ICD-10 Diagnosis Coding

In use by majority of developed nations for years Goes into effect in 12 months (Oct. 1,

2014) Will require considerable adjustment in

coding Need to start preparation & begin testing

ICD-10 Diagnosis Coding ICD-10 better provides for improvements in…

Quality Measurements –healthcare successes on specific diagnoses

Public Health – worldwide sharing of diagnostic data Research – analysis using more precise diagnoses Reimbursement – refined “pay for performance” Cost containment – lower insurance premiums

ICD-10 Diagnosis Coding ICD-10 captures documentation that

ICD-9 omits, such as: Initial vs. Subsequent Encounter vs.

Sequelae Acute or Chronic Condition Right or Left (1/3 of ICD-10 code descriptions are

identical except for indicating laterality)

Normal Healing, Delayed Healing

ICD-10 Diagnosis Coding

CMS: No Clear Mapping Between ICD-9-CM and ICD-10-CM Code Sets.  There are one-to-one correspondences, one-to-many, many-to-one, many-to-many, or no correspondence at all.

ICD-10 Diagnosis Coding

CMS: GEMs (General Equivalency Mapping) The GEMs are to assist with converting large

ICD-9 databases to ICD-10 The GEMs are not a substitute for learning how

to use ICD-10-CM Providers’ coding staff should assign individual

codes from the ICD-10 code books

Senile Cataract

ICD-9

Source

ICD-10

Senile Cataract

ICD-9

Source

Senile Cataract

ICD-9

ICD-10

Source

Source

Pseudoexfoliation of the lens w/o GLC does not exist in ICD-10

Senile Cataract

ICD-10

Source

Source

Pseudoexfoliation of lens capsule convert 366.11 to ICD-10

Senile CataractPseudoexfoliation of the lens

w/o GLC does not exist in ICD-10

ICD-9

Currently must file two lines of code for GLC patient

365.52

365.72

Glaucoma

You only file one code, but you have to chose one of 20 codes

ICD-10 Glaucoma

ICD-10 Diagnosis Coding

CMS: No Clear Mapping Between ICD-9-CM and ICD-10-CM Code Sets.  There are one-to-one correspondences, one-to-many, many-to-one, many-to-many, or no correspondence at all.

ICD-10 Diagnosis Coding Doctors and staff will be faced with learning

curve Learning curves slow down production Learning “on-the-fly” will be disastrous Outline a plan, step by step, your practice

intends to follow

ICD-10 Diagnosis Coding To Help Staff Understand the Complexities of

the Switch to ICD-10… Make a table of the top 20+ diagnoses currently

used by your office Using ICD-10*, make a table of these same

diagnoses, but with the ICD-10 coding

* ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2014/

ICD-10 Diagnosis Coding Establishing a transition plan

All current use ICD-9 will be affected by the transition.

Thus, identify everywhere that your practice uses ICD-9.

Decide who needs training, what type of training they need, and when they need it.

Schedule staff training on a regular basis for questions and feedback

ICD-10 Diagnosis Coding Establishing a transition plan

Share your plan with your EHR vendors and billing services.

Set up time for software vendors to train your staff on computer system changes (whether using EHR or non-EHR software systems).

Coordinate carefully with Billing Service and Clearinghouse vendors

ICD-10 Diagnosis Coding Establish a training plan

Anyone who will test ICD-10 systems before the transition will need training way in advance

Others who use ICD codes can be trained 6 to 9 months before the October 1, 2014, transition

Doctors and staff should become well versed in the multiple changes in diagnosis coding

ICD-10 Diagnosis Coding Other suggestions from CMS

Communicate with your peers, especially those using the same software, clearinghouses, etc.

Set aside a contingency fund for preparation costs and for possible unforeseen implementation hang-ups.

ICD-10 Diagnosis Coding

In Summary, Educate All PersonnelPrepare for ChangesCommunicate with VendorsTest