ICD10 Coding System: What is this beast

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ICD-10 Coding SystemWhat is this beast?

• Jody Smith, PhD, RHIA, FAHIMA
• Professor Chair
• Health Informatics Information Mgmt
• Saint Louis University

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A little history not much, just a little

• Started by the early Greeks
• 17th century
• London Bills of Mortality
• 18th century
• Florence Nightingale-compare hospital data to how
  funds were being spent
• William Farr- International List of Causes of
  Death
• Jacque Bertillon- Bertillon Classification of
  Causes of Death

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Speeding through history

• 1950s-US Public Health Service published the
  International Classification of Diseases, Adapted
  for Indexing Hospital Records by Diseases and
  Operations (ICDA)
• International Classification of Diseases, 9th
  Revision, Clinical Modification (ICD-9-CM)
• Supposed to be updated every 10 years
• Its been 30 years we are a little late

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ICD-9-CM is used to

• Calculate payments
• Adjudicate coverage
• Compile statistics
• Access quality

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Why is ICD-9-CM being replaced?

• US is behind the rest of the world
• Lacks sufficient specificity and detail to
  support modern day medicine
• No longer effective system for reimbursement
• Cannot pay claims fairly

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Why is ICD-9-CM being replaced?

• Running out of capacity to accommodate advances
  in medicine and quality data
• Cannot support US transition to an interoperable
  health data exchange in US
• Difficult to measure medical processes and
  outcomes

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Benefits of transitioning to ICD-10-CM

• More accurate payment for new procedures
• Fewer miscoded, rejected, and improperly
  reimbursed claims
• Improved disease management

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Comparing ICD-9-CM and ICD-10-CM

• ICD-9-CM
• 3 to 5 characters
• First digit is numeric, E or V
• 3 digit minimum for diseases
• Decimal placed after the first three characters

• ICD-10-CM
• 3-7 characters
• First digit alpha
• All letters used except U
• 2nd and 3rd digits numeric
• 4th ,5th ,6th ,7th digits can be alpha or numeric
• Decimal placed after the first three characters

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Code Formats

• ICD-9-CM XXX.XX

• ICD-10-CM
• XXX.XXX X

Category
Category
Etiology Anatomic Site Manifestation
Etiology Anatomic Site Manifestation
Extension
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ICD-10-CM Structure

• 21 Chapters
• Some chapters include the addition of a 6th
  character
• Index and tabular list
• V codes are now Z codes
• Factors Influencing Health Status and Contact
  with Health Services

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ICD-10-CM Structure Continued

• Inclusion of trimester in obstetrics codes and
  elimination of 5th digits for episode of care
• Expanded detail relevant to ambulatory and
  managed care encounters

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Example of expanded code Pressure Ulcers

• ICD-9-CM
• 9 location codes
• 707.00-707.09
• Show broad location but not depth/stage

• ICD-10-CM
• 125 codes
• More specific location
• Example
• L89.131- Pressure ulcer of right lower back,
  stage 1
• L89.132- Pressure ulcer of right lower back,
  stage 2

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7th digit for fractures

• A Initial encounter for closed fracture
• B Initial encounter for open fracture
• D Subsequent encounter for fracture with routine
  healing
• G Subsequent encounter for fracture with delayed
  healing
• K Subsequent encounter for fracture with nonunion
  
• P Subsequent encounter for fracture with malunion
  
• S Sequelae
• Example
• S42.321A, Displaced transverse fracture of shaft
  of humerus, right arm, initial encounter for
  closed fracture.

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Implementation October 1, 2013

• Cost of implementation
• 84,000 small physician practice
• 3 million for large practices
• 14 million for health plans
• 8 billion to implement ICD-10 nationwide

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Prepare Now

• Budget
• Training
• Equipment
• Resources
• Post implementation
• Contract negotiation/renegotiation

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Implementation Planning

• Develop a plan
• Identify stakeholders who will be affected
• Assess impact
• Lost productivity
• Develop training plans for employees at all
  levels
• Average learning curve is 4 to 6 months
• System upgrades/changes
• Testing and go live dates
• Plan for documentation changes

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Implementation Planning

• Implementation/Organizing
• Acquire resources to implement the plan
• Evaluate financial impact on orgaization
• Plan for control
• Develop desired outcomes
• Develop measurement tools
• Plan action steps for implementation
• milestones

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Impact on information systems

• Any electronic transaction requiring a diagnosis
  and/or procedure code will need to be reviewed
  including
• Billing system - Clinical
  protocols
• Clinical systems - Test ordering
  systems
• Encoding software - Clinical reminder
  system
• Abstracting systems
• Accounting systems

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RESOURCES

• http//www.cdc.gov/nchs/icd/icd10cm.htm
• http//www.cdc.gov/nchs/data/dvs/icd10fct.pdf
• http//www.cms.hhs.gov/ICD10/
• http//edocket.access.gpo.gov/2009/pdf/E9-743.pdf
  

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• ICD10-PCS

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Medical and Surgical Procedures

• The seven characters for medical and surgical
  procedures have the following meanings

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Examples of ICD-10-PCS Codes

• Laparoscopic appendectomy 0DTJ4ZZ
• Character 1 0 (Medical and Surgical section)
• Character 2 D (Body System GI)
• Character 3 T (Root Operation Resection)
• Character 4 J (Body Part Appendix)
• Character 5 4 (Approach Percutaneous
  endoscopic)
• Character 6 Z (Device Without device)
• Character 7 Z (Qualifier No qualifier)

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Examples of ICD-10-PCS Codes

• ORIF with screws 0QQH04Z
• Character 1 0 (Medical and Surgical Section)
• Character 2 Q (Body System Lower bones)
• Character 3 Q (Root Operation Repair)
• Character 4 H (Body Part Tibia)
• Character 5 0 (Approach Open)
• Character 6 4 (Device With internal fixation
  device)
• Character 7 Z (Qualifier Without qualifier)