ICD-10 INITIATIVE -Update DRH Practice Management November 13, 2012

Agenda Introduction Preparation and Strategy; What’s your role? I-10 Implementation Date; What ‘s next? Questions from Group

Introduction

ICD-10: Advancing Healthcare The Federal Government, through the Centers for Medicare and Medicaid Services (CMS), is driving the healthcare industry to upgrade diagnosis and inpatient procedure coding standards (ICD-10) by October 1, 2014 ICD-10 Changes Implications ICD-10 (International Classification of Diseases version 10) The ICD is the international standard diagnostic classification for general epidemiological, health management purposes and clinical use ICD-10 CM & PCS is an upgrade of the U.S. developed Clinical modification (ICD-9-CM) of Diagnosis and Procedure Codes, first adopted in 1979 Pervasive Impacts Diagnosis codes and procedure codes flow through mission critical operational systems and analytical tools Alignment of technology remediation with business and technology strategies Business process reengineering, training and change management is essential Comprehensive Benefits Quality Measurement/ROM/SOI Public Health Disease Surveillance Clinical Research Organizational Monitoring and Performance Reimbursement Significant Increase in Clinical Granularity ICD-9 CM (Diagnosis) >14,000 unique codes ICD-10 CM (Diagnosis) > 68,000 unique codes ICD-9 CM (Procedure) ICD-10-PCS (Procedure) > 4,000 unique codes > 72,000 unique codes 9 to 10, 10 to 9 translations CPT/HCPCS will not change

Coding and 7th Character Extensions 2 Numeric 3 - 7 Numeric or Alpha Additional Characters Alpha (Except U) . . X M S A X 2 X 6 X X 5 X x A X Category Etiology, anatomic site, severity Added code extensions (7th character) for obstetrics, injuries, and external causes of injury 3 – 7 Characters

Coding in ICD-10-CM Three to five characters Three to seven characters First digit is numeric but can be alpha (E or V) First character always alpha 2-5 are numeric All letters used except U, “X” is used as the placeholder Always at least three digits Character 2 always numeric: 3-7 can be alpha or numeric Decimal placed after the first three characters (or with E codes, placed after the first four characters) Alpha characters are not case-sensitive Decimal placed after the first three characters

Preparation—Strategy What’s Your Role? Top Diagnoses Evaluate Processes Review Denials (LCD,NCD) Stay Informed (payors, vendors) Train—Consolidate Maestro Care and Documentation Practice

What’s In it for Providers? Documentation specificity will support patient care, quality measures, future payment adjustments, & reimbursement. Therefore, documentation should be consistent regardless of setting—Documentation should support the charge Value-bases Purchasing Relies on I-10 Specificity Enables more accuracy in payment Avoid unspecified/miscellaneous coding Add incremental value to your code selection More accurately demonstrates outcomes of care Reduce medical record requests –Reduce Denials & Rework Accurate Healthgrades

What’s the Bottom Line? Healthcare is centered on change: Improving care delivery systems “If we truly seek better, more affordable health care, then quality improvement, documentation and data analysis in the future will depend on the specificity that ICD-10-CM offers”. Annie Boynton, AAPC

We have an Implementation date what’s next?

Train…..Educate…..Practice 1.) Training and Education on the changes that Impact Departments Role-based Training (accessible media) Documentation Supports Charges 2.) Practice following Training---Knowledge Maintain current claims processes Accuracy counts

Precyse Module E-Learning Example

Example of a quiz in Precyse

references

Questions from Group What are the new codes? The General Equivalence Mappings (GEMS) for both Diagnoses and procedures (CM and PCS) Codes are available on the CMS website at https://www.cms.gov/Medicare/Coding/ICD10/2012-ICD-10-CM-and-GEMs.html What resources can we access to help prepare: CMS has lots of information, including plans and timelines for small and large provider groups. https://www.cms.gov/Medicare/Coding/ICD10/ICD-10andVersion5010ImplementationTimelines.html American Health Information Association (AHIMA) has information on planning, training, Superbill examples, etc. http://www.ahima.org/icd10/ ICD10monitor is a coalition of industry experts providing advice, webinars, and tools related to the conversion. http://icd10monitor.com/ Coder Mappers available for purchase: http://shop.icd10monitor.com/ICD_10_CM_Diagnostic_Code_Mappers_p/codemap2011.htm American Medical Association (AMA) http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance- portability-accountability-act/transaction-code-set-standards/icd10-code-set.page

QUESTIONS?