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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

Joy C. Burnette, RN, BSN, AACC, CHTS-IM, CPHIMS

February 2014

introduction
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

icd past present and future
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

why not icd 11
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
two perspectives
Two Perspectives
  • Administrative
    • Required to process bills
    • Business intelligence reporting
  • Clinical
    • Required for bill processing and payment
    • Increased documentation
    • Increased time for administrative duties
workgroup for electronic data interchange wedi icd 10
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
benefits of icd 10
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
patient benefits of icd 10
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

steps to icd 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
transition method
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
icd 10 code capture
ICD-10 Code Capture
  • Paper superbill
  • Data abstract
  • Electronic charge/bill capture
    • EHR
    • Billing charge capture

Develop protocols for clinical data capture and documentation

after the icd 9 sunset
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
post implementation
Post-implementation
  • Surveillance
  • Continuing process of improving clinical documentation
  • Business analytics
  • Clinical outcomes monitoring
    • Readmissions
    • Mortality
  • Change management
canadian experience with icd 10
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
summary
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