Under the Hood: What will the move to ICD-10 mean to you

1. Under the Hood:What will the move to ICD-10 mean to you? Mary Johnson, RHIT, CCS-P Health Information Management Specialist VA Central Office August 12, 2010

2. 2 Current Coding Rules Health Insurance Portability and Accountability Act mandates: ICD-9* update 10/01 annually w/biannual changes Current Procedural Terminology update 01/01 annually w/ quarterly changes Healthcare Common Procedure Coding System update 01/01 annually w/ quarterly changes Data Capture 14 days following event Inpatient and outpatient Billing Coding and supporting documentation Billing validation within 14 days of the event Code Me report 3 � 5 day window

3. 3 Health and Human Services Final Rules On January 16, 2009, Health and Human Services published the final ruling for adoption of ICD-10-CM* and ICD-10-PCS** code sets, with a compliance date of October 1, 2013 A companion ruling was also published to support required changes to Health Insurance Portability and Accountability Act transaction standards (referred to as �5010/NCPDP�): By January 1, 2012 Eighteen months prior to rollout of new code sets

4. 4 ICD-10* Impacts Processes/method to look up a code will not be changed Impacts as a result of implementation of this NEW code set Software will need to add capabilities of using mandated use of ICD-10* by October 1, 2013 VistA NON-Vista Secondary databases / data stores Delays associated with increased time needed to apply code Providers Coding Code set changes Structure (numeric to alpha-numeric) Volume Specificity Classification

5. Why Go to ICD-10 CM* and PCS* Code Sets? ICD-10-CM/PCS provides detailed diagnosis and procedure coding that will assist research and quality groups to better evaluate medical processes and outcomes ICD-10-PCS improves procedure coding and better defines new technologies and devices 99 countries have adopted I-10: For reporting morbidity data To compare international data Identify new health threats 5

6. Why Go to ICD-10-CM/PCS* Code Sets?? cont. Improvements in: Coding primary care encounters External causes of injury Mental disorders Neoplasms Preventive health Traumatic brain injury Provides codes for advances in medicine that have occurred over the last 30 years Robust, flexible, expandable New categories for post-procedure disorders Added laterality; added distinctions for ambulatory and managed care encounters 6

7. ICD-9* vs. ICD-10* Diagnoses Count 7

8. 8 New ICD-10-CM* Code Structure

9. 9 ICD-10* Diagnosis Code Structure

10. Structural Differences ICD-10-PCS* Procedures ICD-10-PCS has 7 digits Each can be either alpha (not case sensitive) or numeric Numbers 0 � 9 are used Letters O and I are not used to avoid confusion with numbers 0 and 1 Z is a placeholder Examples 0FB03ZX Excision of liver, percutaneous approach, diagnostic 0DQ107Z Repair, esophagus, upper, open with autograft 10

11. ICD-9* vs. ICD-10* Procedure Count 11

12. ICD-10-PCS* Procedure Codes 12

13. 13 Example:ICD-9-CM* Angioplasty Code 39.50 854 ICD-10-PCS angioplasty codes specifying body part, approach, and device, including: 047K04Z Dilation of right femoral artery with drug-eluting intraluminal device, open approach 047K0DZ Dilation of right femoral artery with intraluminal device, open approach 047K0ZZ Dilation of right femoral artery, open approach 047K24Z Dilation of right femoral artery with drug-eluting intraluminal device, open endoscopic approach 047K2DZ Dilation of right femoral artery with intraluminal device, open endoscopic approach

14. General Equivalence Maps (GEM) GEMs provided by Centers for Medicare and Medicaid Services (CMS) and National Center for Health Statistics (NCHS) Purpose: Serve as a translation dictionary to bridge the gap between ICD-9* and ICD-10*. How many are there: Two GEMS for Diagnosis Two GEMS for Procedures Two GEMS for Reimbursement

15. 15 About the General Equivalence Maps (GEM) Current state of the GEM Text File What the maps contain Source system Code Possible equivalent in target system Attributes that further characterize the entry How to use them Database

16. 16 Example Diabetic Retinopathy not using General Equivalence Map ICD-9: Look-up in Tabular List Diabetic Retinopathy 250.5x [362.01] ICD-10: Look-up in Tabular List With Retinopathy E11.319 Specified Type NEC Retinopathy E13.319 Type I With Retinopathy E10.319 Type 2 With Retinopathy E11.319

17. 17 Correlation of ICD-9* to ICD-10* Diagnosis or Procedure codes in ICD-9 may not have a close correspondent in ICD-10 Reasonable equivents in General Equivalence Maps There is NOT a 1:1 correlation between ICD-9 and ICD-10 Almost 60,000 of the ICD-10 codes are mapped to an approximate match with only one option, or an approximate match with several options About 4,500 of the ICD-10s have a one-to-many mapping, where it requires multiple ICD-9s to approximate one ICD-10 code�s definition

18. 18 ICD-10* Challenges Implementation of ICD-10 will have broad impact throughout VHA No centralized inventory; need to identify software, systems, devices, processes, forms, and users that will be affected Need adequate resources to complete business/technical requirements in 2010 Need commitment from Program Offices to serve as business SMEs Need to develop and release search engine and SNOMED (Systematized Nomenclature of Medicine)-to-ICD-10 Problem List functionality at least one year in advance of the date of compliance Need to coordinate with 5010 project Need to allow adequate time for end-to-end testing prior to compliance date Need to plan and conduct enterprise-wide technical and user training

19. 19 ICD-10* PMO Functional Organization Structure

20. 20 Identified Affected VistA Applications Scanned VistA applications for ICD* use Identified 58 affected packages Prioritized applications based on: Role of application as a data source (# of interfaces) Impact on patient care Complexity of implementation Transmission volume Extent of training involved Visibility in the organization

21. 21 Scope of VistA Remediation:  58 Packages

22. 22 Priority List VistA Lexicon Utility Module VistA Patient Care Encounter Module (PX) Admission, Discharge, Transfer (ADT) CPRS: Order Entry/Result Reporting (OE/RR) CPRS: Problem List (GMPL) CPRS: Clinical Reminders (PXRM) VistA Automated Information Collection System Module VistA Integrated Billing Module (IB)

23. 23 Develop Requirements for Affected VistA Applications Conducted focus groups Physicians CACs, nurses Clinical Reminders SMEs Developed initial Business Requirements Document (BRD) Mapped to prioritized VistA applications Lexicon Problem List Encounters Clinical Reminders CPRS

24. 24 VistA Requirements Strategy Identify business owners Identify technical contacts Conduct business requirements gathering sessions Complete Business Requirements Document (BRD) and Requirements Elaboration Specification (RES) document Validate BRD and RES with business owners Submit BRD/RES to Office of Enterprise Development Review requirements with Office of Information and Technology and Requirements Review Team

25. 25 Field Impact Local modifications: Problem List Clinical reminders Encounter forms Class III COTS Medical devices Databases Local impact Quality and performance indicators Staff time for modifications Staff time for training Decreased productivity: coders, providers Potential for staff turnover Potential loss of revenue

26. 26 Current Status Health Information Management ICD-10 Program Management Office Core Team met in DC Feb 23/Mar 23 2010 Included participants from VA OI&T OED and Field Operations Reviewed current status of requirements and defined business requirements strategy/expectations Developed strategy for inventorying local Class III, COTS, medical devices and local/regional Databases Clarified stakeholder responsibilities Initial set of business requirements developed PMO charter drafted and staff assembled Business side advisory group to be re-structured in line with the proposed IPT OI&T $10 million in funding authorized in FY2010 IT contract for VistA analysis and design has been awarded IPT facilitation contract awarded Completed VistA scan of systems to identify all occurrences of ICD-9 codes in current VistA systems � Feb 2010 Business Owner Involvement Focus groups were conducted to identify user needs Physicians Nurses/Clinical Application Coordinators Clinical Reminders Subject Matter Experts Awareness presentations to stakeholder groups in progress National Data Systems completed a survey to identify databases impacted � November 2009

27. 27 Next Steps Collaborate with Office of Information and Technology�s Office of Enterprise Development and Enterprise Field Operations and Development via the Integrated Project Team Execute plans for identifying non-VistA uses of ICD* codes Continue �Awareness� communication activities Plan budget requirements for out-years Plan for large-scale training initiative

28. Stay Engaged ICD-10* Project Intranet Site: http://vaww.vhaco.va.gov/him/icd10.html Periodic updates to this group Join ICD-10 List Serv to receive information and invitations to join the ICD-10 National Stakeholders Calls: ICD-10_STAKEHOLDERS-L at http://vaww.listserv.med.va.gov/archives/icd-10_stakeholders-l.html 28

29. QUESTIONS ??? 29

30. 30 Contact Mary F Johnson Mary.Johnson319481@va.gov 937-855-2186 NOTE � *International Classification of Diseases, 10th Edition, Clinical Modifications **International Classification of Diseases, 10th Revision, Procedure Coding System WHO = World Health Organization CA = Canada