Crossroads Conference

Susan H. Fenton, PhD, RHIA Asst. Dean for Academic Affairs UT School of Biomedical Houston ICD-10 Industry Update

Policy The delay ICD-11 SNOMED Practical impacts Clinical documentation Coding productivity Quality Measures Agenda

H.R SEC DELAY IN TRANSITION FROM ICD–9 TO ICD–10 CODE SETS. The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d–2(c)) and section of title 45, Code of Federal Regulations. $1 billion to $6.6 billion additional – CMS The Delay

“On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No ) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD- 10 beginning October 1, The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.” Latest Update

Part B News, 73% of providers plan to stick with their original ICD- 10 implementation plans, despite the delay, EHR Intelligence reports (Bresnick, EHR Intelligence, 4/24). How providers feel about the delay. Specifically: 34% of organizations ready but appreciate additional time; 31% of organizations disappointed with the delay; 20%+ of organizations frustrated because physicians now might want to delay training; and 13.5% of organizations happy with the delay because they would not have been ready otherwise (Marbury, Medical Economics, 4/23). Provider Responses

Conducted in March ,600 participating organizations; 50% were clearinghouses 127,000 claims submitted with ICD-10-CM/PCS codes 89% of claims were accepted Some claims included intentional errors to ensure the system would reject appropriately Contact local MAC for acknowledgment testing details More end-to-end testing in 2015 CMS ICD-10 Claims Submission Testing

Release delayed to 2017 – WHO Derived from SNOMED Compatible with EHRs 1faq/en/ 1faq/en/ ICD-11

Focused on clinical information Compatible with EHRs 311,000 active concepts 33% agreement on core concept choice Andrews, J.E., Richesson, R.L., and Krischer, J. (2007) SNOMED CT Coding of Clinical Research Concepts, Journal of AMIA, 14(4), SNOMED

Public health Quality patient care Research Reimbursement So, why move at all?

Laterality: No longer accept injuries to limbs or bilateral organ conditions without laterality. Paralytic syndromes require right/left and dominant/nondominant Infectious organisms. How can we help clinicians include these in their documented diagnoses? Clinical Documentation Improvement

A for Initial Encounter – active initial treatment in ER, surgery or new clinician D for Subsequent – healing or recovery such as cast change or aftercare S for Sequela – complications or conditions as a direct result of the injury. Examples include scars or frozen joint Injuries

Open, including Type vs. Closed Routine vs. Delayed healing Nonunion vs. Malunion Displaced vs. Nondisplaced Many types, transverse, comminuted, or spiral to name just a few Fractures

Track use of unspecified codes by clinician Appropriate or not? Random coding of records in ICD-10-CM/PCS to determine adequacy of documentation Feedback Evaluation criteria Clinician-specific Efforts

54 records 6 coders ICD-9-CM Avg Coding Time – ICD-10-CM/PCS Avg Coding Time – Overall on average it took minutes or 69% longer to code a record in ICD-10- CM/PCS Inpatient Coding Productivity

ICD-9-CM Diagnostic =.68 ICD-9-CM Procedural =.61 ICD-10-CM =.49 ICD-10-PCS =.42 Coding Quality or Inter-rater Reliability

Spearman’s Correlation Correlation Coefficient = P-value =.027 As the time spent per record increases, the coding quality decreases Quality vs. Minutes/Record

382 inpatient records 65% decrease in productivity 12.5 minute decrease without procedures 20 minute decrease with procedures Non-OR procedures accounted for longest Veterans Health Administration Inpatient Coding Productivity

1,024 ambulatory care records 6.7% decrease in productivity Longest time to code ER and Therapy Productivity recovered within 2 months Veterans Health Administration Ambulatory Coding Productivity

Comparability Factors or Ratios

Frequencies run for ICD-9-CM and ICD-10-CM diagnostic codes Used the 2013 General Equivalence Maps Used the July 2, 2013 National Hospital Inpatient Quality Measures, Appendix A (ICD-9) and Appendix P (ICD-10) Calculating the Comparability Factors

Joint Commission Core Measure Comparison (ongoing analysis)

Missing ICD-9-CM Cases for AMI I21.02 – STEMI involving diagonal coronary artery I21.4 – Acute subendocardial MI – Subendocardial infarction – AMI of other anterior wall 1

Extra ICD-9 Cases for Respiratory Failure J96.01 – Acute hypoxemic respiratory failure J96.02 – Acute hypercapnic respiratory failure – Acute Respiratory Failure 274

Implementation now slated for 10/1/2015 Review insurance and vendor contracts More time for system upgrades Continue documentation improvement Maybe consider Computer-assisted Coding Identify potential longitudinal data concerns In the Final Analysis

Thank you to Texas Tech and the West Texas AHEC. Questions

Susan H. Fenton, PhD, RHIA, FAHIMA Assistant Dean, UT SBMI Contact Information