icd10 readiness (1)

ICD10 READINESSSUGANTHISRIKUMAR

AGENDA

• INTRODUCTION TO ICD10

• WHO NEEDS ICD10-TRANSITION

• TECHNOLOGY INVOLVED FOR THIS MIGRATION

• HOW END-TO-END TESTING IS ACCOMPLISHED

• CHALLENGES FACED

• ICD-10 COUNTDOWN DAYS.

• INSIGHTS OF MEDICAL PROFESSIONALS

• Q&A

INTRODUCTION TO ICD10

• ABBREVATION

ICD-10 -THE INTERNATIONAL STATISTICAL CLASSIFICATION OF DISEASES AND RELATED HEALTH PROBLEMS , SHORTLY CALLED AS INTERNATIONAL CLASSIFICATION OF DISEASES 10TH REVISION.

• MIGRATION FROM ICD-9 TO ICD-10 (MODERN HISTORY OF THE MEDICAL DICTIONARY WITH ICD-10)

THE ICD IS MAINTAINED BY THE WORLD HEALTH ORGANIZATION(WHO) THE DIRECTING AND COORDINATING AUTHORITY FOR HEALTH WITHIN THE UNITED NATIONS SYSTEM.

DIFFERENCE BETWEEN ICD-9 AND ICD-10 DIAGNOSIS CODES

ICD-9 ICD-103-5 characters in Length 3-7 characters in LengthApproximately 13,000 codes Approximately 68,000 available codesFirst digit may be alpha(E or V) or numeric, digit 2-5 are numeric

Digit 1 is alpha; digit 2 and 3 are numeric; digit 4-7 are alpha or numeric

Limited space for adding new codes Flexible for adding new codesLacks detail Very Specific

• THE EXPANDED NUMBER OF CHARACTERS OF THE ICD-10 DIAGNOSIS CODES PROVIDES GREATER SPECIFICITY TO IDENTIFY DISEASE ETIOLOGY, ANATOMIC SITE AND SEVERITY.

• ICD-10 CODE STRUCTURE:CHARACTERS 1-3 –CATEGORYCHARACTERS 4-6-ETIOLOGY,ANATOMIC SITE, SEVERITY OR OTHER CLINICAL DETAILCHARACTERS 7-EXTENSION

ICD-10 DIAGNOSIS CODE EXAMPLE

• S52 FRACTURE OF FOREARM• S52.5 FRACTURE OF LOWER END OF RADIUS• S52.52 TORUS FRACTURE OF LOWER END OF RADIUS• S52.521 TORUS FRACTURE OF LOWER END OF RIGHT RADIUS• S52.521A TORUS FRACTURE OF LOWER END OF RIGHT RADIUS, INITIAL ENCOUNTER FOR CLOSED

FRACTURE.S52 IS THE CATEGORY. THE FOURTH AND FIFTH CHARACTERS OF “5” AND “2” PROVIDE ADDIONAL CLINICAL DETAIL AND ANATOMIC SITE. THE SIXTH CHARACTER IN THIS EXAMPLE INDICATES LATERALITY I,E RIGHT RADIUS. THE SEVENTH CHARACTER “A” IS AN EXTENSION THAT PROVIDES ADDITIONAL INFORMATION, WHICH MEANS “INITIAL ENCOUNTER” IN THIS EXAMPLE.

DIFFERENCE BETWEEN ICD-9 PROCEDURE CODES AND ICD-10 PROCEDURE CODES

ICD-9-PCS ICD-10-PCS3-4 digits 7 digitsAll digits are Numeric Digits can be either alpha or

numeric.Letters O and I are not used to avoid confusion with the numbers 0 and 1

Decimal after first 3 characters Decimal after first 3 charactersExamples43.5 - Partial gastrectomy with anastomosis to esophagus 44.42 - Suture of duodenal ulcer site.

0FB03ZX - Excision of Liver, Percutaneous Approach, Diagnostic 0DQ10ZZ - Repair upper esophagus, open approach

WHO NEEDS ICD10 TRANSITION

• PROVIDERS, PAYERS(INSURANCE COMPANIES), CLEARINGHOUSES AND BILLING SERVICES WHO EVER COVERED BY HIPAA (HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT) .

• ALL ELECTRONIC TRANSACTIONS MUST USE 5010 STANDARDS WHICH HAVE BEEN REQUIRED SINCE JANUARY 1,2012. 5010 ACCOMMODATES -1CD10 DIAGNOSIS CODES AND ICD10 PROCEDURE CODES.

• ICD-10 DIAGNOSIS CODES MUST BE USED FOR ALL HEALTHCARE SERVICES PROVIDED IN UNITED STATES . ICD-10 PROCEDURE CODES SHOULD BE USED FOR HOSPITAL INPATIENT AND OUTPATIENT BILLS.

TECHNOLOGY INVOLVED FOR THIS MIGRATION

• DATABASE STORED PROCEDURES• ETL MAPPINGS

END-TO-END TESTING

TESTING APPROACH.

REQUESTED FROM THE CLIENTS TO SEND THE CLAIMS DATA, PROVIDER DATA, EREVIEW BILLS, BILLS IN 5010 FORMAT OR ANSI-X12 STANDARD FORMAT . INBOUND PROCESS INVOLVED TO IMPORT THE CLAIMS DATA, PROVIDER DATA AND BILLS IN THE STANDARDS ( EREVIEW, 5010 OR ANSI-X12). OUTBOUND PROCESS INVOLVED TO SEND THE ACK FILE AND PAYMENT FILES.

ENVIRONMENT USED TO ACHIEVE THE TESTING

• EDI ENVIRONMENT

• B2WBF ENVIRONMENT

TEST ENVIRONMENT -EDI

• STEP 1: TEST ENVIRONMENT SETUP• STEP 2: TEST DATA PREPARATION• STEP 3: GENERATE THE TEST FILES• STEP 4: SHARE THE TEST FILES /ACK FILES WITH CLIENTS.

TEST ENVIRONMENT SETUP-CLAIMS

EDI TRANSPOR

T

CLAIMS

DATA

TESTENVIRONMENT SETUP-PROVIDERDATAPROVIDER DATA

EDI TRANSPOR

T

TESTENVIRONMENT SETUP-TRANSPORTSETUP

PAYMENTFILE GENERATION

• .TXT FILE WITH PAYMENT INFORMATION IS THE OUPUTFILE.

TEST ENVIRONMENT – B2BWF

• STEP 1: TEST ENVIRONMENT SETUP• STEP 2: TEST DATA PREPARATION• STEP 3: GENERATE THE TEST FILES• STEP 4: SHARE THE TEST FILES /ACK FILES WITH CLIENTS.

TEST ENVIRONMENT SETUP-B2BWF

ENGINEJOBS

POLLERSMQ BRIDGE TASKS

PGP KEYSHISTORY

CUSTOMERSUSERS

CHALLENGES FACED

• TEST PLANNING AND EXTREME COORDINATION NEEDED WITH PROJECT MANAGEMENT, BUSINESS ANALYST, DEVELOPMENT TEAM , TECHNICAL SERVICES TEAM AND WITH PARTNERS.

• 80% TESTING INVOLVED MANUAL DATA VERIFICATION AND 20% OF TESTING ACHIEVED BY INTERNALLY DEVELOPED REGRESSION EDI AUTOMATION TOOL.

ICD-10 COUNTDOWN DAYS

INSIGHTS OF MEDICAL PROFESSIONALS

Q&A

• EMAIL: SUGANTHIMANI.JOBS@GMAIL.COM