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Surviving and Thriving in the ICD-10 Transition

Surviving and Thriving in the ICD-10 Transition. Joy C. Burnette, RN, BSN, AACC, CHTS-IM, CPHIMS February 2014. Introduction. Hard deadline of October 1, 2014 Two perspectives- clinical and administrative Steps for ICD-10 transition Benefits beyond the ICD-9 sunset

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Surviving and Thriving in the ICD-10 Transition

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  1. Surviving and Thriving in the ICD-10 Transition Joy C. Burnette, RN, BSN, AACC, CHTS-IM, CPHIMS February 2014

  2. Introduction Hard deadline of October 1, 2014 Two perspectives- clinical and administrative Steps for ICD-10 transition Benefits beyond the ICD-9 sunset Transform data into information Information translation to business and clinical practice

  3. ICD Past, Present and Future 1853- First International Statistical Congress 1893- First International List of Causes of Death- U.S., Canada and Mexico 1948 World Health Organization International Statistical Classification of Diseases (ICD) 1976- ICD revision 9 1989- ICD revision 10 October 1, 2014- U.S adoption of ICD-10

  4. Why Not ICD-11? • Web based • Multi-purpose • Coherent classification across nations • Function in the EHR/EMR environment • Different from ICD-10 • Definition of disease • Descriptive characteristics

  5. Two Perspectives • Administrative • Required to process bills • Business intelligence reporting • Clinical • Required for bill processing and payment • Increased documentation • Increased time for administrative duties

  6. Workgroup for Electronic Data Interchange (WEDI) ICD-10 • Survey since 2009- status of industry readiness • October 2013 • Reasons for delay • Change in compliance date • Competing priorities • Other regulatory mandates • Staffing • Vendor readiness

  7. Workgroup for Electronic Data Interchange (WEDI) ICD-10

  8. Benefits of ICD-10 • Consistent with current clinical practices • Room for additional codes, identifying clinical diagnoses and modes of care • Better data • Measure quality, safety, and efficacy of care • Reduce need for attachments • Conducting research • Setting health policy • Designing health care delivery systems • Resource utilization • Detect fraud and abuse • Track public health risks • Move beyond compliance to competitive advantage

  9. Patient Benefits of ICD-10 Improve patient outcomes Best of care- evidence based medicine Financial fitness- decrease risk of fraud Healthcare delivery systems improvements Public health

  10. Steps to ICD-10 • Form a multi-disciplinary leadership team- align expectations • Impact assessment- workflow perspective • Reach out to the vendor(s) • Software tools • Internal testing • External testing • Training plan • Change management • Additional coder time • Additional IT support • Documentation, coding and business analytics • Post transition surveillance

  11. Transition Method • Clinician bills with ICD-9 and billers code ICD-10 (25% of WEDI) • Learning curve initially on the biller side • Clinicians lag in specificity of documentation • Clinician learning curve postponed • Increased communication for clarifications • Increased time to process claims • Potential to lengthen revenue cycle • Clinicians bill with ICD-10 (50% of WEDI) • Learning curve is shared by clinician and biller • Documentation issues resolved jointly

  12. ICD-10 Code Capture • Paper superbill • Data abstract • Electronic charge/bill capture • EHR • Billing charge capture Develop protocols for clinical data capture and documentation

  13. After the ICD-9 Sunset • Benefits of ICD-10 • Patient • Clinician • Institution • Big data analytics • Avoid data paralysis • Start small, well defined question • Prospective vs. retrospective • Data transformed into information • Information translated to clinical practice • Business intelligence

  14. Post-implementation • Surveillance • Continuing process of improving clinical documentation • Business analytics • Clinical outcomes monitoring • Readmissions • Mortality • Change management

  15. Canadian Experience with ICD-10 • 10 year experience • Improvements in care • Diabetes • Acute myocardial infarction • Injury prevention • GEMS as a tool for ICD-9 to ICD-10 • The GEMS shortcuts made learning curve longer • Not a long-term solution

  16. Summary • Start the ICD-10 transition planning now • Budget requirements • Milestones- anticipate roadblocks and pitfalls • Contingency plans • Training- ongoing process • Post implementation surveillance • Analytics • Business • Clinical

  17. …An ounce of planning is more valuable than a pound of procrastination

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