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January 29, 2014
ICD-10ORIENTATION AND SHC
“PLAN”
PRESENTED BY
IN COODINATION WITH SHCIN COODINATION WITH SHC
Rhonda Anderson, RHIA, President
Anderson Health Info. Systems, Inc.
940 W. 17th Street, Suite B
Santa Ana, CA 92706
Tel. 714-558-3887 Fax 714-558-1302
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OBJECTIVES
• Participants will identify:– Dates for New ICD-10– Administrative Support Needed– Documentation support– Some general coding guidelines– SHC Work plan – Key timelines
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FINAL REGULATION
• Final Regulations were released in January 2009
• Implementation Date is October 1, 2014• All billing using ICD-10 begins 10/1/2014
• ICD-10 for billing purposes as far as ability to accept the code known as “5010” was required by October, 2012-SHC is in compliance
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SHC ICD-10 PROJECT TEAM
• Steering Committee- Foothill Resource Team – ( Aisha, Belen, Russell, Kathy Simpson, Greg Sewell, Wesla, Karen Florez, Norma Martinez, Tonya Martinez, Ted Chigaros, Rhonda Anderson)
• VPO’s / VPPS Support Team
• Regional Resource Team
• Facility Level Team
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ICD-10 “HAS TWO PARTS”
• ICD-10 CM – Clinical Modification – Skilled Nursing will use “CM”
• ICD-10 PCS – Procedural Code System (used for procedures, operations within the hospital inpatient setting)
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WHAT DOES ICD-10 COMPLIANCE MEANS?
• ICD-10 compliance means that everyone covered by HIPAA is able to successfully conduct health care transactions using ICD-10 codes
• All Billing Claims will be denied if not ICD-10 by OCTOBER 1, 2014.
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WHO IS AFFECTED??
• Freestanding providers
• Ancillary services – “that means all of us really” who provide services and bill for them under Medicare, Medicaid/Cal and private insurances
• Therapy Providers
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WHO IS AFFECTED?? -2
• Developed for the provider and the coder….(person who may review the documentation and determine if code is accurate)
• Consistent, complete documentation in the medical record is a major emphasis
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STATE MEDICAID PROG. NEED TO TRANSITION TO ICD-10
• Like everyone else covered by HIPAA, state Medicaid programs must comply with ICD-10
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REVIEW YOUR ROLE
• No you will NOT code!– Leadership needs some information about
the importance– To know resources – and resources
needed– Identify SHC Project Team – initiated now– Obtain assurance from the computer system– To know that coding is correct – in future
to have a system to assure accuracy of coding, billing, documentation
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CODES CHANGE EVERY YEAR
• ICD-10 codes will be updated every year
• Not in 2014 unless new technologies and new diseases
• IN 2015 – regular updates (affects training and also purchase of manuals – computer alone is not enough.
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ICD-10 DIFFERENCES
• Organization – Two volumes
• Structure – Alphanumeric categories rather than numeric categories.(has “includes and excludes notes:– Categories are three digits– Chapters – re-arranged– Titles have Changed – examples on
following slides
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ICD-10 DIFFERENCES -2
CHAPTER* ICD-9-CM ICD-10-CM*
1 Infectious and Parasitic Diseases
Certain Infectious and Parasitic Diseases -
A00-B99
2 Neoplasms Malignant Neoplasms
6 Diseases of the Nervous System
and Sense Organs
Diseases of the Nervous System
7 Disease of the Circulatory System
Diseases of the Eye and Adnexa
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ICD-10 DIFFERENCES -3
CHAPTER* ICD-9-CM ICD-10-CM*
8 Diseases of the Respiratory
System
Diseases of the Ear and Mastoid Process
H60-H95
9 Diseases of the Digestive System
Diseases of the Circulatory System
10 Diseases of the Genitourinary
System
Diseases of the Respiratory System
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ICD-10 DIFFERENCES -4
CHAPTER ICD-9-CM ICD-10-CM
13 Diseases of the Musculoskeletal
System and Connective Tissue
Diseases of the Musculoskeletal
System and Connective Tissue
14 Congenital Anomalies
Disease of the Genitourinary System
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ICD-10
• Code composition – increased specificity
• Level of detail
• May consist of up to 7 digits with the seventh digit extensions representing visit encounter or sequelae as stated above
• Includes full code titles and no reference back to common 4th and 5th digits)
• V and E codes are no longer supplemental
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ICD-10-CM DIAGNOSIS CODES – FORMAT & STRUCTURE
• 3-7 characters in length
• Approximately 68,000 codes
• Digit 1 is alpha, digit 2 and 3 are numeric; digit 4-7 are alpha or numeric
• Decimal placed after the first 3 characters,
• All letters used except “U”
• Flexible for adding new codes
• Very specific
• Has laterality18
FIVE-SIX CHARACTER SUBDIVISION
• Way too much detail…but it looks like this!!– J10.8 – Influenza due to other influenza virus
with other manifestations– J10.81 – Influenza gastroenteritis– J10.89 – Influenza with other manifestations:
• Influenzal encephalopathy• Influenzal myocarditis
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FIVE-SIX CHARACTER SUBDIVISION -2
• Way too much detail…but it looks like this!!– ANOTHER EXAMPLE – WITH SPECIFICITY
AND LATERALITY:• S55.011 Laceration of ulnar artery at forearm
level, right arm
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MAPPING TOOLS
• Mapping from ICD-9 to 10 tools are available, General Equivalence Mappings (GEMS) – translation dictionary for diagnoses
• Called “GEMS” – general equivalence mappings
• CM – GEMS available
• PCS – GEMS just available last of September (acute hospital mostly)
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GEM FILES
• Do not despair…you vendor should prepare as much of a crosswalk as possible
• NOTE: will require some conversion for long term resident’s diagnoses by the effective date of ICD-10
• Later TRAININGTRAINING and how to use them…Key to early review!!!
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THE WORKPLAN
TRANSITION TO ICD-10
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Work Plan to Facilities
• Steering Committee – Coordinating Dates1. February – Brief Orientation ( Webinar)
Feb 6 and Feb 7
2. March – 2 hours Webinar – 2 Sessions
March 18 and 20
3. April /May/June/July – “Live Trainings”
4. July /August– Each Facility will transition all Long Term residents to ICD-10.
5. September 1 - All facilities ready ….Dual Coding ICD 9 and ICD-10
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ICD-10 PROJECT PLAN -3
• Determine who and how many staff needs training: – Facility Level ICD- 10 Team/ Attendees: – Administrator– DON– Medical Records – Diagnosis Coder – Nursing Supervisor– Biller – MDS– Admissions– Medical Director/ UR Doctors
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IMPROVE DOCUMENTATION NOW
• All of the information that is required to code according to ICD-10 is information that is necessary to an individual’s care and is already documented in the medical record
• What we will ask is “how does your documentation in your facility compare to what is needed to code accurately using ICD-10?
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ICD-10 CODES REQUIRE
• Clear focus to better documentation• Absolutely critical to the success of ICD-10• Good resident care –focused on
documentation:– Affect so many facets of health care downstream– Quality measures to analytics, research,
payment and surveillance– Must be as accurately documented, coded
and billed
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ICD-10 CODES REQUIRE -2
• Good resident care (cont.)– Requires i.e., physician, nursing, therapy–
efforts to provide good documentation – ?? To Ask– What are you documenting today?– Evaluate documentation “best practices” to
increase quality/quantity as needed
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ICD-10 CODES REQUIRE -3
• Recognition of:– Impact of ICD-10 (not new but = new focus– medical, financial, even regulatory
ramifications
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DEVELOP THE RELATIONSHIP BETWEEN CLINICIANS
• Clinicians Director of Nursing (DON) do not need to understand all of the intricacies of coding, and coders do not need to understand all of the medical – but the 2 must work together to ensure optimal accuracy
• Increase questions from coders as there is a need to understand basic anatomy and pathophysiology.
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STRATEGIES FOR TRAINING
• Leadership are those individuals who are responsible for moving things through the organization:– Understand what the impact of ICD-10 will be– What challenges are anticipated
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STRATEGIES FOR TRAINING -2
• Training Medical Record, MDS/PPS, DON, Business Office, Inquiry Staff, Medical Director:– Have training– Parallel coding taking the same cases and
coding them accurate to ICD-9 and ICD-10– Parallel training and testing – Start in early 2014
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STRATEGIES FOR TRAINING -3
• Leadership should understand enough about the coding changes to understand the implications:– Documentation– Business practices– MDS / Medicare PPS– $$ impact for training, implementation and
billing
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RESOURCES
• HIM Consultant – ICD-10 Certified and Specialized Training
• SHC Team members who have been to training will be “ Trainer” resource
• DCR’s / Medical Records Consultant will assist in Training Facilities
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WHY PREPARE NOW?
• Major understanding for providers, payers and vendors
• Will drive business and systems changes, hospital, SNF, Physicians, Outpatient, et’l, from large national health plans to small provider offices, laboratories, medical testing centers
• Staff time – start looking at who is affected now and what they need to know
• Financial resources• Options for ICD-10 transition
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ICD-10 PROJECT PLAN -4
• Evaluate current documentation
• Identify most commonly used diagnoses by checking out:– Reports – past coding Medicare coverage
issues “ADR”– Documentation to support those diagnoses– Medical staff / Medical Director support– Clinical documentation improvements
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TOO MUCH INFORMATION
• JUST AN EXAMPLE OR TWO – MORE THAN YOU NEED TO KNOW!!!
• Impacts your staff from prior to admission to discharge and beyond – billing finals, et’l
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SPECIFIC INFO. NEEDED TO ACCURATELY CODE
• Diabetes Mellitus– Type of diabetes– Body system affected– Complication or manifestation– If type 2 diabetes, long-term insulin use
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SPECIFIC INFO. NEEDED TO ACCURATELY CODE -2
• Fractures– Site– Laterality– Type– Location
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REVIEW CHANGES IN DOC. REQUIREMENTS
• Injuries– External cause – cause of the injury, more
applicable to op– Place of occurrence – home, at work, in the
car, etc. • More related to op we will have some references
– Resident Activity level code– External code status – indicate if the injury
was related to military, work, or other
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TRANSITION & TESTING
• Jan/Feb, 2014 – September 15, 2014– Conduct high level training on ICD-10 for
clinicians– Codes to prepare for testing– Clinical documentation review– Determine dual coding dates and record
reviews
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COMPLETE TRANSITION / FULL COMPLIANCE
• October 1, 2014
• Complete ICD-10 transition for full compliance– ICD-9 codes continue to be used for services
provided before October 1, 2014– ICD-10 diagnosis and inpatient procedure
codes required for services provided on or after October 1, 2014
– Monitor systems correct errors if needed
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THANKS FOR ATTENDING
Rhonda Anderson, RHIA
President
Anderson Health Information Systems, Inc.
940 W. 17th Street, Suite B
Santa Ana, CA 92706
Mobile 714-299-0573 Office 714-558-3887
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