1. Kyle Miller, Todd Couts CMS ICD-10 PMO February, 2011
Introduction to ICD-10
Kyle Miller, Todd Couts
CMS ICD-10 PMO
February, 2011

2. Agenda
Overview of ICD-10
CMS’ ICD-10 Program and Activities to Date
Impact on ESRD at CMS
Additional Resources

3. The ICD-10 Regulation Adopts ICD-10 code sets under HIPAA Diagnosis
ICD-10 Clinical Modification (CM)
ICD-10 Procedure Coding System (PCS)
Diagnosis
ICD-10 CM replaces ICD-9 CM diagnosis codes in all settings
Procedures
ICD-10 PCS replaces ICD-9 CM procedure codes for hospital inpatient procedures
HCPCS and CPT-4 codes remain the official procedural coding systems for outpatient reporting
Applies to all HIPAA Covered Entities and electronic interactions between those entities

4. Diagnosis and Procedure Codes
All Settings
Inpatient
Single implementation date of October 1, 2013 for all users
Date of service for ambulatory and physician reporting
Ambulatory services provided on or after will use ICD-10-CM diagnosis codes
Date of discharge for inpatient settings
Inpatient discharges occurring on or after will use ICD-10-CM and ICD-10-PCS codes
No delays
No grace period
ICD-9 Volumes 1 and 2 Diagnosis Codes
ICD-9 Volume 3 Procedure codes
ICD-10 Clinical Modification (CM) – DIAGNOSIS CODES
ICD-10 Procedure Coding System (PCS) – INPATIENT PROCEDURE CODES

5. Why ICD-10 Now? ICD-9-CM code set is outdated
30 years old
ICD-9-CM codes cannot reflect current medical technologies
Many code chapters are full, resulting in code placement in non-related chapters
Current codes are often not descriptive enough
The rest of the world is already on ICD-10
ICD-10-CM and ICD-10-PCS provides these improvements
More codes, greater specificity
Greater flexibility to add new codes
Reflects current use of medical technology

6. ICD-10 Advantages for Physicians
Ability to report (inpatient) procedures exactly as performed (OP still CPT)
Ability to describe complex and atypical patients
Less staff time (less expensive) claims coding due to decreased ambiguity and better organization
Better ability of payer to match payment to work involved

7. ICD-10 is Different than Other HIPAA Implementations
Original HIPAA Implementation
Code set standards were already de facto standards – ICD-9, CPT, HCPCS
Significant front-end translation to insulate systems from changes
Heavy IT focus
ICD-10 Implementation
Much more expansive than maintenance updates to ICD-9 codes
First mandated industry wide implementation of a new medical code set
Reach extends into policies, business processes, and systems
Requires broad business and systems focus

8. ICD-10 is No Worse Than Other HIPAA Implementations for Most Providers
Software must be updated and
Staff must be trained but
Physicians only use a small section of codes regularly and
Diagnoses and procedures are all the same, just with clearer distinctions

9. Changes in ICD-10 Structural Changes Clinical Content Differences
Expanded field lengths (diagnosis and procedure codes)
Different field formats (procedure codes)
Clinical Content Differences
New taxonomy for documenting
Diseases, injuries, impairments, cause of injury (diagnosis codes)
Specific procedures done to a patient (procedure codes)
ICD-10 provides greater detail in describing diagnoses and procedures
There are many more ICD-10 codes than ICD-9-CM codes

10. Diagnosis Code Changes

11. Diagnosis Code Example
ICD-10 Codes Provide Greater Specificity in Some Cases
ICD-9 code - Striking against or struck accidentally in sports without subsequent fall (E917.0)
24 ICD-10-CM Detail Codes

12. Nephrology Diagnosis Codes: Consistent Organization
(N00-N08) Glomerular diseases
(N00) Acute nephritic syndrome
(N01) Rapidly progressive nephritic syndrome
(N02) Recurrent and persistent hematuria
(N03) Chronic nephritic syndrome
(N04) Nephrotic syndrome
Lipoid nephrosis
(N05) Unspecified nephritic syndrome
(N06) Isolated proteinuria with specified morphological lesion
(N07) Hereditary nephropathy, not elsewhere classified
(N08) Glomerular disorders in diseases classified elsewhere
Suffixes:
.0 Minor glomerular abnormality
.1 Focal and segmental glomerular lesions
.2 Diffuse membranous glomerulonephritis
.3 Diffuse mesangial proliferative glomerulonephritis
.4 Diffuse endocapillary proliferative glomerulonephritis
.5 Diffuse mesangiocapillary glomerulonephritis
.6 Dense deposit disease
.7 Diffuse crescentic glomerulonephritis
.8 Other
.9 Unspecified

13. Procedure Code Changes

14. Procedure Code Example - 2 ICD-9-CM Codes Replaced by 112 ICD-10-PCS Codes

15. Nephrology Procedure Codes: Better Organization
Example: Percutaneous Pyelostomy
Current Ambiguity
55.03 Percutaneous
Nephrostomy OR
55.12 (Unspecified)
Pyelostomy 1 2 4 3
New
0T9330Z 5 6
Better ability of payer to match payment to work involved

16. ICD-10 and 5010
5010 is short for Version 5010 of the ACS (Accredited Standards Committee) X12 standards for electronic transactions (e.g. claim submission)
5010 is a prerequisite for ICD-10 as 4010/4010A1 transactions cannot carry ICD-10 codes
5010 also enhances diagnosis reporting
Separates principal diagnosis, admitting diagnosis, external cause of injury and reason for visit
Increases number of ICD occurrences on 837 transactions (electronic claims)

17. Tools and Implementation Strategies
Tools/Files
General Equivalence Mappings (GEMs)
Reference mappings to help navigate between code sets. Bi-directional translation dictionaries (9 > 10 and 10 > 9)
All codes in one set that could be used to replace a code in the other
Reimbursement Mapping (9 > 10 and 10 > 9)
To provide non CMS payers a temporary mechanism for mapping records containing ICD-10 codes to “reimbursement equivalent” ICD-9 codes
One code that most closely replaces the resources/costs of the other
Implementation Strategies
Upgrade
Update the impacted systems to accept, use, and send ICD-10 codes natively
Crosswalk
Shield the impacted systems from accepting, using, or sending ICD-10 codes natively

18. Fundamental Payer ICD-10 Strategy Choices

19. Fundamental Provider ICD-10 Strategy Choices
Upgrade
Crosswalk
Physician Codes in ICD-10
Physician Codes in ICD-9
ICD-10 Diagnosis
Codes
ICD-10 Procedure
ICD-10 Diagnosis
Codes
ICD-10 Procedure
Staff Translates ICD-9 to 10
ICD-10 Diagnosis
Codes
ICD-10 Procedure
Office Submits in ICD-10
Office Submits in ICD-10
ICD-10 Diagnosis
Codes
ICD-10 Procedure
ICD-10 Diagnosis
Codes
ICD-10 Procedure
Use GEMS to find new versions of
your most commonly used codes.
Adds extra work, increases errors
and loses the benefits of ICD-10.
All claims MUST be submitted in ICD-10
For DOS after October 1, 2013

20. CMS ICD-10 Program and Activities to Date

21. ICD-10 Program History and Current State

22. ICD-10 Program Organization
ICD-10 Implementation Projects

23. Project Structure

24. High Level Implementation Timeline

25. Key CMS Activities Created GEMS and Reimbursement Mapping Tools
MS-DRG Update and Associated White Paper
October 2009 FFS JAD Session
Analysis CR
Detailed planning conference calls with MACs/Fis/Carriers and Shared System Maintainers
Educational materials and calls

26. Impact on ESRD at CMS

27. Milestones for ESRD QE-0: Preliminary Analysis
QE-1: Policy Decision on How Facilities Will Report Assessment Data for Patients Whose Stay Spans the ICD-10 Implementation Date
QE-2: Mapping/Crosswalk Implementation Strategy Approach Defined
QE-3: End-to-End Testing Strategies Defined
QE-4: CMS Staff and Quality Contractors Educated and Trained
QE-5.1: Form 2728 Updated
QE-5.2: VISION Updated
QE-5.3: REMIS Updated
QE-6.1: ESRD Activities End-to-End Testing Level 1
QE-6.2: ESRD Activities End-to-End Testing Level 2
QE-7: Transition and Implement ESRD Activities Systems
QE-8: Providers, Contractor Provider Contact Centers, and QIOs Educated on the Increased Granularity and Use of ICD-10 Code Set
QE-9: Education and Outreach Provided to External Vendors on ICD-9 to ICD- 10 Translations
QE-10: CROWNWeb Updated

28. Additional Resources

29. CMS Resources ICD-10 General Information http://www.cms.gov/ICD10
MS-DRG Conversion Report
Central Version 5010 and D.0 web page on the CMS website
The CMS ICD-10 website provides the latest ICD-10 information and links to resources for providers to prepare for ICD-10 implementation in a 5010 environment.
CMS Sponsored Calls web page provides current information on CMS national provider conference calls focused on the implementation of ICD-10 You will find copies of call materials (presentations, written and audio transcripts, etc.). 

30. Additional Resources
The following organizations offer providers and others ICD-10 resources
WEDI (Workgroup for Electronic Data Interchange)
HIMSS (Health Information and Management Systems Society)