y codes

ICD-10 Phase 4: Clinical Validation

Phase 4.1 Implementation date: 01/07/14

Age edits

Gender edits

ICD-O Morphology codes for all neoplasms

Neoplasms to

have

morphology

codes

ICD-10 Phase 4: Clinical Validation

Planned: 2015 Phase 4.2

Validation: examples

Dagger & Asterisk mapping

MP & Hospital code

validations

ICD-10 to pharmaceutical code

validations

SA Coding Stds

(Enforce)

Above details to be finalised by the ICD-10 Task Team in 2013

ICD-10 & Clinical

Validations Current Situation:

Clinical validations can ONLY take place within

contractual agreements & for the management of

PMBs.

No other claims can be subject to clinical validation until

phase 4.2 is implemented

For PMBs: medical aids can do validations of codes

between hospital and Dr, ICD-10 to CSSA/RPL

validations, ICD-10 to lab and path code validations,

ICD-10 to NAPPI validations

ICD-10 All the latest ICD-10 information can be obtained as follows:

Documents prior to 2012:Council for Medical Schemes Website, under the ICD-10 portal http://www.medicalschemes.com

2012 Documents & circulars:

www.doh.gov.za and click on:

Resource Centre - Legislation- Notice

Contact Details: Africode Consulting Tel: 011 026 2985 Cell: 082 578 7897 Email: sithara@africode.co.za; shawn@africode.co.za;info@africode.co.za Website: www.africode.co.za