ICD-10: Closer and Bigger Than - PowerPoint Presentation

1. ICD-10: Closer and Bigger Than You ThinkAn OverviewChristi DantCMS Office of E-Health Standards & Services

2. Topics To Be CoveredWhat exactly is changing?Why the change?Getting readySome of the major challengesResources and suggestions to help you prepare

3. What Is Changing?First, HIPAA standards for electronic transactions must be upgraded to Version 4010/4010A  Version 5010Medical diagnosis and inpatient procedure code sets:ICD-9 CM  ICD-10 CM ICD-10 PCS

4. ICD-10Refers to the diagnosis and procedure code setsReplaces ICD-9 code sets and includes updated medical terminology and classification of diseases.More logically organized, more detailed and specific, and more clinically accurate

5. Who Is Affected?Anyone who is covered by HIPAA:Health care providers that conduct electronic transactions Payers including Medicaid and MedicareClearinghousesMany non-HIPAA covered entities use ICD-9 codes:Vendors and business associates of covered entitiesWorker’s compensation programsLife insurance companiesResearchers, epidemiologists, statisticians

6. Why the change?ICD-10 provides more specific data than ICD-9Better reflects current medical practiceAllow addition of new codesThe current coding system is running out of capacityExpanded data captureQuality measurementReduce coding errorsBetter analysis of disease patternsTrack and respond to public health outbreaksMake claim submission more efficientIdentify fraud and abuse

7. More on ICD-10ICD-10 CM/PCS consists of two parts: ICD-10-CM for diagnosis coding in all health care settingsDescribes left vs. right, initial vs. subsequent encounter, routine vs. delayed healing, and nonunion vs. malunionICD-10-PCS for inpatient procedure coding in hospital settingsProvides detailed information on procedures and distinct codes for all types of devicesCPT coding for outpatient and office procedures is not affected by the ICD-10 transition

8. October 1, 2013The Federal Health Enterprise faces an unprecedented challenge.Payer (CMS / IHS / VA / DoD)Direct Provider (IHS, VA, DoD, NIH)Funder (HRSA / CDC)Policy Research, Historical Data and Surveillance/Epidemiology

9. ICD-10 Will Affect Everything From physicians to nurses, to the lab and front desk, everyone will need to understand and prepare for the transition More, and more robust codes. Codes will grow from 17,000 to 140,000.Updated policies and procedures. Any office policy or procedure tied to a diagnosis code, disease management, registries, or tracking must be changedMedical record documentation. ICD-10 codes will better reflect the specificity already inherent in the patient's medical record.

10. Benefits of ICD-10More accurate payments for new proceduresFewer miscoded, rejected, and improper reimbursement claimsImproved ability to measure healthcare servicesIncreased sensitivity when refining grouping and reimbursement methodologiesDecreased need to include supporting documentation with claims

11. Now Is the Time to PrepareVersion 5010 and ICD-10 transitions require business and systems changes throughout the health care industry.Organizations need to have plans and budgets in place to address the potential for rejected claims and delays in reimbursement.

12. Transitioning to ICD-10Identify your current systems and processes that use ICD-9 codes and what needs to be changed in the work flow.Budget for time and money related to the implementation and loss of productivity.Communicate implementation plans between providers, payers and vendors.Allow enough time to test transactions.Assess and plan for staff training needs.

13. Biggest ChallengesLack of full comprehension of the scope and complexity of necessary changes. Significant Blind Spots remain (ubiquity of ICD-9 code applications; impacts on research/historical data) Competing prioritiesThere is no road map.Limited resources – financial, technical & contractualGrow Your Own SMEsCompetition for vendors/contractors will be intense.

14. When Do I Need to Be Ready?DateActionJanuary 1, 2011External Version 5010 TestingJanuary 1, 2012Full Implementation of Version 5010April 1, 2013Recommend Start for Training Staff on ICD-10October 1, 2013Full Implementation of ICD-10Remember These Dates

15. What Can Be Done Now?Active engagement and participation in your ICD-10 steering committee. REMEMBER: THIS IS NOT AN IT PROJECT! Learn more about ICD-10 and embrace how it can improve your operations and outcomes. Lift every rock and peer underneath. Look for ICD-9 codes and its derivative data everywhere and consider who/how to address it. REMEMBER: THIS IS NOT JUST AN IT PROJECT! Start now to enhance clinical documentation to align with ICD-10 and build staff competencies in anatomy and biomedical terminologies.

16. Resources to Help You PrepareCMS ICD-10 Web site: http://cms.gov/ICD10CMS ICD-10 Listserv: http://cms.gov/ICD10/02d_CMS_ICD-10_Industry_Email_Updates.aspProfessional, clinical, trade associations

17. Readily Available CMS Resources

18. More from CMS

19. Industry & Associations Step Up – One Example

20. Training for ICD-10Suggested training curriculum:Basic Understanding of the ICD-10 Code SetCoding for Diagnoses and Inpatient Hospital ProceduresAnatomy & biomedical terminology refreshers (especially for coding staff) Using Systems Updated for ICD-10Workflow changes

21. In ClosingRequest that you all serve as ICD-10 Ambassadors and identify and share best practices. We can all get there together.QUESTIONS?Christi Dant Office of E-Health Standards & ServicesCenters for Medicare & Medicaid Services410-786-5306christi.dant@cms.hhs.gov