ICD-10: mastering the Transition

1. ICD-10: mastering the Transition ICD-10: Mastering the Transition Cortnie R. Simmons, MHA, RHIA, CCS, CDIP Director, ICD-10 Services, Kforce Healthcare

2. Henry Ford slide “Before everything else, getting ready is the secret of success.” Henry Ford

3. Objectives • After attending this session, participants will be able to: • Describe the challenges associated with ICD-10 implementation • Discuss the need for proper planning for the ICD-10 transition • Identify documentation standards necessary for complete and accurate code assignment • Identify the importance of physician documentation and coding

4. Polling Question • Where are you at in your ICD-10 transition? • Have not started planning • Have started planning but not execution of actual plans • In the process of executing ICD-10 plans

5. What is ICD-10? • A new diagnostic coding system intended to improve coding by increasing the level of specificity in diagnostic codes • ICD-10 will enhance the efficiency of clinical data collection, improve treatment outcomes measurement as well as the quality of administrative data • ICD-10 has 156,000 codes, compared with approximately 25,000 in ICD-9 • Effective October 1, 2014, ICD-10 will be implemented, and you must be compliant

6. ICD-10 Adoption Worldwide

7. The most significant difference between ICD-9 and ICD-10 is the size and composition of the new codes ICD-9 is five digits where ICD-10 is 7 alphanumeric characters Re-structured classification Specificity and detail have been expanded Changes to diagnoses codes ICD-10 better describes acuity, complexity and laterality of the patients under your care

8. Changes to procedures codes • Key ICD-10 characteristics • ICD-10 is a “dramatic departure” from current practice • Surgical codes lack decimals • The new code set will allow for incorporation of new procedures and technologies • Terminology is precisely defined and used consistently across all codes ICD-10 procedure codes will require additional and significant detail in surgical reporting

9. ICD-10 CM Documentation Changes

10. ICD-10 CM Documentation changes

11. Key changes for providers • Documentation will need to support the higher level of specificity found in ICD-10 to include: • Laterality • Stages of healing • Trimesters in pregnancy • Episode of care (ex. initial, subsequent) • Paper superbills will need to updated to ICD-10 or converted to an electronic format • Prescriptions that have re-fills, that will cross the cutover date, may require additional information or intervention from the provider Did you know that auto insurance and worker’s compensation claims aren’t required to move to ICD-10?

12. Key changes for providers (cont’d) • Therapy services that will cross the cutover date, may also require additional information or intervention from the provider • Medical necessity and pre-authorization for services on or after October 1, 2014 will require ICD-10 codes • Questions to ask yourself • What forms or cheat sheets that I utilize contain ICD codes? • What additional information may be required to schedule a surgical procedure for my patient? • What technology updates will be required for my billing and medical records systems to become ICD-10 compliant? Outpatient and physician office coding will continue to utilize ICD for diagnoses and CPT for procedures

13. ICD-10 CM Code Structure ICD-9-CM Structure • 883.1 ICD-10-CM Structure S 6 1 0 2 1 A

14. Example of surgical code in ICD-9 and ICD-10 PCS In ICD-9 two distinctly different procedures utilize the same procedure code

15. Considerations, Challenges and impacts

16. Importance of Complete Documentation Accurate Clinical Picture Due to Increased Specificity Identify Quality of Care Provided Support Initiatives Aimed at Improving Quality of Care Justify Medical Necessity Reducing Costs via Value Based Purchasing Avoiding Misinterpretation of Diagnosis by Auditors and Coders Accurate Reflection of Patient Acuity, Outcome and Resources Used for Patient Care

17. Challenges • Documentation by the physician of specific components of a particular classification (diagnosis code) is required: • Test results, labs, x-rays, EKGs, echo reports, path reports, studies performed for diagnosis are not sufficient documentation for classifying (coding) a disease/injury • Coders are only allowed to use physician documentation to classify a disease/injury or procedure

18. Future of Documentation • This transition is NOT just for reimbursement for hospitals • The data collection taking place over the next 2 years -- as well as 2 years following implementation -- will feed initiatives impacting: • Measurement of patient care outcomes • Quality of care initiatives • Healthcare policy development • Research related to profiling providers of healthcare • Pay for performance initiatives • Justifying medical necessity

19. Considerations • ICD-10 requires collaboration, collaboration and more collaboration between all members of the clinical and non-clinical healthcare team: • Education of coding staff • Template/Superbillrevisions • Query revisions

20. What if we get it wrong? • Wrong code or unspecified code is utilize for pre-authorization or medical necessity? • Your patient may be required to pay more out of pocket or have a service denied entirely • Your patient may need to obtain additional information from you in order to have coverage for services • Your practice could see a delay or denial of payment • Wrong code on practice claim (HCFA 1500)? • Your practice could see a delay or denial of payment • You could be requested to provide additional documentation

21. Provider Impacts

22. IT – Technology Roadmap * Calendar Year

23. Operations Roadmap

24. ICD-10: What about planning?

25. Provider Education • Understand the differences between awareness, education and training • Physicians learn better from physicians • Find a champion • Consider departmental or specialty liaisons • Don’t take on the entire ICD-10 Classification • Introduction to ICD-10-CM AND PCS • Intense training by specialty, as needed • Documentation reviews to guide training plan • High volume MS-DRGs • Top 25 diagnoses • Top 10 procedures by physician

26. Salient Points: Provider Education • Consider the type of organization and setting • Small physician practice • Large group practice • Integrated healthcare system • Inpatient vs. Outpatient • Make it Mandatory • Ensure senior leaders are engaged to encourage participation • Multi-faceted education • Documentation improvement is behavioral in nature • Incorporate new language into problem list selection • Partner with CDI staff (if applicable) • Offer classroom, video and online education

27. Proper Planning Prevents Poor Performance Preparation is Key

28. Recommended Steps • Strategize • Communication Plan • Assess Impacted Areas • Inventory of Impacted Systems and Processes • Plan Training • Clinical Documentation Improvement • Budgeting COMMUNICATE! COMMUNICATE! COMMUNICATE! COMMUNICATE! COMMUNICATE! COMMUNICATE! COMMUNICATE!

29. Delivery of Patient Care (Clinical) Appropriate and Timely Medical Record Documentation Accurate Medical Coding (ICD-9 or ICD-10) Reported Data is Accurate, Complete and True Clinical Picture of Patient’s Disease Process, Treatment and Quality of Care Provided! Getting it Right

30. In Summary… A multi-disciplinary approach for achieving the best quality of clinical data produced by the assignment of the most specific ICD-10 codes based upon complete and accurate clinical documentation will have far-reaching effects within healthcare organizations as well as the entire healthcare delivery system.

31. Questions?csimmons2@kforce.com