1 ICD-10 Working Session Building Awareness and Tools/Resources Karen Navarro Claudia Yoakum-Watson April 16, 2010

2 ICD-10 Working Session Building Awareness and Tools/Resources 1. Overview 2. Structure and Use 3. Actions and Timeline 4. Tools and Resource

3 #1Overview of ICD What is ICD? Why are we moving to ICD-10? When does ICD-10 happen? Where can I get information? Who uses ICD-10?

4 ICD-10 Working Session Building Awareness and Tools/Resources 2.ICD Structure and Use 3.Actions and Timeline 4.Tools and Resource

5 #2ICD Structure & Use The patient is in the office for the first visit because of closed greenstick fracture of the right radial shaft. ICD Fracture of radius and ulna; shaft, closed radius (alone) ICD-10 S52.311A Greenstick fracture of shaft of radius, right arm, initial encounter for closed fracture

6 Diagnosis Code Structure S52.311AGreenstick fracture of shaft of radius, right arm, initial encounter for closed fracture Root SiteSeverityEtiologyExtension S52311A Injury, poisoning and certain other consequences of external causes Injuries to the elbow and forearm Fracture of Forearm Radial Shaft GreenstickRightInitial Encounter

7 Procedure Code Structure OTF4ZZZLithotripsy SectionBody System Root Procedure Treatmen t Site ApproachDeviceQualifier OTF4ZZZ MedicalUrinaryFragment- ation Left Renal Pelvis No Approach Noted No Device Noted No Qualifier Noted

8 Mapping of ICD-9 CM can be mapped to ??? ICD-10 CM Codes.

9 #3Action Overview ICD-10 Awareness Budget Strategy Business Assessment Internal System assessment External (Vendor) System assessment Implementation Education Testing Maintenance and Ongoing Support

10 ICD-10 Awareness Provide information on ICD usage and format Identify why we need ICD-10 Determine what needs to be done Identify who needs to be involved Discuss a time line for maximum benefit Collect needed tools and resources

11 Building Awareness Outline benefits and challenges of ICD-10 Identify where ICD is currently used Identify how ICD-10 could be used

12 Benefits and Challenges Mandatory Will cost – time and money Learning something different Documentation requirements Improve business practices Improve reporting Reduce costs Increase efficiency Improve timely claim processing

13 Education Coder System users Business users Management Physicians

14 Actions Identify a timeline Develop a plan Establish a budget

15 Timeline April 16, 2010 – October 1, 2013 Years – 3.5 Calendar months – 42.5 Working weeks – 166 Working days – 830

16 Not Just Information Systems Internal Systems External Systems Business Function 1.Assessment 2.Implementation 3.Testing 4.Maintenance

17 Interdisciplinary Team Senior management Medical staff Financial management Information systems Reporting Coding or HIM Project manager

18 Business Impact Assessment Operational processes Reports Procedures Charge Master or Super bills Pre-authorizations Coding changes

19 Business Impact Assessment Budget impact Cash flow Contract revisions Fee schedule changes/revisions Pay for performance initiatives Productivity losses

20 Internal System Impact Assessment Electronic record Decision support and reporting systems Billing and Claim systems Utilization management Case mix systems Accounting systems Disease management systems Provider profiling systems Performance measurement systems Medical necessity software

21 External System Impact Assessment Vendor Readiness Vendor Timeline Interfaces Cost System changes/upgrades Testing

22 Business Implementation Work flow Processes Education Update resources Productivity variances

23 Internal System Implementation Data structure differences Field structure Programs Maintain both ICD-9 and ICD-10 data Implement and test systems changes.

24 External System Implementation Keep abreast of external readiness Identify any issues Evaluate and assign resolution

25 Maintenance Business Internal System External System

26 #4Resources HIPAA COW – AHIMA – AAPC – CMS – WHO – CDC – AMA –

27 Summary ICD Structure and Use Actions and Timeline Tools and Resource Discussion and Questions

28 Discussion and Questions?

29 Notes

30 HIPAA COW – AHIMA – CMS – WHO – CDC – AMA – Karen Navarro Claudia Yoakum-Watson, CPC