ICD-10 Overview Practice Resources, LLC 2015 Practice Resources, LLC 20151

A new diagnosis coding system is coming to your practice. ICD-10-CM will replace ICD-9-CM as a HIPAA- named code set. – Final Rule published Jan. 16, 2009 – Compliance date: October 1, 2015 Practice Resources, LLC 20152

Implementation Dates Single implementation date of the ICD-10 code sets for all users. – ICD-9 will not be accepted for DOS on or after 10/1/15 – ICD-9 will be required for DOS prior to 10/1/15 Practice Resources, LLC 20153

Why The Change? Our current coding system is more than 30 years old and is outdated. – Many categories are full. – Some terms and classifications are outdated/obsolete. – Not descriptive enough for all current uses. Practice Resources, LLC 20154

The Advantage The change to ICD-10 will allow the U.S. to compare data internationally – Track the incidence and spread of disease and treatment. The transition to ICD-10 is a means to incorporate the U.S., into a stronger international health care community that promotes improved patient outcomes, expanded research opportunities, lower health care costs and a healthier population overall. Practice Resources, LLC 20155

Other Benefits Added detail: – Streamlined payment with decreasing delays and pended claims. – Reduce volume of rejected claims and inappropriate denials. – Positive impact on revenue cycles. – Can support refined reimbursement models that reimburse for more complex conditions. Practice Resources, LLC 20156

The transition to ICD-10-CM will be a very big change. ICD-9 contains 17,000 codes ICD-10-CM contains more about 70,000 codes Physicians will continue to use CPT for coding procedures. Practice Resources, LLC 20157

ICD-10-CM: Structural Differences B07Viral warts R03.0Elevated blood pressure, without diagnosis of HTN E11.65DM Type 2, with hyperglycemia S00.412Abrasion of left ear T36.0x1aPoisoning by penicillin, accidental (unintentional),initial encounter. – All start with a letter – Can be 3-7 characters – Decimal after 1 st 3 characters. – Left vs. right – Place holders (x) Practice Resources, LLC 20158

ICD-10-CM: Similarities ICD-9-CM429.3Cardiomegaly ICD-10-CMI51.7Cardiomegaly – GEMS General Equivalency Mapping Practice Resources, LLC 20159

ICD-10-CM: Differences Hypertension – ICD-9: 401.0Malignant hypertension 401.1Benign hypertension 401.9Unspecified hypertension – ICD-10: I10:Essential (primary) hypertension Practice Resources, LLC

ICD-10-CM: Great Differences ICD-9:274.0xGouty arthropathy – Gouty arthropathy, unspecified – Acute gouty arthropathy – Chronic gouty arthropathy, without mention of tophus – Chronic gouty arthropathy, with tophus ICD-10: – M10.0xIdiopathic gout (24 codes) – M10.1xLead-induced gout(24 codes) – M10.2xDrug-induced gout (24 codes) – M10.3xGout due to renal impairment(24 codes) – M10.4xOther secondary gout(24 codes) – Unspecified, shoulder, elbow, wrist, hand, hip, knee, ankle and foot, vertebrae, multiple sites – Right, left, unspecified Practice Resources, LLC

ICD-10-CM: Great Differences Some codes are quite different ICD-9:555.xCrohn’s Disease (see also Enteritis, regional) – 555.0Regional enteritis, small intestine (ICD-9) – 555.1Regional enteritis, large intestine (ICD-9) – 555.2Regional enteritis, small with large (ICD-9) – 555.9Unspecified regional enteritis ICD-10:K50Crohn’s disease – K50Crohn’s disease (ICD-10) There are 28 separate codes with axes for site (large, small, combined unspecified) with complications of fistula, obstruction, bleeding abscess, other or none) K50.00 – K Practice Resources, LLC

ICD-10-CM - Granularity Granularity: Refers to the level of hierarchy and the amount of information it provides to the diagnostic description – 230.0Carcinoma in situ of lip, oral cavity, and pharynx (ICD-9) – D00.01Carcinoma in situ of labial mucosa and vermilion border – D00.02Carcinoma in situ of buccal mucosa – D00.03Carcinoma in situ of gingiva and edentulous alveolar ridge – D00.04Carcinoma in situ of soft palate – D00.05Carcinoma in situ of hard palate – D00.06Carcinoma in situ of floor of mouth – D00.07Carcinoma in situ of tongue – D00.08Carcinoma in situ of pharynx. Practice Resources, LLC

ICD-10-CM: Great Differences Closed fracture of shaft of clavicle – S42.021ADisplaced closed fx, shaft right clavicle, initial encounter – S42.022ADisplaced closed fx, shaft left clavicle, initial encounter – S42.023ADisplaced closed fx, unspecified clavicle, initial encounter – S42.024ANondisplaced closed fx, shaft right clavicle, initial encounter – S42.025ANondisplaced closed fx, shaft left clavicle, initial encounter – S42.026ANondisplaced closed fx unspecified clavicle, initial encounter Practice Resources, LLC

ICD-9-CM: Hyperlipidemia 272.xDisorders of Lipid Metabolism – 272.0Pure hypercholesterolemia – 272.1Pure hyperglyceridemia – 272.2Mixed hyperlipidemia – 272.3Hyperchylomicronemia – 272.4Other and Unspecified hyperlipidemia – 272.5Lipoprotein deficiencies – 272.6Lipodystrophy – 272.7Lipidoses – 272.8Other disorders of lipoid metabolism Practice Resources, LLC

ICD-10-CM: Hyperlipidemia E78.0Pure hypercholesterolemia E78.1Pure hyperglyceridemia E78.2Mixed hyperlipidemia E78.3Hyperchylomicronemia E78.4Other hyperlipidemia E78.5Hyperlipidemia, unspecified E78.6Lipoprotein deficiency E78.7xDisorders of bile acid and cholesterol metabolism – E78.79Disorders of bile acid and cholesterol metabolism, unspecified – E78.71Barth syndrome – E78.72Smith-Lemil-Opitz syndrome – E78.79Other disorders of bile acid and cholesterol metabolism E78.8x Other disorders of lipoprotein metabolism – E78.81Lipoid – E78.89Other lipoprotein metabolism disorders – E78.9Disorder of lipoprotein metabolism, unspecified Practice Resources, LLC

ICD-9-CM: Open Wound Hand Open wound of hand except finger(s) alone – without mention of complication – Complicated – with tendon involvement Practice Resources, LLC

ICD-10-CM Open Wound Hand 45 different choices to pick from S61.401_ Unspecified open wound right hand S61.402_ Unspecified open wound left hand S61.409_ Unspecified open wound of unspecified hand S61.411_ Laceration w/out foreign body right hand S61.412_ Laceration w/out foreign body left hand S61.419_ Laceration w/out foreign body unspecified hand S61.421_ Laceration w/foreign body right hand S61.422_ Laceration w/foreign body left hand S61.429_ Laceration w/foreign body unspecified hand S61.431_ Puncture wound w/out foreign body right hand S61.432_ Puncture wound w/out foreign body left hand S61.439_ Puncture wound w/out foreign body unspecified hand S61.441_ Puncture wound w/foreign body right hand S61.442_ Puncture wound w/foreign body left hand S61.449_ Puncture wound w/foreign body unspecified hand Each of these codes have option of A (initial) D (subsequent) or S (sequela) in the 7 th character. Practice Resources, LLC

Unspecified Codes There will still be unspecified codes for ICD-10-CM. We are advising offices not to utilize them when a more specific diagnosis is available. Practice Resources, LLC

Inpatient Services That Overlap Patient is admitted on September 29, 2015 Same patient is discharged on October 2, 2015 Separate claims will be needed – 1 claim for 29 th & 30 th with ICD-9 codes – 1 claim for 1 st & 2 nd with ICD-10 codes Practice Resources, LLC

Documentation Improvement Successfully embracing ICD-10 boils down to meticulous documentation. – How can we help you? – Rely on certified coders and ancillary staff. – The solution is not to train physicians in ICD-10 coding but to show them the clinical documentation requirements that align with their specialty and are needed for the hospital to provide quality patient care and be successful in transitioning to ICD-10. Practice Resources, LLC

Will your office be ready? Do you frequently need to ask your office for diagnosis codes? Is your office aware of these ICD-10 changes? What can you do to help with the transition? Practice Resources, LLC

The Most Critical Issue For Practices Assess the status of your organization. – Assign an ICD-10-CM implementation team. – Determine the readiness of software vendors. – Consider workflow changes that may be needed. – Practice clinical documentation improvement based on changes. – Determine staffing needs. – Develop a training plan. – Determine the readiness of referring providers. – Determine the readiness of your payers. – Consider reimbursement delays. Practice Resources, LLC

Help educate yourself! Review medical policies frequently used Review the top 50 diagnosis for your office ICD-10 Cheat Sheets on SharePoint Look at some mapping conversions ICD9/ICD10 – Chart Central in Medent – ICD9data.com – Medicare website Practice Resources, LLC

Additional information NYS W/C is adopting the ICD-10-CM Medent Version 22.0 will have edits for ICD-10 Websites: – – – – Practice Resources, LLC

QUESTIONS? Practice Resources, LLC