ICD-10-CM Everything You Need to Know

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ICD-10-CM Everything You Need to Know For Now
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Main Objective

• Create an awareness of ICD-10-CM.
• Start to consider the impact the conversion to
  ICD-10 will have on your operations.
• Participants can help spread the word
  throughout the University.

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What is ICD-10-CM and When is it Coming?
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What is ICD and ICD-10?

• ICD is the World Health Organization's
  International Classification of Diseases and
  Related Health Problems and is the international
  standard diagnostic classification system.
• ICD-10 is the abbreviated term used to refer to
  the 10th revision of the ICD.

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What is ICD-10-CM and ICD-10-PCS?

• ICD-10-CM
• The U.S. clinical modification (CM) of the WHOs
  ICD-10, maintained by the NCHS.
• Includes diagnoses which will be used by all
  providers in every health care setting.
• ICD-10-PCS
• The procedural coding system developed under
  contract by the CMS.
• Includes procedure codes which will only by used
  for hospitals claims for inpatient hospital
  procedures.

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Implementation Date October 1, 2013

• On January 16, 2009, the Department of Health and
  Human Services published a Final Rule for the
  adoption of ICD-10-CM and ICD-10-PCS code sets.
• All HIPAA covered entities must be ICD-10
  compliant on October 1, 2013.
• The compliance date is firm and not subject to
  change
• There will be no delay.
• There will be no grace period for implementation.
• There will be no impact on CPT and HCPCS codes.

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ICD-9-CM vs. ICD-10-CM
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Why is ICD-9 Being Replaced?

• ICD-9-CM is out of date and running out of space
  for new codes.
• Lacks specificity and detail
• No longer reflects current medical practice
• ICD-10 is the international standard to report
  and monitor diseases and mortality, making it
  important for the U.S. to adopt ICD-10 based
  classifications for reporting and surveillance.
• ICD codes are the core elements of HIT systems,
  conversion to ICD-10 is necessary to fully
  realize benefits of HIT adoption.

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Coding Process Remains the Same

• ICD-10-CM code book retains the same traditional
  format
• Index
• Tabular
• Process of coding is similar
• Look up a condition in the Index
• Confirm the code in the Tabular

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Major Differences Between ICD-9-CM and ICD-10-CM
ICD 9-CM ICD 10-CM
13,600 codes 69,000 codes
Code book contains 17 chapters Code book contains 21 chapters
Consists of 3 to 5 characters Consists of 3 to 7 characters
1st character is alpha or numeric 1st character is alpha
Only utilizes letters E and V Utilizes all letters (except U)
Second, third, fourth, and fifth characters are always numeric Second character is always numeric
Third, fourth, fifth, sixth, and seventh characters can be alpha or numeric
Shorter code descriptions because of lack of specificity and abbreviated code titles Longer code descriptions because of greater clinical detail and specificity and full code titles
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Comparison of ICD-9-CM and ICD-10-CM

• ICD-9-CM Code

• Icd-10-CM code

• A - Category of code
• B - Etiology, anatomical site, and manifestation
  

• A - Category of code
• B - Etiology, anatomical site, and/or severity
• C - Extension
• 7th character for obstetrics, injuries, and
  external causes of injury

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Comparison of ICD-9-CM and ICD-10-CM
ICD-9-CM Codes ICD-10-CM Codes
Pressure ulcer codes 9 codes 707.00 707.09 Pressure ulcer codes 125 codes L89.0-L89.94
Codes 707.0 Pressure ulcer 707.00 -
unspecified site 707.01 - elbow
707.02 - upper back
707.03 - lower back 707.04 - hip
707.05 - buttock 707.06
- ankle 707.07 - heel
707.09 - other site
Code Examples L89.131 Pressure ulcer of right
lower back, stage I L89.132 Pressure ulcer of
right lower back, stage II L89.133 Pressure
ulcer of right lower back, stage III L89.134
Pressure ulcer of right lower back, stage
IV L89.139 Pressure ulcer of right lower back,
unspecified stage L89.141 Pressure ulcer of
left lower back, stage I L89.142 Pressure ulcer
of left lower back, stage II L89.143 Pressure
ulcer of left lower back, stage III L89.144
Pressure ulcer of left lower back, stage
IV L89.149 Pressure ulcer of left lower back,
unspecified stage L89.151 Pressure ulcer of
sacral region, stage I L89.152 Pressure ulcer
of sacral region, stage II L89.90 Pressure
ulcer of unspecified site, unspecified stage
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New Features of ICD-10-CM

• Combination codes for conditions and common
  symptoms or manifestations
• Combination codes for poisonings and external
  causes
• Added laterality
• Expanded codes injury, diabetes,
  alcohol/substance abuse, postoperative
  complications

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New Features of ICD-10-CM

• Added extensions for episode of care
• Inclusion of trimester in obstetrics codes and
  elimination of fifth digits for episode of care
• Expanded detail relevant to ambulatory and
  managed care encounters
• Inclusion of clinical concepts that do not exist
  in ICD-9-CM
• Changes in timeframes specified in certain codes

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Examples ICD-10-CM Codes

• I10, Essential (primary) hypertension
• A69.21, Meningitis due to Lyme Disease
• O9A.311, Physical abuse complicating pregnancy,
  first trimester
• S52.131A, Displaced fracture of neck of right
  radius, initial encounter for closed fracture

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Examples - Combination Codes

• Combination codes for conditions and common
  associated symptoms and manifestations
• I25.110, Arteriosclerotic heart disease of native
  coronary artery with unstable angina pectoris
• K50.013, Crohns disease of small intestine with
  fistula
• Combination codes for poisonings and their
  associated external cause
• T42.3X2S, Poisoning by barbiturates, intentional
  self harm, sequela

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Examples Combination Codes
Diabetes Codes in ICD-9 Diabetes Codes in ICD-10
249.70 - Secondary diabetes mellitus with peripheral circulatory disorders, not stated as uncontrolled 785.4 - Diabetic gangrene 443.81 - Diabetic peripheral angiopathy E09.52 - Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene
250.31 - Diabetes with other coma, type I, not stated as uncontrolled E10.11 - Type 1 diabetes mellitus with ketoacidosis with coma
250.60 - Diabetes with neurological manifestations, type II or unspecified, not stated as uncontrolled 355.9 - Mononeuritis of unspecified site E11.41 - Type 2 diabetes mellitus with diabetic mononeuropathy
249.40 - Secondary diabetes mellitus with renal manifestations , not stated as uncontrolled 585.9 - Chronic kidney disease, unspecified E08.22 - Diabetes mellitus due to an underlying condition with diabetic chronic kidney disease
http//library.ahima.org/xpedio/groups/public/docu
ments/ahima/bok1_038084.hcsp?dDocNamebok1_038084
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Examples Added Laterality

• C50.212, Malignant neoplasm of upper-inner
  quadrant of left female breast
• H16.013, Central corneal ulcer, bilateral
• L89.213, Pressure ulcer of right hip, stage III

• H61.20, Impacted cerumen, unspecified, ear
• H61.21, Impacted cerumen, right ear
• H61.22, Impacted cerumen, left ear
• H61.23, Impacted cerumen, bilateral

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Examples Obstetrics and New Clinical Concepts

• Obstetric codes identify trimester instead of
  episode of care
• O26.02, Excessive weight gain in pregnancy,
  second trimester
• Inclusion of clinical concepts that do not exist
  in ICD-9-CM
• T45.526D, Underdosing of antithrombotic drugs,
  subsequent encounter
• Z67.40, Type O blood, Rh positive

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New Official Guidelines and Coding Clinic

• The AHA Central Office serves as the
  clearinghouse for issues related to the use of
  ICD-9-CM.
• With the transfer to ICD-10, a new office will be
  developed called AHA Central Office on ICD-10-CM
• Creation of new official guidelines
• Development of the AHA Coding Clinic for ICD-10
  (similar to the Coding Clinic for ICD-9 but will
  require a major overhaul)

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General Equivalence Mappings
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What are GEMs?

• GEMs stands for General Equivalence Mappings
• The CMS and the CDC created GEMs to ensure
  consistent national data when the U.S. adopts
  ICD-10.
• The GEMs will act as a translation dictionary to
  bridge the language gap between the two code
  sets and can be used to map an ICD-9 code to an
  ICD-10 code and vice versa.

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Purpose of GEMs

• Designed to give all sectors of the healthcare
  industry that use coded data the tools to
• Convert large databases and test system
  applications
• Link data in long-term clinical studies
• Develop application-specific mappings
• Analyze data collected before and after the
  transition to ICD-10-CM

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Not a Substitute for Coding

• The GEMs should not be used as a substitute for
  learning how to use the ICD-10-CM code sets.
• GEMs are not a substitute for learning
  ICD-10-PCS and ICD-10-CM coding. Theyll help
  you convert large data sets.
• Mapping simply links concepts in the two code
  sets, without consideration of context of
  specific patient information, whereas coding
  involves assigning the most appropriate code
  based on documentation and applicable coding
  guidelines.

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Why a GEM Wont Always Work

• A clear one-to-one correspondence between an
  ICD-9 or ICD-10 code is the exception rather than
  the rule.
• ICD-9 codes 414.01 Coronary atherosclerosis of
  native coronary artery and 411.1 Intermediate
  coronary syndrome (unstable angina)
• ICD-10 code I25.110 Atherosclerotic heart
  disease of native coronary artery with unstable
  angina
• There are situations when a code in the target
  system does not exist
• T503x6A Underdosing of electrolytic, caloric and
  water-balance agents, initial encounter

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Forward and Backward Mapping
Forward Mapping
ICD-9 Code Description (Source)
820.8 Fracture of unspecified part of neck of femur, closed
Backward Mapping
ICD-9 Code Description (Target)
820.8 Fracture of unspecified part of neck of femur, closed
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Preparing for ICD-10
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ICD-10 Implementation Plan
Checklist http//www.ahima.org/icd10/ICD-10Prepar
ationChecklist.mht
2009/ 2010
2011
2012
2013
Year
Awareness and Impact Assessment
Phase I
Preparing for Implementation
Phase II
Go Live Preparation
Phase III
Post Implementation
Phase IV
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ICD-10-CM Preparation

• Create awareness among faculty and staff.
• Identify your current systems and work processes,
  whether electronic or manual, in which you use
  ICD-9.
• Identify potential changes to existing practice
  workflow and business processes.

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ICD-10-CM Preparation

• Assess status of business associates and vendors
  ICD-10 readiness.
• Budget for implementation costs.
• Conduct a detailed assessment of education needs.

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Assessment of Educational Needs

• Identify who will require education
• Coding professionals
• Providers
• Billing personnel
• Clinical personnel
• Administrative staff and Management
• Researchers

• Determine what type and level of education they
  will need.
• Assess the current level of coder education and
  experience.
• Assess the level of knowledge necessary per
  person/role based on job responsibilities.
• Determine the best method of education.

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Coder Training and Education

• Build awareness to understand the impact of the
  code set change and the differences between the
  code sets
• Develop pre-requisite skills where needed, for
  example, in the biomedical sciences
• Educate on the foundational concepts on the
  structure and organization of the code sets
• Role-based application just in time
• 3 9 months prior to implementation

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Coder Training and Education

• The DHHS recommends inpatient/hospital coders
  receive 50 hours of training and outpatient
  coders receive 10 hours of training.
• AHA/AHIMA anticipates that a maximum of 16 hours
  of training may be sufficient for experienced
  coding professionals on ICD-10-CM only.
• 6 hours learning the fundamentals (structure,
  coding conventions, guidelines and how ICD-10 is
  different)
• 6 hours in more intensive training applying the
  conventions and guidelines
• 4 hours practicing applying codes to typical
  encounters

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Education Requirements - AHIMA

• AHIMA Certified Professionals are required to
  participate in a predetermined number of
  mandatory baseline educational experiences
  specific to ICD-10-CM.
• RHIT 6 CEUs
• RHIA 6 CEUs
• CCS-P 12 CEUs
• CCS 18 CEUs
• CCA 18 CEUs

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Proficiency Test - AAPC

• AAPC members holding a credential will have two
  years to pass a proficiency test
• You will be given two (2) years to pass the exam,
  beginning October 1, 2012 (one year before
  implementation of ICD-10) and ending September
  30, 2014 (one year after implementation)
• The test will consist of 75 questions
• The test will be open-book, online and
  un-proctored
• Coders will be allowed two (2) attempts to pass
  for the 60 administration fee

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Clinical Documentation

• The increased specificity of the ICD-10 codes
  requires more detailed clinical documentation in
  order to code some diagnoses to the highest level
  of specificity.
• There are unspecified codes in ICD-10-CM for
  those instances when medical record documentation
  is not available to support more specific codes.
• The benefits of ICD-10 can not be realized if
  non-specific codes are used rather than taking
  advantage of the specificity ICD-10 offers.

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Improving Documentation

• Conduct medical record documentation assessments
• Evaluate records to determine adequacy of
  documentation to support the required level of
  detail in new coding systems
• Implement a documentation improvement program to
  address deficiencies identified during the review
  process
• Educate providers about documentation
  requirements for the new coding system through
  specific examples
• Emphasize the value of more concise data capture
  for optimal results and better data quality

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Physician Training

• DHHS agrees that some physicians will want
  intensive training on ICD-10 but some will seek
  awareness training.
• Nolan study estimates 8 hours of intensive
  physician training
• Nachimson Advisors, LLC study predicts 12 hours
  of physician training in both the code set and
  documentation procedures.
• AHIMA believes most physicians would want no more
  than 4 hours of training.

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Fee Tickets

• AHIMA/AHA study found the process of converting
  fee tickets to ICD-10-CM is not difficult, time
  consuming, or expensive. Most can be converted
  to ICD-10 in just a few hours and they are no
  longer in length than existing fee tickets.
• Making the fee ticket more manageable
• Electronic fee ticket
• Hybrid coding
• Context-specific fee tickets
• Limit specificity/code options
• List 7th character separate

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Coder Proficiency

• AHA/AHIMA field test demonstrated that people
  with previous ICD-9-CM experience can learn
  ICD-10-CM easily.
• Proficiency in use of the system will be
  dependent on a number of factors, including level
  of coder education and experience.
• It is anticipated that most coders will have a
  high level of proficiency within 6 months of use.

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ICD-10 Web Resources

• 2010 versions of ICD-10-CM, GEMs and the Official
  Guidelines are all available on-line.
• CMS, AHA, AHIMA and NCHS/CDC all have ICD-10
  resource centers.
• AHIMA has a free monthly ICD-10 Newsletter
• http//www.ahima.org/images/newsletters/ICDTen/sub
  scribe.html

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Conclusion

• While it is too early to start learning how to
  code utilizing the ICD-10-CM code set, it is
  never to early to start planning/preparing for
  the transition.