Introduction The 5 Phases of the ICD-10 Transition 1. Engaging and - - PowerPoint PPT Presentation

Introduction

The 5 Phases of the ICD-10 Transition

• 1. Engaging and educating Physicians and Staff
• 2. Organizing your implementation effort
• 3. Creating your Timeline and Transition Plan
• 4. Implementing your Transition Plan
• 5. Post Transition Analysis and Reporting

Each phase is the prerequisite for the next.

Most physician practices are in Phase One!

Why ICD-10?

• ICD-9-CM is outdated

– Over 30 years old – Many categories full – Not descriptive enough

• Coding system needs to be:

– Flexible enough to quickly incorporate emerging diagnoses – Exact enough to precisely identify diagnoses

ICD-9-CM and ICD-10-CM Differences

ICD-9-CM Diagnosis Codes ICD-10-CM Diagnosis Codes

• 3-5 numeric digits in length
• 3-7 Alpha-Numeric characters in length
• Approximately 14,000 codes
• Approximately 69,000 available codes
• First digit may be alpha (E or V) or numeric;
• Digits 2-5 are numeric
• Digit one is alpha; Digits two and three are

numeric; digits 4-7 are alpha or numeric

• Limited space for adding new codes
• Flexible for adding new codes
• Lacks detail
• Very specific
• Lacks laterality
• Has laterality
• Difficult to analyze data due to non-specific

codes

• Specificity improves coding accuracy and

rich-ness of data for analysis

• Codes are non-specific and do not

adequately define diagnosis needed for medical research

• Detail improves the accuracy of data used

for medical research

• Does not support interoperability because it

is not used by other countries

• Supports interoperability and the exchange
• f health data between other countries and

the United States

Documentation needs and Responsibility for ICD-10 Success

• Create documentation awareness now!
• Physician Documentation is the cornerstone for

ICD-10 Transition success

• This is the primary responsibility physicians have

in the move to ICD-10

• VII. Tools you will need for the

Transition

• ICD-10 Transition Software – saves valuable

conversion time

• Documentation and Coding Training Guides
• Do-it-yourself ICD-10 implementation Tool

kits - Impact Assessment/Planning Guide

• Chart Documentation Reviews
• Role Based Training Plan
• Budget- Money and time!

Documentation: The KEY to ICD-10 Success

With increased dx coding specificity comes a requirement for detailed documentation.

Jeri Leong, President, Healthcare Coding Consultants of Hawaii:

“…(for current audits), 40% of the time we were unable to assign a specific ICD-10-CM code based on current documentation.”

How good is YOUR current documentation?

Increase in Codes?

Here’s the Real Story

• Gastroenterologists: 596 ICD-9 codes and 706 codes in ICD-10 (+110)
• Pulmonologists: 255 codes in ICD-9 and 336 codes in ICD-10 (+81)
• Urologists: 389 codes in ICD-9 and 591 codes in ICD-10 (+202)
• Endocrinologists: 335 codes in ICD-9 and 675 codes in ICD-10 (+340)*
• Neurologists: 459 codes in ICD-9 and 591 codes in ICD-10 (+132)
• Pediatricians: 702 codes in ICD-9 down to 591 codes in ICD-10 (-111)
• Infectious disease: 1,270 in ICD-9 down to 1,056 in ICD-10 (-214)

A few hundred new codes = a few dozen new documentation elements * ICD-10-CM includes more combination codes containing co- morbidities and associated conditions. Example - Diabetes

Do Now: Physician’s Documentation:

A Chart Audit

• 1. Per Doctor: list top 25 diagnoses (by revenue,

frequency)

• 2. Use GEMS to translate ICD-9 to ICD-10
• 3. Pull patient charts containing those ICD- 9

diagnoses

• 4. Assess current documentation as sufficient or

not

• 5. Create report for providers
• 6. Customize training by provider
• 7. Continue to monitor documentation

Do Now: Create Documentation

Coding Tools

• 1. Make a list of your practice’s top 20 most frequently

used ICD-9-CM diagnosis codes

• 2. Use the GEMs mapping tool to translate the ICD-9

codes to ICD-10

• 3. For each ICD-10-CM code, highlight unique

documentation and coding requirements

• 4. Create flash cards, one per code, for your providers

If providers start now and learn the unique documentation and coding requirements for 1 or 2 diagnoses codes per week, they will be prepared for ICD-10-CM when the

• Oct. 1, 2014 deadline arrives.

Advice from Other Countries

• Begin now, take advantage of lead time
• Expect significant ICD-9/ICD-10 data comparability issues due to the

fundamental differences in the coding schemes

• Sharpen anatomy and physiology skills
• Keep up coding credentials
• Plan for 6 month productivity loss/learning curve
• Focus on documentation
• Purge bad habits
• Vendor readiness is extremely important
• Communication is critical

Questions?

Thank you!

Suzanne MacEwan ICD-10 Trainer and Implementation Consultant smacewan@emr-hit.com 904-710-7062