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Transcript of 1450 Winter VAR Conference February 3, 2012 1 Denisha M. Torres-Lich, MS, RHIA, LHRM President...
ICD-10 –CM and the Impact on Physician
Practices
1450 Winter VAR ConferenceFebruary 3, 2012
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Denisha M. Torres-Lich, MS, RHIA, LHRMPresidentTorres-Lich & Associates, Inc.
Over 30 years old Codes are insufficient Lack specificity and detail Limits the ability of payers and others Do not provide the level of detail
Current System Limitations
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ICD-10 Final Rule CMS-0013-F◦ http://edocket.access.gpo.gov/
2009/pdf/E9-743.pdf ◦ Published January 16, 2009
Compliance Date for Implementation◦ October 1, 2013
First implement the “Version 5010” electronic health care transaction standards◦ January 1, 2012
The Beginning: ICD-10
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Improve operational processes Update the terminology and disease
classifications Increase flexibility Enhance coding accuracy and specificity Support refined reimbursement models
Benefits
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Allows for greater automation = fewer payer-physician inquiries
Provides more detailed data Greater diagnostic specificity Provides for more effective detection and
investigation of potential fraud or abuse
Benefits
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Standard coding convention that:◦ flexible ◦ provides unique codes ◦ allows new procedures and diagnoses to be easily
incorporated Two Components
◦ ICD-10 – CM Diagnosis classification system
◦ ICD-10-PCS Procedure classification system for inpatient hospital
use
Characteristics of ICD-10
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Both components can improve:◦ quality measurements◦ patient safety ◦ evaluation of medical processes and outcomes.
ICD–10–PCS ◦ can readily expand and capture new procedures
and technologies
Characteristics ICD-10
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ICD-9 ICD- 10
17 Chapters 21 Chapters
3 – 5 Digits 3 – 7 Digits
Supplemental Chapters 1st Digit is alpha (E & V) = all other Numeric
1st Digit is alpha2nd Digit is numeric3rd – 7th Digit is alpha
Approx. 14,500 Approx. 70,000
Antiquated terminology Current terminology
Complications of Medical Care in 1 Chapter Complications have been moved to procedure specific body system chapters
Partial code titles Full code titles
Code extensions for specificity and laterality
Dummy place holder
813.15, Open fracture of head of radius S52123C, Displaced fracture of head of unspecified radius, initial encounter for open fracture type IIIA, IIIB, or IIIC
Structural Difference between – ICD-9-CM and ICD-10- CM
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Table of Contents◦ 1 Certain infectious and parasitic diseases (A00-B99)
◦ 2 Neoplasms (C00-D49)◦ 3 Diseases of the blood and blood-forming organs
and certain disorders involving the immune mechanism (D50-D89)
◦ 4 Endocrine, nutritional and metabolic diseases (E00-E89)
◦ 12 Diseases of the skin and subcutaneous tissue (L00-L99)
◦ 13 Diseases of the musculoskeletal system and connective tissue (M00-M99)
◦ 14 Diseases of the genitourinary system (N00-N99)
ICD-10-CM TABULAR LIST of DISEASES and INJURIES
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ICD-9 ICD- 10
3 – 4 Digits 3 – 7 Digits
Codes are numeric Codes are alphanumeric
Approx. 3,000+ Approx. 72,000
Antiquated terminology Current terminology
Does not have laterality Has laterality
Generic details of body parts Full detail of body part
Detail of methodology and approach
Flexible
48.36 [Endoscopic] polypectomy of rectum 0DBP8ZZ Excision of Rectum, Via Natural or Artificial Opening Endoscopic
Structural Difference between – ICD-9-CM Vol 3 and ICD-10- PCS
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0 D B 6 8 X Z Med/Surg
Gastrointestinal
Excision
Stomach
Transorifice Intraluminal Endoscopic
None
Diagnostic
SectionBody
SystemRoot
OperationBodyPart Approach Device Qualifier
Example of ICD-10-PCS
network of relationships between the two code sets ◦ ICD-9-CM to ICD-10-CM (forward mapping)◦ ICD-10-CM to ICD-9-CM (backward mapping)
“…a series of possible compromises rather than the mirror image of one code in the other code set.”
General Equivalence Mappings -(GEMS)
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Diagnosis Codes and Differences in Classification ◦ For example:
I-9 code description - “complicated open wound” Delayed healing, delayed treatment, foreign body or
infection I-10 categorizes open wounds
wound type -laceration or puncture wound, and whether a foreign body is present
depending on the documentation in the record, the correct correspondence between and I-9 and I-10 code could be one of several.
Challenges with Mapping
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Diagnosis Codes and Levels of Specificity codes. ◦ i.e. in I-9, category 733, Other disorders of bone
and cartilage, contains the codes: 733.93 Stress fracture of tibia or fibula 733.94 Stress fracture of the metatarsals 733.95 Stress fracture of other bone 733.96 Stress fracture of femoral neck 733.97 Stress fracture of shaft of femur 733.98 Stress fracture of pelvis
in many instances I-10 provides specific codes for all likely sites of a stress fracture, including more specificity for the bones of the extremities, the pelvis and the vertebra. Stress fracture data coded in I-10 possesses a consistent level of specificity.
Challenges with Mapping
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73395 M4840XA 1000073395 M4841XA 1000073395 M4842XA 1000073395 M4843XA 1000073395 M4844XA 1000073395 M4845XA 1000073395 M4846XA 1000073395 M4847XA 1000073395 M4848XA 1000073395 M8430XA 1000073395 M84319A 1000073395 M84329A 1000073395 M84339A 1000073395 M84343A 1000073395 M84373A 1000073395 M8438XA 10000
Example of I-9 to I-10 GEM
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Diagnosis Codes in Combination i.e.
I – 9 code 115.11Histoplasma duboisii meningitis = I – 10 codes B39.5 Histoplasmosis duboisii
AND G02 Meningitis in other infectious and parasitic diseases classified elsewhere
Challenges with Mapping
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ICD-10-CM
Many possible codes
Specificity looks like this…
S72301A Unspecified fracture of shaft of right femur, initial encounter for closed fracture
S72322A Displaced transverse fracture of shaft of left femur, initial encounter for closed fracture
S72326A Nondisplaced transverse fracture of shaft of unspecified femur, initial encounter for closed fracture
S72301G Unspecified fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing
S72322G Displaced transverse fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing
S72326G Nondisplaced transverse fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing
S72302A Unspecified fracture of shaft of left femur, initial encounter for closed fracture
S72323A Displaced transverse fracture of shaft of unspecified femur, initial encounter for closed fracture
S72331A Displaced oblique fracture of shaft of right femur, initial encounter for closed fracture
S72302G Unspecified fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing
S72323G Displaced transverse fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing
S72331G Displaced oblique fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing
S72309A Unspecified fracture of shaft of unspecified femur, initial encounter for closed fracture
S72324A Nondisplaced transverse fracture of shaft of right femur, initial encounter for closed fracture
S72332A Displaced oblique fracture of shaft of left femur, initial encounter for closed fracture
S72309G Unspecified fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing
S72324G Nondisplaced transverse fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing
S72332G Displaced oblique fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing
S72321A Displaced transverse fracture of shaft of right femur, initial encounter for closed fracture
S72325A Nondisplaced transverse fracture of shaft of left femur, initial encounter for closed fracture
S72333A Displaced oblique fracture of shaft of unspecified femur, initial encounter for closed fracture
S72321G Displaced transverse fracture of shaft of right femur, subsequent encounter for closed fracture with delayed healing
S72325G Nondisplaced transverse fracture of shaft of left femur, subsequent encounter for closed fracture with delayed healing
S72333G Displaced oblique fracture of shaft of unspecified femur, subsequent encounter for closed fracture with delayed healing
ICD-9-CM
821.01 Fracture of femur, shaft,
closed
Impact
Hospitals Health care
practitioners & institutions
Health insurers & other third-party payers
Electronic-transaction clearinghouses
Hardware & software manufacturers & vendors
Billing & practice-management service providers
Health care administrative & oversight agencies
Public & private health care research institutions
All reporting/billing health care providers • ICD-10-CM
– Hospitals, physicians, clinics, laboratory, radiology, psychiatric, rehab, nursing homes etc. All diagnosis codes
• ICD-10-PCS– Procedures for Hospital InpatientsCPT/HCPCS– Procedures for Hospital Outpatients,
Physician, Laboratory and Radiology Outpatients
Users
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- Electronic Health Records- Practice Management Systems- Billing- Accounts Receivable- Productivity Loss
Impact on Physician Practices
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Physician Perception Impact on Practice Management Impact on reimbursement Physician practice changes
Challenges of Engaging Physicians
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Six phases: ◦ Planning ◦ Communication and Awareness ◦ Assessment ◦ Operational Implementation ◦ Testing ◦ Transition
Milestones & Tasks
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Quality vs. Quantity More stringent
documentation◦ i.e. Myocardial Infarction ICD-
10 documentation will need to include: Type of Infarction Age of Infarction Specific Site of Myocardium
involved Coronary Artery Involved Information regarding initial or
subsequent MI within 4 weeks
Impact on Coding and Documentation
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Work toward better documentation to◦ Avoid misinterpretation by third parties (auditors,
payers, attorneys, etc.)◦ Justify medical necessity ◦ Provide a more accurate clinical picture of quality
of care provided
Coding and Documentation
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Speech Recognition◦ Back End◦ Front End
Computer Assisted Physician Documentation
Computerized Assisted Coding◦ reduce costs and claims rejections ◦ improve productivity and accuracy
Electronic Tools to Facilitate Coding & Documentation Process
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2012 ICD-10◦ http://www.cdc.gov/nchs/icd/icd10cm.htm◦ http://www.cms.hhs.gov/ICD10
AHIMA ICD-10 Resources◦ http://www.ahima.org/ICD10/default.aspx
Provider Resources◦ http://
www.cms.gov/ICD10/05a_ProviderResources.asp
Web Resources
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Denisha M. Torres-Lich, MS, RHIA,LHRMPresident
Torres-Lich & Associates, Inc.(727) 515-2355
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