ROCHESTER HEALTH INFORMATION MANAGEMENT ICD-10 WAS ALMOST HERE !!! Amy M. Crowfoot, MSHA, RHIA, C-CDI April 23, 2014

ICD-10 READINESS: WERE YOU READY?

Days to ICD-10 The number of days remaining to get ready for ICD-10 ?? Was 201, now 524!!

Why the Transition to ICD-10 ? ICD-10-CM will be used in all U.S. health care settings to allow for a much more specified and substantially different coding system

ICD-10 Fun Fact !! Among the tens of thousands of codes included in the generic ICD-10, there are distinctions for "wounds inflicted by macaws" and "wounds inflicted by parrots." An important distinction, or a ludicrously extraneous detail?

Why the Transition to ICD-10 ? The transition to ICD-10 is occurring because ICD-9 data about patients medical conditions and hospital inpatient procedures are limited, its inconsistent with current medical practice, and the current ICD-9 coding system as we know it, is limited in expansion due to the three digit category structure

Look at the Expansion ! 14,000 Diagnoses Codes Numeric Codes: -Max of 5 digits 4,000 Procedure Codes Numeric Codes: -Max of 4 digits Alphanumeric Codes: Always Start with a Letter (Exc. U) Max of 7 Char. 87,000 Procedure Codes (ICD-10-PCS) Approximately 68,000 Diagnoses Codes Alpha/Numeric Codes: Start with a Number or Letter (Exc. O or I to avoid confusion with 0/1

ICD-10 Timeline ICD-10 codes will be required on all claims with dates of service on or after October 1, 2015 This includes professional and institutional claims as mandated by HIPAA regulations

General Overview ICD-10 documentation requirements will impact physicians, hospitals, and other providers ICD-10 diagnosis codes, based upon greater documentation specificity, will be used by all providers in all care settings ICD-10 will increase the level of clinical detail ICD-10 will change in organization and structure ICD-10 will change in code composition – 14K – 68K Dx Codes, 4K – 87K Proc. Codes with a combination of alpha and numeric codes

ICD-10 Code Comparison Examples Tobacco Abuse ICD-9-CM: 1 Codes ICD-10-CM: 5 Codes Diabetes Mellitus ICD-9-CM: 10 Code ICD-10-CM: 318 Codes Fracture of Radius ICD-9-CM: 33 Codes ICD-10-CM: 1818 Codes 10

Benefits to ICD-10 ? The new classification system will provide much better data needed for; Measuring the quality and safety of patient care Improvem the explanation of the patient’s condition Assist with research, clinical trial studies, disease management Assist with the redesign of payment systems Assist with claims processing for reimbursement Greater flexibility for expansion of new codes

Greater Specificity Keep in mind…..HIM, Coders, and Documentation Specialists…will continue to play a key role………….. Coders have to communicate documentation updates to providers and others in the organization Work with providers concurrently to meet new documentation demands Increase coding queries to ensure new documentation specificity

?? Coding Productivity How much longer will it take to code each inpatient case ? 10%, 20%, 30% How much longer will it take to code each OPT case ? 0%, 5%, 10% Will there be more inpatient queries ? Will there be more medical necessity denials ? Coding will tie directly back to CMI, SOI, ROM

WILL WE GET PAID ? All claims will require an ICD-10 code(s) to be paid for the following; Inpatient Outpatient ED, Amb Surgery, Clinic, Ref’s/RCR’s

ICD-10 Areas Being Impacted Any area that currently utilizes ICD-9 codes; a.HIM b.Information Technology c. Billing d. Physicians/Providers/CDI e. Nursing f. Performance Improvement

Impact to Information Technology Interfaces, software upgrades Claims Processing Testing of interfaces Testing to ensure you can produce an I-10 bill Internal reporting External reporting

Impact to Billing Systems Can and will we be able to get a claim out the door ??

Impact to Billing Systems 1.Are your billing systems updated to capture ICD-10 coding system ? 2.Do these systems have edits to ensure ICD- 10’s are captured correctly ? 3.Have your systems been updated to capture both I-9’s and I-10’s? 4.Have you begun reviewing and testing your interfaces ? 5.Have your billing system claim forms been updated to be able to output ICD-10’s ?

Impact to Providers Physicians documentation – BIG changes Physician specificity is critical to avoid the unknown and unspecified coding choices Physician specificity critical to inpatient and procedural coding Training and education should be underway Modify all queries to begin the ‘behavior changes’ in documentation practices

Physicians’ Role Vital Make sure approach is collaborative vs. punitive Physicians should already have been involved in the transition to I-10 Leverage their natural competitiveness Goal always remains on patient care Provide physicians data in ‘real time’ Recognize physician success

Look What We Have to Know ! Fracture of the Radius 1. Fracture Type 2. Healing Process 3. Localization 4. Encounter 5. Displacement 6. Classification 7. Laterality 8. Joint Involvement 9. Fracture Pattern 10. Named Fractures 10 documentation points when classifying and coding a fracture of the radius !!!!

Providers Documentation Some Tips That Might Help ! Laterality Acute/Chronic Trimester of pregnancy Episode of care Stages of healing Specific location of injury Mild, moderate, severe Overweight/Under weight

Internal Provider Impact Nursing Performance Improvement: critical areas of documentation and trend reports Performance Improvement: should begin to review compiled reports, internal reports, external reports and how these will be rebuilt and ready for ICD-10 Physician reports: should begin reviewing and transitioning these to I-10

Measure of Readiness Do you have the ability to ‘dual code’ now throughout all your systems ? If you can answer that question, it will help you know what you need to keep moving ahead, getting the pieces in place !

ICD-10 Road Map for Success Plan your budget for 2015 Review your impact assessment/gap analysis Review with your stakeholders/steering committee where you stand ? Review your vendor lists, clearinghouse and payers processes Continue your education efforts with providers and coding staff Continue your testing and system redesign Continue your training efforts with your dual coding funtionality Lets wait to see what the government is forecasting for ICD-10 for 2015 !

Clinical Documentation Improvement Efforts… Keep in mind….. If you have poor documentation/coding today under ICD-9, this will continue with the implementation of ICD-10…… Now is the time to strengthen your program !

Clinical Specificity Today versus ‘Tomorrow’ Today =‘s Tomorrow So why wait ???? Lets not wait !

Integrate ICD-10 Continue to incorporate clinical specificity into established medical necessity processes Make I-10 part of your clinical review and coding practice…….even today, every day Require your providers to practice clinical excellence through accurate documentation of their clinical thoughts and decision making These are the keys to accurate inpatient coding assignments

Integration Continued…. Incorporate clinical specificity into medical necessity for your all your service lines More specific documentation will improve compliance with medical necessity and will enhance provider’s E/M level assignment Enhanced documentation will lead to improved revenue, happy CFO’s !!

Questions ???

Rochester Regional Health Information Management Association Resources: The ICD-10-CM Official Guidelines are available at : Amy M. Crowfoot, MSHA, RHIA, C-CDI (p) (f)