ICD-10 Staff Awareness

WHAT IS THIS COURSE?This course is designed to provide a basic awareness and understanding of ICD-10 and why it is so critical to our organization

WHAT IS ICD-10?We have all been hearing the whispers … and screams …

about the transition to ICD-10.

For many of you, you may know all too well what it means and how it affects you in your job. For others, you may not

know much about ICD-10 and what the fuss is all about.

International Classification of Diseases (ICD)

ICD-9 is currently the official system of assigning codes to diagnoses and procedures associated with hospital, outpatient, clinical and physician utilization in the United States

We will be transitioning to the next version

of ICD codes – ICD-10

• The DIAGNOSTIC CODE is like the rebar in the cement of a building

You may not know it’s there, but it provides the structure and it is everywhere!

• Defines Patient Illness (diagnosis, signs, symptoms, diseases, disorders, treatment, and medication)

Provides for Billing and Reimbursement

Measure Quality of Care Facilitates Clinical Research Determines Medical Necessity Captures Data for Reporting

World Health Organization (WHO) took over responsibility for ICD at its creation in 1948 in its Sixth Revision (ICD-6) to provide a consistent way to monitor and trend diagnoses and diseases

The United States has been using ICD-9 for over 30 years

Payers cannot pay claims fairly using ICD-9, since the classification does not accurately reflect current technology

It is difficult to evaluate the outcome of new procedures and emerging healthcare conditions when codes are not precise

The healthcare industry cannot accurately measure Quality of Care, particularly causes of mortality

Clinical Research will be improved Impacts Billing and Reimbursement

ICD-9 Outdated

The U.S. is one of the few developed nations that has not transitioned to the ICD-10 system

WHEN DOES THE CHANGE FROM ICD-9 TO ICD-10 HAPPEN?

The deadline for organizations to convert from ICD-9 codes to

ICD-10 codes is October 1, 2015

BENEFITS OF ICD-10

We will be able to capture more detailed data to support clinical research, quality outcomes, and patient care

For an academic organization, ICD-10 will accommodate data capture of new technologies and procedures and allow us to better define the complexity of care provided

ICD-10 data will be more easily retrieved in electronic format, resulting in less manual work in reporting, quality reviews, and auditing

BENEFITS OF ICD-10 (CONT’D)

ICD-10 was designed with the idea that healthcare delivery and technology are not static, but constantly changing. It has far greater granularity, specificity, and more current healthcare information

An important benefit and result:  The widespread efforts within our organization to prepare for ICD-10 will yield improved workflows, improved efficiency, and greater organizational integration and teamwork

HOW DO WE MAKE THIS CHANGE HAPPEN?

There are seven BUMD-T/S ICD-10 teams who will be leading the implementation effort: Clinical Documentation Team – responsible for facilitating effective

clinical documentation Coding Team – responsible for transition to new ICD-10 codes Education Team – responsible for staff training Revenue Cycle Team – responsible for redesign of revenue cycle

processes Reimbursement/Finance Team – responsible for ensuring payer and

contract readiness, reimbursement and financial reporting Technology Team – responsible for remediation and integration of

IT systems for ICD-10 implementation The Health Plan – responsible for implementation as a payer

INTEGRATION WITH EPIC

• ICD-10 teams and Epic teams are integrated Enables both projects to be in sync

with one another

ICD-10 IMPLEMENTATION PROCESS

Education needs are based on the staff member’s position within the organization

Several different forms of training will be used: learning modules via HealthStream, posters, group forums, etc.

Coordination with Epic team Epic includes both ICD-9 and -10 for dual coding

optionsICD-10 tools are embedded in Epic to facilitate the

transition

WHAT CHANGES CAN WE EXPECT?

The number of diagnostic codes will increase from approximately 17,000 today to 140,000 after ICD-10 is implemented

Clinical documentation will require greater specificity

All providers and staff involved in documentation and coding must have a thorough understanding of ICD-10

UAHN systems and workflows will need to be modified to include ICD-10

NEXT STEPS

The ICD-10 Teams will coordinate with the departments impacted by the change

Additional implementation training for providers and staff directly affected by ICD-10, will be rolled out through September, 2015

Regular communications will keep everyone informed of project progress