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Introduction ICD-10-CM Overview

Introduction ICD-10-CM Overview. Presented By Erline Franks CCS-P. ICD-10-CM Facts. The United States is the only nation that has not implemented ICD-10 ICD-10-CM set to begin October 1, 2014 Regular updates which go into effect October 1 of each year, starting in 2015.

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Introduction ICD-10-CM Overview

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  1. Introduction ICD-10-CM Overview Presented By Erline Franks CCS-P

  2. ICD-10-CM Facts • The United States is the only nation that has not implemented ICD-10 • ICD-10-CM set to begin October 1, 2014 • Regular updates which go into effect October 1 of each year, starting in 2015. • ICD-10-CM consists of 21 chapters compared to 17 chapters in ICD-9-CM • ICD-10-CM is based on statistical classifications of disease by the World Health Organization (WHO) • Guidelines have been approved by the American Hospital Association (AHA), American Health Information Management Association (AHIMA), CMS, and NCHS

  3. ICD-10-CM Facts cont. • The transition to ICD-10-CM is happening because ICD-9 provides limited data about the medical conditions of patients’ and hospital inpatient procedures. ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice. The structure of ICD-9 also limits the number of new codes that can be created, and many categories in ICD-9 are full.

  4. Diagnosis Code Comparison

  5. Who will be affected? • ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by HIPAA (Health Insurance Portability and Accountability Act), not just for those who submit Medicare or Medicaid claims. • This change does not affect CPT coding for outpatient procedures. • This change includes: Providers, Payers, Software vendors, Clearinghouses, and third-party billing services.

  6. What should providers do to Prepare? • Create a practice ICD-10 Team • Budget for Implementation Costs • Create a timeline (including a team leader responsible for each area) • Identify current and future educational needs for staff • Communicate with your Practice Management System Vendor

  7. What should providers do to Prepare? Cont. • Communicate with your billing Service, Clearinghouse, and Payers as to hardware and software concerns • Communicate with your payers about how your contracts will be affected • Identify changes to your Practice Work Flow and Business Processes

  8. What should providers do to Prepare? Cont. Identify your education needs: • Get a copy of the ICD-10-CM code set. • Identify your practices’ top 50 diagnosis codes currently used. • Remove the unspecified codes. (Remember, unspecified codes may not be reimbursed with ICD-10) • Review your documentation and determine the changes that will need to take place to support the more specific ICD-10 codes. • Continue education on the rest of the top 50 codes

  9. Where do I find information regarding ICD-10-CM? • CMS (Centers for Medicare & Medicaid Services) www.cms.gov/Medicare/Coding/ICD10/ • AHIMA (The American Health Information Management Association) www.ahima.org/icd10/ • SS&G Healthcare, LLC www.ssandghc.com • Specialty Specific Societies • Software and System Vendors

  10. When should I begin the transition? • Yesterday!!! • Health care organizations that submit transactions electronically are required to upgrade transaction standards from 4010/4010A to Version 5010 effective January, 2013

  11. When should I begin the transition?Cont. • AHIMA Checklist— www.ahima.org/downloads/pdfs/resources/checklist.pdf • Phase 1: Implementation plan development and impact assessment (first quarter 2009 to second quarter 2011) • Phase 2: Implementation preparation (first quarter 2011 to second quarter 2013)

  12. When should I begin the transition?Cont. • Phase 3: “Go live” preparation (first quarter 2013 to third quarter 2013) • Phase 4: Post-implementation follow-up (fourth quarter 2013 to fourth quarter 2014) • Expect a significant reduction in productivity for the first three to six months • Expect an impact in your cash flow

  13. General Equivalence Mapping (GEMs) • Mappings between ICD-9-CM and ICD-10-CM classifications have been developed to transition one code set to another • The NCHS ( National Center for Health Statistics) has released the GEMs, along with documentation and a user’s guide, are available on the NCHS website http://www.cdc.gov/nchc/icd/icd10cm.htm and the GEMs website http://www.cms.hhs/gov/ICD10)

  14. Use of GEMs • Appropriate Usage: • Convert multiple databases from ICD-9-CM to ICD-10-CM • Variety of research applications involving data trend • Inappropriate Usage: • Crosswalks- There is not a one -to-one match between ICD-9-CM and ICD-10-CM codes, for a multitude of reasons (e.g. new concepts in ICD-10-CM , a single ICD-9-CM code may map to multiple ICD-10-CM codes)

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