Basic Introduction to ICD-10 CM/PCS

ICD-10 Implementation October 1, 2015 – Compliance date for implementation of ICD-10-CM (diagnoses) and ICD-10-PCS (procedures) ICD-10-CM (diagnoses) will be used by all providers in every health care setting ICD-10-PCS (procedures) will be used only for hospital claims for inpatient hospital procedures ◦ ICD-10-PCS will not be used on physician claims, even those for inpatient visits

CPT and HCPCs Codes No impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes CPT and HCPCS will continue to be used for physician and ambulatory services including physician visits to inpatients

ICD-10 Implementation Single implementation date of October 1, 2015 for all users Ambulatory and physician services provided on or after October 1, 2015 will use ICD- 10-CM diagnosis codes Inpatient discharges occurring on or after October 1, 2015 will use ICD-10-CM and ICD-10-PCS codes

Why ICD-10 Current ICD-9 Code Set is: Outdated: 30 years old Current code structure limits amount of new codes that can be created Has obsolete groupings of disease families Lacks specificity and detail to support: ◦ Accurate anatomical positions ◦ Differentiation of risk & severity ◦ Key parameters to differentiate disease manifestations

Diagnosis Code Structure Comparison ICD-9-CM (Volume 1 & 2)ICD-10-CM 3-5 characters in length3-7 characters in length Approximately 14,000 codesApproximately 68,000 codes First digit may be alpha (E or V) or numeric; digits 2-5 are numeric Digit 1 is alpha (to indicate the category); Digit 2 is numeric (in the future, alpha characters may be used if code expansion is needed); Digits 3-7 can be alpha or numeric Limited space for adding new codesFlexible for adding new codes Lacks detailVery specific Lacks lateralityIncludes laterality (i.e., codes identifying right vs. left)

ICD-10-CM (diagnosis) Code Format S A Alpha (except U) 2 nd – Always Numeric 3 rd -7 th Alpha or Numeric Additional Characters CategoryEtiology, Anatomic Site, Severity Added code extensions (7 th Character) for obstetrics, injuries and external causes of injuries 3-7 Characters

Comparison: ICD-9 to ICD Cerebral embolism with infarction Code represents embolism of cerebral arteries with infarction I63.40Cerebral infarction dew to embolism of unspecified cerebral artery I63.49Of other cerebral artery I63.411Of right middle cerebral artery I63.412Of left middle cerebral artery I63.419Of unspecified middle cerebral artery I63.421Of right anterior cerebral artery I63.422Of left anterior cerebral artery I63.429Of unspecified anterior cerebral artery I63.431Of left posterior cerebral artery I63.432Of right posterior cerebral artery I63.439Of unspecified posterior cerebral artery I63.441Of right cerebellar artery I63.442Of left cerebellar artery I63.449Of unspecified cerebellar artery With specificity and laterality, one ICD-9 code translates into 14 possible ICD-10 codes

Procedure Code Structure Comparison ICD-9-CM (Volume 3)ICD-10-PCS 3-4 numbers in length7 alpha-numeric characters in length Approximately 3,000 codesApproximately 87,000 available codes Based on outdated technologyReflects current usage of medical terminology and devices Limited space for adding new codes Flexible for adding new codes Lacks detailVery specific Lacks lateralityHas laterality Generic terms for body partsDetailed descriptions for body parts Lacks descriptions of methodology and approach for procedures Provides detailed descriptions of methodology and approach for procedures Lacks precision to adequately define procedures Precisely defines procedures with detail regarding body part, approach, any device used, and qualifying information

ICD-10-PCS Code Format S A Section Body System Root Operation Body Part Approach Device Qualifier

Comparison: ICD-9 to ICD-10 ICD-9 Procedure Code Angioplasty Suture of artery Laparoscopic appendectomy ICD-10 Procedure Code 0DN90ZZ Release of duodenum, open approach 0FB03ZX Excision of liver, percutaneous approach, diagnostic 02PS0CZ Removal, extraluminal device from pulmonary vein, right, open

ICD-10 Provider Impacts Clinical documentation is the foundation of successful ICD-10 Implementation Golden Rule of Documentation ◦ If it isn’t documented by the physician, it didn’t happen ◦ If it didn’t happen, it can’t be billed The purpose in documentation is to tell the story of what was performed and what is diagnosed accurately and thoroughly reflecting the condition of the patient ◦ what services were rendered and ◦ what is the severity of the illness The key word is SPECIFICITY ◦ Granularity ◦ Laterality Complete and concise documentation allows for accurate coding which leads to maximized reimbursement

ICD-10 Changes Everything! ICD-10 is a Business Function Change, not just another code set change. ICD-10 Implementation will impact everyone: ◦ Registration, Nurses, Managers, Lab, Clinical Area, Billing, Physicians, and Coding. Know your role – How is ICD-10 going to change what you do?

ICD-10 Next Steps Assess & track vendor compatibility UHS Master Education Plan ◦ Identify all employees and medical staff who need training by April 15, ◦ Assign all Precyse Courses in Healthstream by April 30,  Be mindful of assigned staff training hours Dual coding / practicing with ICD-10-CM/PCS

ICD-10 Facility Resources Cost centers have been established specifically for the resources needed to implement ICD-10 successfully. This covers both the training of employees and any necessary back-fill of staff during training. ◦ ICD -10 Training: coded to account #xxx Two ICD-10 translation tools: ◦ Code Translation Tool (CTT)  Translates ICD-9 to ICD-10 utilizing description, specific code, code ranges or list of codes.  Training and Roll-out of the CTT tool has been completed and end users are actively using the tool for Code translation needs. ◦ Financial Impact Tool (FIT)  Analyzes historical DRG data to predict the financial impact of ICD-10, both positive and negative. Variance reports can be utilized to identify avoidable DRG shifts in order to reduce financial risk through physician documentation education.  Training and Roll-out of the FIT tool is in progress.

ICD-10 Resources CMS Resources ◦ MS-DRG Conversion Report ◦ ICD-10 General Information The following organizations offer providers and others ICD- 10 resources ◦ AHIMA (American Health Information Management Association) ◦ WEDI (Workgroup for Electronic Data Interchange) ◦ HIMSS (Health Information and Management Systems Society)

OCTOBER 1, 2015!!

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