CDI

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CDI
ICD-10
READY OR NOT!
Terrance Govender, MD, MBBCh, C-CDI, CHBC
OBJECTIVES
• History of ICD
• Benefits and Goals
• Impacts on the Industry
• How to prepare
• What next?
HISTORY
• Core of the healthcare payment system in the
United States.
• Current set: ICD-9, been in use since 1980!
• Advancement in medicine, but not the code
set.
• Rely heavily on the codes: Medical record
words never leave the hospital. Only the codes
do.
• ICD 10 is essentially a new language with
which we are expected to describe and report
healthcare encounters.
HISTORY
• ICD-10 copyrighted by the WHO (World Health
Organization) They own and publish the
classification.
• Global standard for reporting and categorizing
diseases, health related conditions and
external causes of diseases and injury.
• ICD-10 code set has been modified by many
countries to suit their own medical systems.
BACK IN TIME
• 1893: The first International list of causes of
death. Bertillon Classification
• 1900-1929: France convened the first
international conference for the revision of
the Bertillon of International list of causes of
death in 1900.
• 1938: First international conference for the
revision of the International list of causes of
death.
• 1948: International conference for the 6th
Revision of the International lists of diseases
and causes of death in Paris.
BACK IN TIME
• 1955-1983: 3 successive decennial revision
conferences in 55, 65, 75, recognized the
increasing use of ICD for the indexing of
hospital medical records.
• 1977: ICD 9 was published.
• 1980: ICD-9 implemented in the US.
• 1983: DRG (Diagnosis Related Groups
implemented in the US)
• 1996-2006: ICD-10 implementation begins
outside the US.
• 1999: US starts to use ICD-10 for mortality
stats.
BACK IN TIME
• 2007: IIPS- Changed to a Medicare Severity
DRG system (MS-DRG)
• 2014: ICD-10 will be implemented in the USA.
IMPLEMENTATION OF ICD-10 AROUND
THE WORLD
GOALS OF ICD-10 IMPLEMENTATION
• ICD-10 will provide greater detail and a more
accurate depiction of patient severity.
• This will enhance the ability to measure
quality  more information will be
provided/captured about the relationship
between a providers performance and the
patient’s condition.
GOALS OF ICD-10 IMPLEMENTATION
• Provide greater specificity of clinical data.
• Obtain relevant robust clinical data that can
be used to make intelligent data driven
decisions.
• Allow for more accurate payments for new
procedures.
• Provide better data for fraud and abuse
monitoring.
• Reduce the number of miscoded, rejected and
improper reimbursement claims.
GOALS OF ICD-10 IMPLEMENTATION
• Offer a better understanding of the value of
new medical procedures.
• Improve the understanding of healthcare
outcomes.
• Provide more ICD codes to address Global
Disease Emergencies.
ICD-10 STRUCTURE AND FORMAT
ICD-9- CM Diagnosis Codes
ICD-10-CM Diagnosis Codes
• 3-5 Characters in length.
• Approximately 13,500
codes.
• Limited space for adding
new codes.
• Lacks detail
• Lacks laterality
• Difficult to analyze data due
to non specific codes.
• Does not support
interoperability because not
used by other countries.
• 3-7 Characters in length.
• Approximately 69,000
codes.
• Flexible for adding new
codes.
• Very Specific
• Has Laterality
• Specificity improves coding
accuracy and data analysis.
• Supports interoperability
and the exchange of health
data between US and others
ICD 10 Overview
90000
80000
70000
60000
50000
ICD 9
40000
ICD 10
30000
20000
10000
0
Diagnosis Codes
Procedure Codes
IMPACT ON THE INDUSTRY
• From hospitals to physician offices, health
plans to patients  Everyone will be affected.
• Expect changes in documentation,
reimbursement, coverage, insurance plans
structure, quality measures, audits, etc.
PAYMENTS
• Most info regarding payments will not be
released until very close to the
implementation.
• Financial Impact really cannot be predicted.
• Expect delays in payments, teething phase.
• Expect denials and rejections.
• Unless there is a drastic culture change in your
providers, revenue will drop significantly.
PROVIDER DOCUMENTATION
• SPECIFICITY-SPECIFICITY-SPECIFICITY!!
• Not as daunting as it sounds.
• Get away with a lot in ICD-9. ICD-10 world:
Poor documentation = rejection of claim.
• Not otherwise specified, unless absolutely
correct, will not cut it come 2014.
• More queries from coders, increase in
documentation times.
• Clinicians need to be onboard early.
IMPLEMENTING ICD-10
• CMS suggests the ffg. Milestones and tasks for
the implementation of ICD-10:
1.
2.
3.
4.
5.
6.
Planning
Communication and awareness
Assessment
Operational Implementation
Testing Phase
Transition
BREAKDOWN
• Important: Must get
stakeholders/admin/medical staff involved
from the get go!
1. CREATE AWARENESS:
»
»
»
»
»
Start today
Designate 1 person to initiate interest in ICD-10
Use CMS, AMA and WHO as valuable resources for
information.
Accountability is important
Frequent meetings and updates
IMPLEMENTATION
2. PLANNING COMMUNICATION:
– Different parts of your organization affected
– Make sure ALL are on the same page
– Identify critical staff members involved eg. Physician
Champions, CIO etc.
– What’s the best means of communication for your
organization or specific groups of individuals
IMPLEMENTATION
3. CONDUCT AN IMPACT ANALYSIS:
» Take a look at your systems and how they will be impacted
by the transition
» Includes things like work flow, operational systems and
business processes.
» Eg. Revenue cycle alone:
• Charge Capture
• Coding and Documentation
• Utilization Management
• Managed Care Contracts
• Billing
• Collections
IMPLEMENTATION
4. DOCUMENTATION:
» 3M suggests that this will be the largest impact area of
the implementation.
» Assess current documentation
» Does it meet current ICD-9 requirements?
» Perform an audit- can be done in house.
» Start training with clinicians early.
» Instill good habits.
IMPLEMENTATION
5. CHECK YOUR VENDORS:
» Does your current system accommodate changes to ICD10
» Modifications to 4010 transition to 5010 billing form.
» What changes and updates will need to be made and how
much will this cost me?
» Have one individual in charge of dealing with vendors and
request frequent updates.
» Do this with ALL vendors, document and file the
response.
IMPLEMENTATION
• 6. FINANCIAL EFFECTS:
» Creating a steering committee  possible incentives
necessary for certain key members.
» Upgrade to systems
» Implementation of new systems
» Awareness and training of staff
» Anticipated delays in claims processing.
» Possible rejections/denials of claims.
» Decrease in coder productivity.
» Reimbursement implication.
» How long can you survive if claims are delayed for a
prolonged period of time (physician practices)
WHAT NEXT?
• START NOW!
• Establish awareness among your
administration and clinical leadership.
• Identify those key players: 1 coordination
player.
• Budget accordingly
• Good luck! 
QUESTIONS

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