Comprehensive Overview of ICD-10 Transition: Key Changes and Industry Impact
This session provides an in-depth overview of the ICD-10 transition, highlighting its significance for healthcare providers. Key topics include the distinction between ICD-10-CM and ICD-10-PCS coding systems, the timeline for implementation, and the impact on both providers and payers. We will also explore the benefits of ICD-10 data for healthcare delivery, operational planning, and fraud prevention. Finally, attendees will gain insights into necessary training resources and updates from Arkansas Medicaid regarding the ongoing remediation efforts.
Comprehensive Overview of ICD-10 Transition: Key Changes and Industry Impact
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Presentation Transcript
Provider Education Cathy Munn MPH RHIA CPHQ Sr. Consultant Basic ICD-10 Overview
Agenda • Status of ICD-10 Transition • Who, What, Where, When & Why • Industry Update • Impact of the Change • Providers • Payers • Translation Examples • Arkansas DMS Remediation Update • Next Steps & Resources
Who: The Healthcare Industry • ICD-10-CM (diagnoses) will be used by all providers in every health care setting • ICD-10-PCS (procedures) will be used only for hospital claims for inpatient hospital procedures • No impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes • CPT and HCPCS will continue to be used for physician and ambulatory services including physician inpatient hospital visits
What: ICD-10 CM/PCS • ICD-9-CM: International Classification of Diseases, 9th revision, Clinical Modification • US transitioned from ICD-8 to ICD-9 in 1979 • Annual updates • ICD-10: Developed by the World Health Organization as the nomenclature for all countries • ICD-10-CM: International Classification of Diseases, 10th revision, Clinical Modification – US only • ICD-10-PCS: International Classification of Diseases, 10th revision, Procedure Classification System – US only
When: October 1, 20XX • Final Rule Originally Published by HHS on January 16, 2009 requiring the adoption of ICD-10 on October 1, 2013 • Dates of Service (outpatient) After 10/1/2013 • Dates of Discharge (Inpatient) After 10/1/2013 • House Bill 4302 passed on March 31, 2014 delays the implementation of ICD-10 until “no earlier than October 2015” • This is a Federal Mandate
Where: Inpatient vs Outpatient • Systems will have to utilize both ICD-9-CM and ICD-10-CM for overlap e.g. claims backlog, Arkansas Medicaid allows providers 365 days to submit a claim. • Inpatient discharges occurring on or after 10-1-20XX will use ICD-10-CM and ICD-10-PCS codes regardless of date of admission. • Outpatient dates of service occurring on or after 10-1-20XX will use ICD-10-CM codes • There will be period of time when payers will be processing claims in both ICD-9 and ICD-10
Why: Data Benefits of ICD-10 • Better data will be available for: • Measuring the quality, safety and efficacy of care • Designing payment systems and processing claims for reimbursement • Conducting research, epidemiological studies and clinical trials • Setting health policy • Operational and strategic planning and designing healthcare delivery systems • Monitoring resource utilization • Improving clinical, financial and administrative performance • Preventing and detecting healthcare fraud and abuse • Tracking public health and risk
ICD-9 vs. ICD-10 Diagnosis Codes ICD-9 - E codes reference External Causes of Injury & Poisoning ICD-10 - E references the Endocrine System ICD- 9 - V codes reference Health Status & Contact with Health Services ICD-10 - V – Y codes reference External Causes of Morbidity
ICD-9 Procedure vs. ICD-10-PCS The increase in the number of procedure codes is driven by the increased specificity, granularity & laterality contained within the ICD-10 codes. There are also 7th digit designations (A or D) which identify initial or subsequent encounter for care.
Code Translations • Asthma
Code Translations • Otitis Media
Code Translations • Congestive Heart Failure
Clinical Documentation Resources • AHIMA Online Education Physician Series • Clinical Documentation for ICD-10: Principles & Practice • Short, self-paced training modules • Case-based, real life examples • Provides more than 200 bite-sized, on-demand, specialty-specific training modules that can be accessed anytime or anywhere with a mobile device – computer, tablet or smartphone • Delivers 3-5 minutes modules that cover physician’s 10 – 20 most commonly billed diagnoses & conditions making learning targeted and relevant to their practice specialty. • www.ahima.org\physicianICD10
Training Resources • There are a wide variety of training opportunities and materials available through a variety of resources: • Professional Coding Associations – AAPC, AHIMA • Online Courses – ICD10 Monitor, Contexo University, Precyse, Nuance • Webinars – ICD10 Monitor, HCPro • Onsite Training – Train-the-Trainer approach, Coding Boot Camp • Arkansas Hospital Association – monthly coding classes • Non-Traditional - Partner with the HIM Department at a nearby hospital
Akansas DHS Current Stated • Arkansas Medicaid has been working on ICD-10 for over two years • Completed • Operational assessment • Remediation of Medical Policy, Edits and Audits complete • Provider Manual Updates – HP coordinating revisions • Data Requirements – HP/MMIS, Xerox/ACS, integrated & stand alone systems • Ongoing • Remediation of Pharmacy Policy & Edits • Remediation of DHS reports, forms, and brochures • Provider Outreach • Meetings/Webcasts • Provider Bulletins • Newsletters • ICD-10 Website www.humanservices.Arkansas.gov/ICD10 • Internal & external testing to begin mid-year
AMA ICD-10 Checklist • Create a checklist of all systems & work flow processes that currently use ICD-9 • Create a list of vendor contact information • Identify all staff who work with ICD-9 • Identify all possible work flow changes that will need to switch to ICD-10 • Identify the practice billing service (if applicable) • Identify the practice clearinghouse • Identify a contact for each of the practice’s payers
AMA ICD-10 Checklist • Contact vendors to determine their ICD-10 implementation plans • Contact the practice’s billing service, if applicable, to identify their ICD-10 implementation plans • Contact payers to determine their ICD-10 implementation plans • Identify any internal work flow processes that will need to be change for ICD-10 http://www.ama-assn.org/resources/doc/washington/icd10-checklist.pdf
Industry Website Resources • www.CMS.gov/ICD10 • www.CMS.gov/NPC • http://www.roadto10.org/ • www.AHIMA.org • www.AAPC.com • http://www.cms.gov/Medicare/Coding/ICD-10/Downloads/ICD10SmallandMediumPractices508.pdf • http://www.himss.org/ASP/topics_icd10playbook.asp • www.WEDI.org • www.humanservices.Arkansas.gov/ICD10
Additional ICD-10 Resources • White Papers (including but not limited to) • ICD-10 A Primer • ICD-10 Clinical Documentation • ICD-10 Physician Impact • ICD-10 Advantages • ICD-10 Specified or Unspecified http://healthdataconsulting.com/ • Checklists published by CMS for providers (small, medium and large) at: • http://www.cms.gov/Medicare/Coding/ICD10/ICD-10ImplementationTimelines.html • http://www.roadto10.org/
