Beyond basics a closer look at the icd-10 transition

Beyond Basics: A Closer Look at the ICD-10 Transition

Jasmine Gee Director, Product Marketing

The information presented in this Webinar is current as of date of live airing – February 12, 2013

October 1, 2014

October 1, 2014

October 1, 2014

1975 WHO

approves

ICD-9

1981 AIDS clinically

observed for

the first time

ICD-10 Timeline

75 85 80 95 90 05 00 15 10

2014 U.S.

adopts

ICD-10

2008 Korea

adopts

ICD-10

2010

ICD-11

released

1990 WHO

approves

ICD-10

1999 US adopts ICD-10

for mortality

coding

2007 Thailand

adopts

ICD-10

1997 Sweden

adopts

ICD-10

1998 Australia

adopts

ICD-10

2000 Canada

adopts

ICD-10

Diagnosis Codes for Sprained & Strained Ankles

ICD-9 ICD-10

SCORECARD No. of ICD-9 Codes No. of ICD-10 Codes

4 72

Z89.419: Acquired absence of unspecified great toe

Cerebral Artery Occlusion/Stenosis with Infarction

*ICD-10 Changes Appear in RED BOLD

ICD-9-CM ICD-10-CM

Etiology:

• Embolism

• Thrombosis

• Unspecified occlusion/stenosis

Etiology: Same as ICD-9-CM

• Embolism

• Thrombosis

• Unspecified occlusion/stenosis

Site:

• Cerebral artery

• Anterior

• Middle

• Posterior

• Cerebellar

• Other specified cerebral artery

• Unspecified cerebral artery

Laterality:

• Right

• Left

• Bilateral

• Unspecified

Review ICD-10 resources from CMS, trade associations, payers, and vendors

Inform your staff/colleagues of

upcoming changes (1 month)

Create an ICD-10 project team

(1 month)

Identify how ICD-10 will affect your

practice (3months)

• How will ICD-10 affect your people

and processes? To find out, ask all

staff members how/where they

use/see ICD-9

• Include ICD-10 as you plan for

projects like meaningful use of

electronic health records

✔

✔

✔

✔

Develop and complete and ICD-10 project plan for your organization (1 month)

• Identify each task, including deadline

and who is responsible

• Develop plan for communicating with

staff and business partners about ICD-10

Estimate and secure budget (potential costs

include updates to practice management

systems, new coding guides and superbills,

staff training) (2 months)

Ask your payers and vendors –

software/systems, clearinghouse, billing

services — about ICD-10 readiness (2

months)

• Ask about systems changes, a timeline,

costs, and testing plans

• Ask when they will start testing, how

long they will need, and how you and other clients will be involved

✔

✔

✔

2013 2014

2Q 3Q 4Q 1Q 2Q 3Q 4Q

ICD-10 DEPLOYMENT TIMELINE

Deployment

Design, Development, Usability Studies, and Pilot

Payer Testing Familiarization Compliance

ICD-10 AND ICD-9 Required

ICD-9 Required

ICD-10 Required

What is supposed to happen

PRE-COMPLIANCE

DATE OF SERVICE

ICD-9

ICD-10 Enforcement Date

10/1/2014

POST-COMPLIANCE

DATE OF SERVICE

ICD-10

ICD-9 Required

What will happen

PRE-COMPLIANCE

DATE OF SERVICE

ICD-9

ICD-10 Enforcement Date

10/1/2014

POST-COMPLIANCE

DATE OF SERVICE

AND PAYER READINESS

ICD-10

Coding and Documentation (Specialty-Specific)

Application

Change Management

Providers

Clinical Staff

Administrative Clerical

Management

Billing Staff

Role-based learning needs for the ICD-10 transition

Healing Type Encounter Type Body Part

Stress fracture of tibia 21 Possible Codes

M84.361 M84.362 M84.361S M84.362G M84.362S M84.369S M84.369K

M84.369A M84.361K M84.362A M84.361P M84.361A M84.369D M84.369P

M84.361D M84.362K M84.362D M84.362P M84.369S M84.369G M84.361G

• Unspecified tibia and fibula

• Tibia and fibula

• Right tibia

• Left tibia



M84.361 M84.362 M84.361S M84.362G M84.362S M84.369S M84.369K

M84.369A M84.361K M84.362A M84.361P M84.361A M84.369D M84.369P

M84.361D M84.362K M84.362D M84.362P M84.369S M84.369G M84.361G

• Initial encounter

• Subsequent encounter



• Right tibia

• Left tibia



M84.361 M84.362 M84.361S M84.362G M84.362S M84.369S M84.369K

M84.369A M84.361K M84.362A M84.361P M84.361A M84.369D M84.369P

M84.361D M84.362K M84.362D M84.362P M84.369S M84.369G M84.361G

• Routine healing

• Delayed healing

• Nonunion

• Malunion

• Initial encounter

• Subsequent encounter



• Right tibia

• Left tibia


M84.361P Stress fracture, right tibia, subsequent encounter

for fracture with malunion


M84.361 M84.362 M84.361S M84.362G M84.362S M84.369S M84.369K

M84.369A M84.361K M84.362A M84.361P M84.361A M84.369D M84.369P

M84.361D M84.362K M84.362D M84.362P M84.369S M84.369G M84.361G

http://www.nachimsonadvisors.com/Documents/ICD-10%20Impacts%20on%20Providers.pdf

Typical Small

Practice

Typical Medium

Practice

Typical Large

Practice

Education $2,405 $4,745 $46,280

Process Analysis $6,900 $12,000 $48,000

Changes to Superbills $2,985 $9,950 $99,500

IT Costs $7,500 $15,000 $100,000

Increased

Documentation Costs $44,000 $178,500 $1,785,000

Cash Flow Disruption $19,500 $65,000 $650,000

Total $83,290 $285,195 $2,728,780

http://www.nachimsonadvisors.com/Documents/ICD-10 Impacts on Providers.pdf



There is no opt-out of ICD-10.

Failure means:

► Not getting paid at all

► Getting paid incorrectly

► Inability to send clinical communication to

labs, pharmacies, hospitals, etc.

“2013 Best in KLAS Awards: Software & Services,” January, 2014. © 2014 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com

#1 Overall

Software

Vendor

#1 Overall Physician

Practice Vendor

#1 Patient

Portal

#1 Practice

Management

System (1-10, 11-75 physicians)

#2 EHR

(1-10, 11-75

physicians)

2013 Best in KLAS

Ranked #1 Most Usable EHR by

KLAS

Single instance of continuously

updated software – All

athenahealth clients are on

the ICD-10 ready version of

athenaNet

ICD-10 upgrade pushed out in

February 2014 at no additional

cost

Tracking payer,

clearinghouse, vendor and

interface readiness s

Managing ICD-9/10 codes

based on payer readiness

Using data from the patient

chart to present ICD-10 codes

intelligently at the point of

care

Working directly with payers

and clearninghouses to define

and execute a comprehensive

testing schedule

Behave like a 50,000 provider

health organization for

priority access to payers

Life Cycle of the

Patient Relationship

8% average decline in no-show rates

121 patient interactions via portal per PPM

Improved collection of patient payments

Life Cycle of Claim

29% average improvement in client DAR

8% average improvement in collections

Reduced administrative work

WHY IT MATTERS

Life Cycle of the Chart

96% Meaningful Use attestation in 2012

1,329 clinical documents processed on average per physician per

month (PPM)

Improved P4P revenue capture

Life Cycle of the Order

Increased volume and revenue capture from patients and

insurance companies

Reduced administrative work for both sender and receiver

2000

2006

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2011

Point of Care Medical

Applications

Mobile medical software for drug interaction, EHR, drug

prices, dosing, disease, medical dictionary, ICD9 Code,

Medicare Part D, and CME

2013

Questions?