ICD-10-CM/PCS Implementation

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ICD-10-CM/PCS Implementation

• Senior Managers
• date
• Presented By ____

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The 5 Things You Need to know TODAY about ICD-10

• This is a complete re-write of the coding system.
• Anyone who codes a diagnosis or procedure on a
  patient chart needs to understand the new coding
  system.
• This affects any information technology system
  that uses an ICD diagnosis or procedure code.
• The implementation date is firm.
• We need your help to make it happen at (hospital
  name).

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ICD-10-CM/PCS Overview

• Used for reporting health care diagnoses and
  inpatient procedures
• Replaces ICD-9-CM/PCS
• ICD International Classification of Diseases
• CM Clinical Modification for the US (diseases)
• PCS Procedural Classification System (for
  inpatient surgical procedures ONLY)
• Requires claims transaction changes
• Version 4010 to 5010 for expansion of code sets

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Why change to ICD-10?

• United States is behind the rest of the world
• United Kingdom went live with ICD-10 in 1995
• ICD-9
• Outdated unable to accept new codes
• Lacks detail to describe symptom, diagnosis, or
  procedure.
• ICD-10 codes provides more precise information to
  better evaluate the type and cost of services
  used for a specific diagnosis.
• Restricts bio-surveillance/epidemic capabilities

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ICD Codes Used by/for

• Healthcare providers in every health care setting
  Hospitals, Physician offices, Health Dept.,
  Clinics, etc.
• Health Plans Our healthcare insurance
• Insurance claims submission Patient Accounts
• Healthcare Clearinghouses
• Research Cancers, heart disease, others
• Quality measures and initiatives QRM
• Utilization/Case Management Care Coordination
• Data Reporting and Analysis QRM, HIM, KHA, AMA

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ICD-10-CM Structure
ICD-9-CM 3 -5 characters Mostly numeric codes Only alpha letters for some codes are E and V 13,000 diagnoses codes 4,000 procedure codes ICD-10-CM 3 -7 characters Character 1 is alpha (all letters except U are used) Character 2 is numeric Characters 3 -7 are alpha or numeric 68,000 diagnoses codes 72,000 procedure codes
CPT HCPCS codes are not affected!
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Examples
ICD-9-CM Structure 3 -5 Characters 496 414 .00 V 55.3 ICD-10-CM Structure 3 -7 Characters P09 S32.010A O9A.211 M1A.0111
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The implementation date is firm!

• October 1, 2014 Single implementation date for
  all users
• Date of service on or after 10/1/2014 for
  ambulatory and physician reporting will use
  ICD-10-CM diagnosis codes
• Date of discharge for hospital claims for
  inpatient discharges occurring on or after
  10-1-2014 will use ICD-10-CM and ICD-10-PCS codes
• ICD-9 codes will not be accepted on claims for
  services on or after 10/1/2014
• Medical Necessity Well need to use ICD-10 for
  checking necessity for exams scheduled after
  10/1/2014, even if they are scheduled beforehand!

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This affects manyinformation technology systems
(sample page with own page to do)
Hospital

• Clinics
• NextGen
• DME
• BrightTree
• Hospice
• CareAnywhere

• MEDITECH
• Abstracts
• Billing
• MDS for Skilled Care
• 3M Encoder
• SSI
• Iatric Systems
• Medical Necessity Checking
• NextGen ExpressCare

What are we missing???
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Education

• Anyone who touches an ICD diagnosis or procedure
  code needs to understand the new coding system.
• This means anatomy patho-physiology education
  prior to training on the code system itself.
• This education needs to be in your budget for
  2012 through 2014.

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ICD-10 Organizational Chart (sample and do your
own)
Subcommittees/dept
Subcommittees/dept
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Project Phases

• Phase 1 Planning
• Project Charter What, why, who, when, and how
  much?
• Project Plan Develop tasks and assign resources
• Readiness and risk assessments
• Departmental and vendor questionnaires
• Develop departmental budgets
• Phase 2 Implementation
• Analysis/Develop action plan of departmental and
  vendor impact assessments
• Phase 3 Go-Live preparation then GO-LIVE
• Develop Go-Live plan
• Training
• Internal/External software modifications and
  testing
• Phase 4 Post Go-Live
• Code charts, complete/submit claims, evaluate
  payments, audit

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Processes, Systems, Operational and Financial
Impacts

• Modified IT systems.
• Requires greater detail in clinical documentation
  to code with ICD-10 (affects entire healthcare
  team).
• Budgets
• 2012-2013 Anatomy Patho-physiology Training
• 2014 ICD-10 CM PCS Training
• Decreased coding productivity less claims
  decreased revenue.
• Complete halt of revenue if project not
  implemented.

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We need your help to make it happen at (HOSPITAL
NAME)!

• Commitment
• Communication
• Planning
• Complete tasks and responsibilities on time
• Assessments
• What systems to you have that utilize ICD-9
  codes?
• What is the base level of knowledge in your
  staff?
• Training
• Thorough testing

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Questions?