ICD-9-CM ICD-10 Comparison Created By: Donna, Kristina, Stephanie and Adam

ICD-9-CM Established in 1979. Was created to provide a standard, and uniform code set for diagnoses, and procedures in the United States. Used for the purpose of payer claims reimbursement, and clinical research. (Green, 2014)

ICD-10-CM Due to be implemented October 14, 2015. Established to replace the ICD-9-CM in order for more specificity in coding (“Coding to the highest level of specificity”). Additional digits provide for identifying right, and left, and specific encounter. (Valerius & Bayes, et. Al., 2014)

ICD-9-CM, and ICD-10-CM Diagnostic Code Comparison 3-5 numeric characters in length Approximately 13,000 codes Limited space for new codes Lacks detail Lacks laterality 3-7 alphanumeric characters in length Approximately 68,000 codes Space for additional codes Very specific Codes identify right and left (AMA, 2012)

Example of code differences Diagnosis: stage III pressure ulcer of the right lower back. ICD 9 Two codes are needed for location, and stage, but laterality can not be classified. Pressure ulcer, lower back 707.03 Pressure ulcer stage III 707.23 ICD 10 A combination code is used, and laterality is classified. Pressure ulcer of right lower back, stage III L89.133 (Green, 2014)

Other differences in the ICD-10-CM The ICD-10 uses a placeholder character “x” to allow for expansion of certain codes. If a code that requires a 7th character is not 6 characters in length, then the placeholder “x” will take the 6th character place. Square brackets enclose manifestation codes in the ICD-10 instead of slanted brackets used in the ICD-9. Boxed notes are not used. (Green, 2014)

Benefits of ICD-10 (why should we convert) Due to the specificity of ICD-10 there will be greater accuracy, and fewer denials, or underpayments. The need for additional paperwork sent with claims will be reduced, providing a faster turnaround of claims. The upgraded classification of the ICD-10 allows room to add additional advancements in medicine. (HIMSS, 2012)

Impact ICD-10 On The Insurance Industry Will lead to Much greater specificity and clinical information, which results in: Improved ability to measure health care services; Increased sensitivity when refining grouping and reimbursement methodologies; Enhanced ability to conduct public health surveillance; and Decreased need to include supporting documentation with claims; (Boyd, 2014)

Impact ICD-10 On The Insurance Industry Better data for: Designing payment systems; - system conversion is expensive Processing claims; less rework so cheaper in the long run Tracking public health - easier, more specificity Identifying fraud and abuse - insurance companies will be able to crack down on fraud/abuse Conducting research. - better more precise date (Boyd, 2014)

Impact ICD-10 On The Insurance Company Transition to ICD-10 may lead to decreased revenue. Training staff to understand the new coding system will cost many thousands of dollars. Transition to ICD-10 may lead to loss of information. ICD-10 codes would cause the greatest disruption to billing, staffing, inventory selection, practice management, and clinical revenue. (Boyd, 2014)

Impact ICD-10 On the Insurance Company Assigning ICD-10-CM codes that do not directly map to a code in ICD-9-CM can impact an organization’s reporting and the management of information systems. This is important in regards to the medical records and Insurance companies. (Boyd, 2014)

Two Reasons why the implementation of ICD-10-CM was delayed Costs to the providers Allowed health care provider’s and other covered entities the time to prepare and fully test their systems (McCann, 2012).

Costs to the providers (American Medical Association, 2015). Types of practices Small Medium Large Payment Disruption $22,579 - $100,349 $75,26 - $334,498 $752,630 - $3,334,976 Vendor/Software Upgrade $0 - $60,000 $0 - $200,000 $0 - $2,000,000 Testing $15,248 - $28,805 $47,906 - $93,098 $428,740 - $880,660 Productivity Loss $8,500 - $20,250 $72,649 - $166,649 $726,487 - $1,666,487 Assessment $4,300 - $7,000 $6,535 - $9,600 $19,320 Process Remediation $3,312 - $6,701 $6,211 - $12,900 $14,874 - $31,821 Training $2,700 - $3,000 $4,800 - $7,900 $75,100 Total Cost $56,639 – 226,105 $213,364 - $824,735 $2,017,151 - $8,018,364 (American Medical Association, 2015).

Time To Prepare Benefits Improve quality of care Document medical complications Categorize diseases Track healthcare outcomes more effectively Cost savings due to accuracy of payments and reduction of unpaid claims Ability to test the system to ensure a smooth transition (Sanders, et. al., 2012).

Time to Prepare Benefits Reduce medical errors Efficient delivery of services Improvements in the areas of Patient safety Disease Management Quality Measures (Sanders, et. al., 2012).

Time To Prepare Challenges Financial cost of the transition $25,000 to $20,000,000 depending on size of facility Planning and implementation Shortage of qualified coders Average age is 54 May opt to retire instead of learning new coding requirements Need for further training and education of employees Loss of productivity (Sanders, et. al., 2012).

Approaching ICD-10-CM We are ultimately responsible for making sure that when we get to a Healthcare facility we have a good understanding of ICD-10-CM. Check it out!! https://www.aapc.com/icd-10/bootcamp-icd-10-coding.aspx

Approaching ICD-10-CM The high costs risk adjustment of research, training, demonstrations, developing and implementing payment policies. These are expenses that are associated with the new diagnosis system making the cost of accessing it to be way more expensive.

Approaching ICD-10-CM The way we look for the codes will have us better prepared to find ICD-10-CM codes. The codes are going to change but the way we find the codes are going to be the same.

References American Medical Association (2012). The difference between icd9 and icd10. Retrieved from http://www.unitypoint.org/waterloo/filesimages/For%20Providers/ICD9-ICD10- Differences.pdf American Medical Association (2015). ICD-10 cost estimates increased for most physicians. Retrieved from http://www.ama.assn.org/ama/pub/news/news/ 2014/2014-02-12-icd10- cost-estimates-increased-for-most-physicians.page Boyd, L. (2014). Study: ICD-10 transition to cause financial, information loss. Journal of tables and charts, 29 (9). Retrieved from Ebscohost.com. Green, M. (2014). 3-2-1 Code it. Clifton Park, NY: Delmar. Healthcare Information and Management Systems Society (2012). Ten reasons why icd-10 implementation cannot be further delayed. Retrieved from http://www.himss.org

References McCann, E. (2012). HHS announces one-year delay for ICD-10. Retrieved from: http://www.healthcareitnews.com/news/hhs-announces-rule-delaying-icd-10 Sanders, T., Bowens, F., Pierce, W., Stasher-Booker, B., Thompson, E., & Jones, W. (2012). The Road to ICD-10-CM/PCS Implementation: Forecasting the Transition for Providers, Payers, and Other Healthcare Organizations. Perspectives in Health Information Management / AHIMA, American Health Information Management Association, 9(Winter), 1f. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329203/#__articleid745943aff-info Valerius, J., Bayes, N., Newby, C., & Blochowiak, A. (2014). Medical insurance: An integrated claims process approach. New York, NY: McGraw-Hill