1450 Winter VAR Conference February 3, Denisha M. Torres-Lich, MS, RHIA, LHRM President Torres-Lich & Associates, Inc.

 Over 30 years old  Codes are insufficient  Lack specificity and detail  Limits the ability of payers and others  Do not provide the level of detail 2

 ICD-10 Final Rule CMS-0013-F ◦ 09/pdf/E9-743.pdf ◦ Published January 16, 2009  Compliance Date for Implementation ◦ October 1, 2013  First implement the “Version 5010” electronic health care transaction standards ◦ January 1,

 Improve operational processes  Update the terminology and disease classifications  Increase flexibility  Enhance coding accuracy and specificity  Support refined reimbursement models 4

 Allows for greater automation = fewer payer- physician inquiries  Provides more detailed data  Greater diagnostic specificity  Provides for more effective detection and investigation of potential fraud or abuse 5

 Standard coding convention that: ◦ flexible ◦ provides unique codes ◦ allows new procedures and diagnoses to be easily incorporated  Two Components ◦ ICD-10 – CM  Diagnosis classification system ◦ ICD-10-PCS  Procedure classification system for inpatient hospital use 6

 Both components can improve: ◦ quality measurements ◦ patient safety ◦ evaluation of medical processes and outcomes.  ICD–10–PCS ◦ can readily expand and capture new procedures and technologies 7

ICD-9ICD Chapters21 Chapters 3 – 5 Digits3 – 7 Digits Supplemental Chapters 1 st Digit is alpha (E & V) = all other Numeric 1 st Digit is alpha 2 nd Digit is numeric 3 rd – 7 th Digit is alpha Approx. 14,500Approx. 70,000 Antiquated terminologyCurrent terminology Complications of Medical Care in 1 ChapterComplications have been moved to procedure specific body system chapters Partial code titlesFull code titles Code extensions for specificity and laterality Dummy place holder , Open fracture of head of radiusS52123C, Displaced fracture of head of unspecified radius, initial encounter for open fracture type IIIA, IIIB, or IIIC 8

 Table of Contents ◦ 1Certain infectious and parasitic diseases (A00-B99) ◦ 2Neoplasms (C00-D49) ◦ 3Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50- D89) ◦ 4Endocrine, nutritional and metabolic diseases (E00-E89) ◦ 12 Diseases of the skin and subcutaneous tissue (L00-L99) ◦ 13 Diseases of the musculoskeletal system and connective tissue (M00-M99) ◦ 14 Diseases of the genitourinary system (N00-N99) 9

ICD-9ICD – 4 Digits3 – 7 Digits Codes are numericCodes are alphanumeric Approx. 3,000+Approx. 72,000 Antiquated terminologyCurrent terminology Does not have lateralityHas laterality Generic details of body partsFull detail of body part Detail of methodology and approach Flexible [Endoscopic] polypectomy of rectum0DBP8ZZ Excision of Rectum, Via Natural or Artificial Opening Endoscopic 10

Med/Surg Gastrointestinal Excision Stomach Transorifice Intraluminal Endoscopic None Diagnostic Section Body System Body System Root Operation Root Operation Body Part Body Part Approach Device Qualifier Example of ICD-10-PCS

 network of relationships between the two code sets ◦ ICD-9-CM to ICD-10-CM (forward mapping) ◦ ICD-10-CM to ICD-9-CM (backward mapping) “…a series of possible compromises rather than the mirror image of one code in the other code set.” 12

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 Diagnosis Codes and Differences in Classification ◦ For example:  I-9 code description - “complicated open wound”  Delayed healing, delayed treatment, foreign body or infection  I-10 categorizes open wounds  wound type - laceration or puncture wound, and whether a foreign body is present  depending on the documentation in the record, the correct correspondence between and I-9 and I-10 code could be one of several. 14

 Diagnosis Codes and Levels of Specificity codes. ◦ i.e. in I-9, category 733, Other disorders of bone and cartilage, contains the codes:  Stress fracture of tibia or fibula  Stress fracture of the metatarsals  Stress fracture of other bone  Stress fracture of femoral neck  Stress fracture of shaft of femur  Stress fracture of pelvis  in many instances I-10 provides specific codes for all likely sites of a stress fracture, including more specificity for the bones of the extremities, the pelvis and the vertebra. Stress fracture data coded in I-10 possesses a consistent level of specificity. 15

73395 M4840XA M4841XA M4842XA M4843XA M4844XA M4845XA M4846XA M4847XA M4848XA M8430XA M84319A M84329A M84339A M84343A M84373A M8438XA

 Diagnosis Codes in Combination  i.e. I – 9 code Histoplasma duboisii meningitis = I – 10 codes B39.5 Histoplasmosis duboisii AND G02 Meningitis in other infectious and parasitic diseases classified elsewhere 17

ICD-10-CM Many possible codes ICD-10-CM Many possible codes S72301A Unspecified fracture of shaft of right femur, initial encounter for closed fracture S72322A Displaced transverse fracture of shaft of left femur, initial encounter for closed fracture S72326A Nondisplaced transverse fracture of shaft of unspecified femur, initial encounter for closed fracture S72301G Unspecified fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing S72322G Displaced transverse fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing S72326G Nondisplaced transverse fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing S72302A Unspecified fracture of shaft of left femur, initial encounter for closed fracture S72323A Displaced transverse fracture of shaft of unspecified femur, initial encounter for closed fracture S72331A Displaced oblique fracture of shaft of right femur, initial encounter for closed fracture S72302G Unspecified fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing S72323G Displaced transverse fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing S72331G Displaced oblique fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing S72309A Unspecified fracture of shaft of unspecified femur, initial encounter for closed fracture S72324A Nondisplaced transverse fracture of shaft of right femur, initial encounter for closed fracture S72332A Displaced oblique fracture of shaft of left femur, initial encounter for closed fracture S72309G Unspecified fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing S72324G Nondisplaced transverse fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing S72332G Displaced oblique fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing S72321A Displaced transverse fracture of shaft of right femur, initial encounter for closed fracture S72325A Nondisplaced transverse fracture of shaft of left femur, initial encounter for closed fracture S72333A Displaced oblique fracture of shaft of unspecified femur, initial encounter for closed fracture S72321G Displaced transverse fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing S72325G Nondisplaced transverse fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing S72333G Displaced oblique fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing ICD-9-CM Fracture of femur, shaft, closed ICD-9-CM Fracture of femur, shaft, closed

 Hospitals  Health care practitioners & institutions  Health insurers & other third-party payers  Electronic- transaction clearinghouses  Hardware & software manufacturers & vendors  Billing & practice- management service providers  Health care administrative & oversight agencies  Public & private health care research institutions

All reporting/billing health care providers ICD-10-CM – Hospitals, physicians, clinics, laboratory, radiology, psychiatric, rehab, nursing homes etc. All diagnosis codes ICD-10-PCS – Procedures for Hospital Inpatients CPT/HCPCS – Procedures for Hospital Outpatients, Physician, Laboratory and Radiology Outpatients 20

- Electronic Health Records - Practice Management Systems - Billing - Accounts Receivable - Productivity Loss 21

 Physician Perception  Impact on Practice Management  Impact on reimbursement  Physician practice changes 22

 Six phases: ◦ Planning ◦ Communication and Awareness ◦ Assessment ◦ Operational Implementation ◦ Testing ◦ Transition 23

 Quality vs. Quantity  More stringent documentation ◦ i.e. Myocardial Infarction ICD- 10 documentation will need to include:  Type of Infarction  Age of Infarction  Specific Site of Myocardium involved  Coronary Artery Involved  Information regarding initial or subsequent MI within 4 weeks 24

 Work toward better documentation to ◦ Avoid misinterpretation by third parties (auditors, payers, attorneys, etc.) ◦ Justify medical necessity ◦ Provide a more accurate clinical picture of quality of care provided 25

 Speech Recognition ◦ Back End ◦ Front End  Computer Assisted Physician Documentation  Computerized Assisted Coding ◦ reduce costs and claims rejections ◦ improve productivity and accuracy 26

 2012 ICD-10 ◦ ◦  AHIMA ICD-10 Resources ◦  Provider Resources ◦ es.asp es.asp 27

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Denisha M. Torres-Lich, MS, RHIA,LHRM President Torres-Lich & Associates, Inc. (727)