1. Prepared by: Sherry A. Milton, RHIA Milton & Associates P.O. Box 683 Erin, Tennessee October 13, 2011

2.  Quality Measures  Public Health  Research  Organized Monitoring and Performance  Information System Advances  Reimbursement

3.  Medical ◦ Constant ◦ W/O CC/MCC ◦ W/CC ◦ W/CC/MCC ◦ W/MCC  Surgical ◦ Constant ◦ W/O CC/MCC ◦ W CC ◦ W/CC/MCC ◦ W/MCC

4.  Congestive Heart Failure ◦ CHF without CC/MCC – Wt..6853 - $3,769.15 ◦ CHF with CC – Wt. 1.0302 - $5,666.10 ◦ CHF with MCC – Wt. 1.4943 - $8,218.65 DIASTOLIC/SYSTOLIC ACUTE/CHRONIC

5.  Pneumonia – as principal – Wt..7096 - $3,902.80 ◦ CHF – Unspecified (W/O CC/MCC)  Pneumonia as principal – Wt. 1.0152 - $$5.583.60 ◦ CHF – Chronic, diastolic/systolic/both (W CC)  Pneumonia – as principal – Wt. 1.4796 - $8,137.80 ◦ CHF – Acute, diastolic/systolic/both (W MCC)

6.  No longer meet the demands of healthcare’s data needs  Cannot accurately describe the diagnoses and inpatient procedures for care delivered  Coded data is well beyond the purposes of ICD-9-CM  Greater need for coding accuracy and specificity  ICD-9-CM initially was not used for reimbursement purposes  ICD-9-CM procedures are outdated and inadequate  ICD-9-CM cannot support many of the IT and data exchange initiatives.

7.  Quality measures and medical error reduction (Patient safety)  Outcomes measurement  Clinical, financial and administrative performance improvement  Health Policy planning  Payment systems design and claims processing  Provider profiling  Refinements to current reimbursement systems, such as severity-adjusted DRG systems  Pay-for Performance programs  Educating consumers on costs and outcomes of treatment options

8.  More accurate payment for new procedures  Fewer rejected claims  Fewer fraudulent claims  Better understanding of new procedures  Improved disease management

9. Combination Codes for conditions and common symptoms or manifestations E10.21 -Type I diabetes mellitus with diabetic nephropathy I125.110 - Arteriosclerotic heart disease of native coronary artery with unstable angina pectoris K50.112 - Crohn’s disease of large intestine with intestinal obstruction

10. Combination codes for poisonings and external causes  T36.0x1D – Poisoning by penicillin, accidental (unintentional), subsequent encounter  T42.4x5A – Adverse effect of benzodiazepines, initial encounter

11. Added Laterality  H60.332 – Swimmer’s ear, left ear  M94-211 – Chondromalacia, right shoulder  S40.259A – Superficial foreign body of unspecified shoulder, initial encounter

12. Added seventh-character extensions for episode of care  M80.051A – Age related osteoporosis with current pathological fracture, right femur, initial encounter for fracture  S06.0x1A – Concussion with loss of consciousness of 30 minutes or less, initial encounter  S52-132B – Displaced fracture of neck of left radius, initial encounter for open fracture, Type I or II or initial encounter for open fracture NOS

13. Expanded codes (injuries, diabetes, alcohol and substance abuse, postoperative complications  E11.341 – Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema  F14.221 – Cocaine dependence with intoxication delirium  K91.71 – Accidental puncture and laceration of a digestive system organ or structure during a digestive system procedure.

14. Inclusion of trimesters in obstetrical codes (and elimination of fifth digits for episode of care)  010.012 – Pre-existing essential hypertension complicating pregnancy, second trimester  O99.013 – Anemia, complicating pregnancy, third trimester

15. Changes in timeframes specified in certain codes  Acute myocardial infarction – time period changed from 8 weeks to 4 weeks  Time frame for abortion versus fetal death changed from 22 weeks to 20 weeks.

16. DOCUMENTATION

17.  Anatomy and Physiology  Microbiology  Pharmacology  Coding rules understanding  DRG Payment Methodology