ICD-10-CM An Introduction 2013

1. ICD-10-CM An Introduction 2013 Bobbi Buell, MBA onPoint Oncology LLC 800-795-2633 bbuell@onpointoncology.cim

2. Main Objective • Inspire panic---this is not that far away. • Create an awareness of ICD-10-CM. • Start to consider the impact the conversion to ICD-10 will have on your operations. • Start to understand what it means and does not mean in Oncology.

3. Latest Update • This is happening 10/1/2014 • CMS intimated that the deadline would not be postponed. • The AMA still vehemently opposes this deadline. • Hospitals have spent millions on it. • You be the judge.

4. Implications of the Transition – Who? • Providers • Hospitals • Physicians • Outpatient facilities • Post-acute providers (home health agencies, skilled nursing facilities, etc.) • Health Plans or Payers • Third party administrators • Employers

5. Implications of the Transition – Who? • Others • Laboratories • Free standing ancillaries • Researchers • Public health agencies et al • Data collection agencies/organizations (tumor registries) • Vendors • Clearinghouses • Business associates and partners • Patients

6. ICD-9-CM vs. ICD-10-CM

7. Why is ICD-9 Being Replaced? • ICD-9-CM is out of date and running out of space for new codes on the procedural side. • Lacks specificity and detail • No longer reflects current medical practice • ICD-10 is the international standard to report and monitor diseases and mortality, making it important for the U.S. to adopt ICD-10 based classifications for reporting and surveillance. • ICD codes are the core elements of HIT systems, conversion to ICD-10 is necessary to fully realize benefits of HIT adoption.

8. Reimbursement Issues With ICD-9? • Example: Fracture of Wrist • Skateboarder fractures right wrist • A month later, fractures left wrist • ICD-9 would require additional documentation to find out which wrist was fractured • ICD-10-CM describes in fracture codes • Left versus right • Initial or subsequent encounter • Routine healing , delayed healing, nonunion or malunion

9. There Are Benefits of ICD-10 • Reflects more emerging technologies, particularly PCS • Captures the details of EMRs • Might reduce ADRs from payers due to more specificity • Statistical outcomes will be more measurable and specific • May support better epidemiological trending

10. What is ICD-10-CM? • CM = Clinical modification to ICD-10 used around the world • Consultation with • Physician groups • Clinical coders • Other users of ICD-9-CM

11. Who Runs The Show? • National Center for Health Statistics (NCHS) is the federal agency that is responsible for maintaining the diagnostic coding systems in the U.S. • CMS partners with them to oversee publicly available coding systems • WHO oversees ICD-10 without the –CM • The American Health Information Management Association (AHIMA) oversees education and training

12. Coding Process Remains the Same • ICD-10-CM code book retains the same traditional format • Index • Tabular • Process of coding is similar • Look up a condition in the Index • Confirm the code in the Tabular

13. Major Differences Between ICD-9-CM and ICD-10-CM

14. Character Changes

15. Comparison of ICD-9-CM and ICD-10-CM ICD-9-CM CODE ICD-10-CM CODE A - Category of code B - Etiology, anatomical site, and/or severity C - Extension 7th character for obstetrics, injuries, and external causes of injury • A - Category of code • B - Etiology, anatomical site, and manifestation A A B C B

16. ICD-9-CM Structure – Format Numeric or Alpha (E or V) Numeric X V 5 E 4 X 1 X 4 X 0 0 X . . Category Etiology, Anatomic Site, Manifestation 3 – 5 Characters

17. ICD-10-CM Structure – Format Alpha (Except U) Additional Characters 2 - 7 Numeric or Alpha . . X X X A M A X S 3 X 2 X X 0 1 0 Added code extensions (7th character) for obstetrics, injuries, and external causes of injury Category Etiology, Anatomic Site, Severity 3 – 7 Characters

18. Characteristics of ICD-10-CM • ICD-10-CM far exceeds its predecessors in the number of concepts and codes provided • The disease classification has been greatly expanded to include health-related conditions and to provide greater specificity at the sixth digit level and with the seventh digit extension • By the way, the 6th and 7th digit extensions ARE NOT optional for the codes where they are present

19. Arrangement of Volumes of ICD-10 • Volume 1: Main classifications • Volume 2: Instruction/ Guidance to users • Volume 3: Alphabetical Index • ICD-10 has 21 chapters against 17 Chapters in ICD-9

20. Chapters of ICD-10 • Chapters I to XVII: Diseases and other morbid conditions • Chapter XVIII: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified. • Chapter XIX: Injuries, poisoning and certain other consequences of external causes. • Chapter XX: External causes of morbidity and mortality, • Chapter XXI: Factors influencing health status and contact with health services.

21. What You Should Worry About • The codes you most frequently use • Can you run a report from your PM or EMR system that shows you all ICD-9’s that you have billed more than 50-100 times over the past 2-3 years? Your limits will depend upon your size. • These are the codes you need to know and translate. • You do not need to know 69,000 codes • But, physicians need to access to non-cancer codes to use when they are evaluating and/or managing patients

22. General Equivalence Mappings

23. Forward and Backward Mapping Forward Mapping Backward Mapping

24. GEMS Example #1

25. GEMS Example #2

26. GEMS #3

27. GEMS Example #4

28. Other Major Differences With ICD-10 • Use additional codes • Sequelae • Combination codes • Differences in anemia • Mandatory 6th and 7th digits

29. Cancer Differences • Laterality • Mandatory’ use additional’ codes—look at lung cancer • 6th digits (check out skin and breast cancers) • Much more detail and confusion surrounding lymphoma • More detail in myeloid leukemia • Help with CUP

30. And this must be documented….

31. Preparing for ICD-10

32. ICD-10 Implementation Plan Checklist: http://www.ahima.org/icd10/ICD-10PreparationChecklist.mht Year 2011 2012 2013 2014 Phase I Awareness and ImpactAssessment Phase II Preparing for Implementation Phase III Go Live Preparation Phase IV Post – Implementation

33. Where to Start?

34. Diagnostic Codes are Ubiquitous • Diagnostic codes are everywhere – used by every person, every process, every system…. • Superbills • Payments/EOBs/ERAs • Referrals • Contracts • EMRs • But, again, this is limited to codes you actually use

35. Solo Practitioner Or Small Group (2-10) Practice Implementation Planning • Organize Implementation Effort • Establish Communication Plan • Conduct Impact Analysis • Contact System Vendors • Estimate Budget • Implementation Planning • Develop Training Plan • Analyze Business Processes • Education and Training • Policy Change Development • Deployment of Code • Implementation Compliance Source: AAPC

36. 2013 Plan

37. Organize Implementation Effort • Enlist staff person (coder, biller, manager) to oversee effort who will be key point person • Prepare information to share with other providers and staff • Identify work and scope for implementation • Should be a team effort involving all medical practice staff and the staff needs to believe that this will actually happen. • If everyone is not signed on to this, your effort will not work long term

38. Organize Implementation Effort • Examine the level of coding you have in your practice—who is certified? Who has experienced a change before, e.g. E/M, admin codes? Who is equipped to deal with this? • Look at all areas that will impact practice and identify each one that will be affected • List of codes • Practice management system • Electronic Medical Record (EMR), if applicable • Superbills • Clinical areas and pharmacy • Schedule regular meetings to share information with physicians and discuss progress and barriers of implementation.

39. Establish Communication Plan • How will point person communicate with all staff? • Most practices communicate via meetings or memos • No need to change method of communications • Develop regular schedule for ICD-10 progress efforts • Monthly until 6 months prior to implementation • Bi-weekly thereafter • Include information, publications, and articles • Document all meetings and what was discussed herein and make sure you are tracking with your plan.

40. Conduct Impact Analysis • Take this step prior to development of budget • In depth look at resources required for implementation • Maybe check for a little process improvement • Helps determine what costs might be involved as well as work processes

41. Potential Areas that will be Impacted!

42. Potential Areas that will be Impacted! For those that can’t read the small print… • Clinical Area • Patient Coverage • Superbills • ABN’s • Physicians • Documentation • Code Specificity • Problem lists • Nurses • Forms • Documentation • Prior Authorization • Managers • Policies & Procedures • Vendor/Payer Contracts • Budgets • Training Plan Source: AAPC 2012

43. Potential Areas that will be Impacted! • Lab • Documentation • Reporting • Billing • Policies & Procedures • Training • Pharmacy • Infusion Room • Coding • Code Set • Clinical Knowledge • Concurrent Use • Front Desk • Referrals/ History codes • Systems Source: AAPC 2012

44. List Every Area That Uses Codes • Geographical • Technological • Processes • Vendors • Payers • Paper • Etc

45. What It Looks like Source: AMA ICD-10 Project

46. Conduct Impact Analysis • Develop reasonable timeline that can be accomplished in your practice • Map out a project plan on a simple Excel spreadsheet with benchmarks and status of completion • Managers and/or coders should get physician approval for the project plan and its impact on the practice. Make sure you show and tell them the level of work it will take.

47. From Impact Analysis • Develop a plan for • Processes • Departments • Training • Then, go to the next step…

49. Vendor Readiness

50. Contact System Vendors • Will they be able to accommodate the need to move to ICD-10? Really? Were they ready for 5010? • What plans do they have in place for implementation? • Will they have new tools in place to help you with ICD-10? Will these have a cost? Will they create savings? How long will they run parallel coding? • When will they have software available for testing? • Will we need new hardware or is current hardware sufficient? • What is the cost?