This document provides an overview of ICD-10 and the transition from ICD-9 to ICD-10 for clinical staff. It discusses that ICD-10 will have significantly more diagnosis and procedure codes than ICD-9 to provide more specific clinical detail. The transition requires clinicians to become familiar with the new coding system to ensure accurate medical coding. The document provides examples of how a condition may be coded differently between ICD-9 and ICD-10.
2. ICD-‐10
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
A
Cornerstone
of
Healthcare
Informa�on
Pa�ent
Provider
Condi�on
ICD-‐10-‐CM
Service
ICD-‐10-‐PCS
Source:
Health
Data
Consul�ng
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
3. ICD10
Quick
Facts
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
ICD-‐10
interna�onal
version
– Adopted
by
WHO
in
1990
– Most
countries
other
than
the
US
currently
use
ICD-‐10
– ICD-‐10
(Interna�onal
version)
~
12,500
diagnos�c
codes
– ICD-‐10
used
for
mortality
repor�ng
in
the
US
-‐
1999
ICD-‐10-‐CM
(US
version)
– ~
69,000
diagnos�c
codes
– Final
rule
published
–
2009
– Compliance
date
–
Oct
1,
2014
ICD-‐10-‐PCS
– ~72,000
codes
– Not
part
of
an
interna�onal
standard
– Inpa�ent
procedures
only
– Compliance
date
–
Oct
1,
2014
Source:
Health
Data
Consul�ng
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
4. Nature
of
the
Changes
Volume
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
ICD-‐9-‐CM
ICD-‐10-‐CM
ICD-‐10
(WHO)
ICD-‐9-‐CM
ICD-‐10-‐PCS
ICD-‐10
(WHO)
Diagnosis
Procedure
Diagnosis
Procedure
Source:
Health
Data
Consul�ng
Source:
Health
Data
Consul�ng
For
a
complete
copy
of
this
presenta�on
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us:
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5. Same
Condi�on
–
Different
Codes
September
2014
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
What’s
the
Difference?
October
2014
ICD-‐9
ICD-‐10
82111:
Open
fracture
of
Sha�
of
Femur
S72351C:
Displaced
comminuted
fracture
of
sha�
of
right
femur,
ini�al
encounter
for
open
fracture
type
IIIA,
IIIB,
or
IIIC
All
codes
for
femur
fractures
=
16
All
codes
for
femur
fractures
=
1530
Source:
Health
Data
Consul�ng
For
a
complete
copy
of
this
presenta�on
contact
us:
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6. ICD9
Comparison
to
ICD10-‐CM
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Diagnosis
Codes
–
Clinical
Example
A
pa�ent
is
admi�ed
as
the
result
of
[rupture
of
the
cardiac
wall
without
bleeding
into
the
pericardium].
The
pa�ent
is
[within
4
weeks]
of
a
[myocardial
infarc�on].
ICD9 Code Description
42979
Certain
sequelae
of
myocardial
infarc�on,
not
elsewhere
classified,
other
ICD10 Code Description
I233
Rupture
of
cardiac
wall
without
hemopericardium
as
current
complica�on
following
acute
myocardial
infarc�on
Source:
Health
Data
Consul�ng
For
a
complete
copy
of
this
presenta�on
contact
us:
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7. ICD9
Comparison
to
ICD10-‐CM
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Diagnosis
Codes
–
Clinical
Example
A
pa�ent
is
admi�ed
as
the
result
of
[rupture
of
the
cardiac
wall
without
bleeding
into
the
pericardium].
The
pa�ent
is
[within
4
weeks]
of
a
[myocardial
infarc�on].
ICD9 Code Description
42979
Certain
sequelae
of
myocardial
infarc�on,
not
elsewhere
classified,
other
ICD10 Code Description
I233
Rupture
of
cardiac
wall
without
hemopericardium
as
current
complica�on
following
acute
myocardial
infarc�on
Source:
Health
Data
Consul�ng
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
8. Current
Distribu�on
of
ICD-‐9
diagnosis
codes
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
All
claims
data
sample
containing
565
million
codes
(1
year
of
data)
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Total
Charges
by
Diagnosis
Code
(ICD-‐9)
3years
-‐
$10
Bill
Charge
%
For
a
complete
copy
of
this
presenta�on
contact
us:
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9. ICD-‐10
PCS
Factoids
ICD-‐10
PCS
is
a
system
of
coding
for
ins�tu�onal
procedures.
These
procedure
codes
do
not
apply
to
coding
for
services
or
procedures
delivered
in
a
non-‐ins�tu�onal
environment
ICD-‐9CM
chapter
3
is
the
equivalent
of
ICD-‐10PCS
The
WHO
(World
Health
Organiza�on)
is
not
involved
in
the
standardiza�on
of
ins�tu�onal
procedure
codes
CMS
is
responsible
for
maintenance
of
ICD-‐10PCS
codes
Contract
with
3-‐M
to
develop
the
codes
in
1993;
first
dra�
in
1993.
1998
ini�al
release
of
ICD-‐10
PCS
with
annual
updates
every
year
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
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10. ICD9
Comparison
to
ICD10
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Ins�tu�onal
Procedure
Codes
–
Clinical
Example
While
hospitalized,
a
pa�ent
has
a
procedure
done
through
an
[endoscope]
inserted
[through
the
skin]
to
[bypass]
the
blood
flow
from
the
[abdominal
aorta]
to
the
[right]
[renal
artery]
using
a
[synthe�c
material]
ICD9 Code Description
3924 Aorta-‐renal
Bypass
ICD10 Code Description
04104J3
Bypass
Abdominal
Aorta
to
Right
Renal
Artery
with
Synthe�c
Subs�tute,
Percutaneous
Endoscopic
Approach
Source:
Health
Data
Consul�ng
For
a
complete
copy
of
this
presenta�on
contact
us:
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11. ICD9
Comparison
to
ICD10
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Ins�tu�onal
Procedure
Codes
–
Clinical
Example
While
hospitalized,
a
pa�ent
has
a
procedure
done
through
an
[endoscope]
inserted
[through
the
skin]
to
[bypass]
the
blood
flow
from
the
[abdominal
aorta]
to
the
[right]
[renal
artery]
using
a
[synthe�c
material]
ICD9 Code Description
3924 Aorta-‐renal
Bypass
ICD10 Code Description
04104J3
Bypass
Abdominal
Aorta
to
Right
Renal
Artery
with
Synthe�c
Subs�tute,
Percutaneous
Endoscopic
Approach
[Note]
For
all
codes
related
to
Aorta-‐renal
Bypass:
• ICD-‐9
codes
=
2
• ICD-‐10
codes
=
30
Source:
Health
Data
Consul�ng
For
a
complete
copy
of
this
presenta�on
contact
us:
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12. Defini�on
and
Terminology
Changes
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
ICD-9 Procedure Term ICD-10 Procedure Term
Amputation Detachment
Amniocentesis Drainage
Arthroscopy, Cystoscopy… Inspection… Endoscopic Approach
Closed Reduction Reposition
Debridement Excision, Extraction, Irrigation, Extirpation
Radical Mastectomy Resection (right, left or bilateral)
Subtotal Mastectomy Excision
Tracheostomy, Bypass
Cesarean section Extraction of Products of Conception
Incision No ICD-10 term
Source:
Health
Data
Consul�ng
Source:
Health
Data
Consul�ng
For
a
complete
copy
of
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presenta�on
contact
us:
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13. “There
are
too
many
Codes”
There
are
lots
of
words
in
the
dic�onary,
but
that
doesn’t
seem
to
trouble
authors…
34,250
(50%)
of
all
ICD-‐10CM
codes
are
related
to
the
musculoskeletal
system
17,045
(25%)
of
all
ICD-‐10CM
codes
are
related
to
fractures
10,582
(62%)
of
fracture
codes
to
dis�nguish
‘right’
vs.
‘le�’
There
are
over
1800
codes
for
fractures
of
the
radius
(forearm)
but
only
~
50
concepts
used
repeatedly
in
different
pa�erns
Only
a
very
small
percentage
of
the
codes
will
be
used
most
providers
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
14. “ICD-‐10
is
much
too
complicated”
Physicians
have
as
much
educa�on
as
rocket
scien�sts…
this
isn’t
rocket
science.
ICD-‐10
is
actually
more
consistent
and
pa�erns
are
reasonably
understandable
There
are
great
evolving
tools
that
will
help
clinicians
iden�fy
the
right
codes
(assuming
they
accurately
document
the
facts)
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
15. “We
should
wait
for
ICD-‐11”
ICD-‐9
(WHO)
Published
in
1978
ICD-‐10
(WHO)
–
Endorsed
in
1990
ICD-‐10-‐CM
dra�
released
in
1995
Proposed
rule
for
ICD-‐10
adop�on
in
2008
ICD-‐10
used
for
Mortality
in
the
US
since
1999
ICD-‐11(WHO)
not
slated
for
release
un�l
2015
Based
on
historical
implementa�ons
by
the
�me
we
get
to
ICD-‐11-‐CM
and
from
there
to
implementa�on,
it
will
be
2039.
The
gap
between
ICD-‐9
and
ICD-‐10
is
not
nearly
as
drama�c
as
the
gap
between
ICD-‐9
and
ICD-‐11
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
16. “Documenta�on
for
ICD-‐10
is
an
unnecessary
burden.”
The
number
and
type
of
new
concepts
required
for
ICD-‐10
are
not
foreign
to
clinicians
The
focus
of
documenta�on
is
good
pa�ent
care
Pa�ents
deserve
to
have
accurate
and
complete
documenta�on
of
their
condi�ons
If
other
industries
understand
the
value
of
accurate
and
complete
documenta�on
of
data
about
encounters;
shouldn’t
we?
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
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17. “We
should
just
go
to
SNOMED.”
If
you
like
lot’s
of
codes,
you’ll
love
SNOMED
(over
300,000
codes)
Most
stakeholders
in
the
industry
have
no
familiarity
with
SNOMED
Most
physicians
cannot
describe
the
nature
of
SNOMED
Coding
in
SNOMED
is
more
complex
than
ICD-‐10
SNOMED
is
not
an
adopted
interna�onal
standard
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
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18. “ICD-‐10
won’t
help
me
take
care
of
my
pa�ents.”
Difficult
to
make
the
case
about
how
ICD-‐10
will
help
Dr.
Smith
with
his
encounter
with
Mary
Jones
Healthcare
crosses
the
boundary
of
�me
and
providers
Improving
healthcare
requires
a
broad
understanding
of
what
works
and
what
doesn't
work
Clinicians
should
be
leaders
in
the
healthcare
industry
by
providing
accurate
data,
accurate
analysis
of
the
data
and
change
in
healthcare
to
con�nuously
improve
the
value
their
pa�ents
receive
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
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19. “ICD
diagnosis
codes
are
irrelevant
to
my
business.”
ICD-‐9
codes
factor
into:
ü Payer
processing
rules
ü The
determina�on
of
appropriateness
ü Measures
of
quality
(pay
for
performance)
ü Compliance
(meaningful
use)
ü Contrac�ng
decisions
ü Risk
adjustments
ü Fraud
waste
and
abuse
ü Audits
ü Authoriza�ons
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
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20. “ICD
diagnosis
codes
are
irrelevant
to
my
business.”
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
ICD-‐10
codes
are
likely
to
factor
into:
ü Changes
in
reimbursement
based
on
both
“what”
was
done
and
“why”
ü Managing
financial
risks
for
contracted
popula�ons
ü Changes
in
reimbursement
based
on
more
robust
models
of
payment
adjusted
for
risk
and
severity
ü More
sophis�cated
weigh�ng
of
payments
based
on
DRGs,
episodes
or
other
groupers
of
care.
For
a
complete
copy
of
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presenta�on
contact
us:
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21. “It’s
unreasonable
for
administra�ve
bureaucrats
to
interfere
with
how
I
take
care
of
pa�ents.”
The
success
or
failure
of
healthcare
goes
well
beyond
Dr.
Smith
and
his
visit
with
Mary
Jones.
Purchasers
of
healthcare,
including
government
and
private
en��es
have
a
responsibility
to
assure
that
the
popula�on
they
are
responsible
for
gets
the
best
value
for
services
delivered.
Providers
are
receiving
payment
for
services,
it
is
reasonable
to
believe
that
they
should
be
just
as
accountable
for
what
they
do
as
other
organiza�ons
that
provide
services
and
goods.
Healthcare
has
clearly
moved
into
a
marketed
industry
and
“professionalism”
alone
cannot
assure
quality
and
limit
abuse.
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
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22. “There
are
a
bunch
of
dumb
codes
that
make
no
sense.”
Clinician
organiza�ons
have
used
codes
like;
“Hit
by
a
spacecra�”
or
“Suicide
by
paintball
gun”
as
examples
of
the
“stupidity”
of
the
ICD-‐10
codes.
Interes�ng
to
note
however
is
that
the
codes
noted
above
are
ICD-‐9
codes
and
have
been
around
for
a
long
�me.
The
bo�om
line;
don’t
use
the
codes
that
don’t
make
sense
or
don’t
accurately
represent
your
pa�ent’s
condi�on.
They
may
mean
something
to
someone,
but
shouldn’t
bother
you.
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
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23. “More
�me
is
needed
to
implement.”
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
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24. “There
are
too
many
new
ini�a�ves
and
mandates.”
Now
there’s
a
statement
we
can
all
relate
to…
Without
accurate
standardized
data
about
the
pa�ents
health
condi�on:
ü Meaningful
use
isn’t
very
meaningful
ü Accountable
care
can’t
be
accountable
ü It
will
be
difficult
to
reach
the
goal
of
affordable
care
ü Health
informa�on
exchanges
may
not
be
interoperable
ü Quality
measures
will
lack
quality
data
ü Outcomes
can’t
be
independently
verified
ü Pa�ent
Safety
can’t
be
assured
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
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25. ICD-‐10?
“Top
Ten
Reasons”
1. The
value
of
good
data
for
be�er
care
2. Audits
-‐
Fraud,
waste
and
abuse,
RAC,
and
other
annoyances…
3. Impact
on
denials
and
payment
delays
4. Impact
on
quality
measurement
5. Improving
pa�ent
safety
6. Improving
healthcare
for
all
pa�ents
7. Impact
on
pa�ents
directly
8. Be�er
popula�on
based
research
9. The
goal
of
interoperability
10. Changing
models
of
reimbursement
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Why
should
I
care?
Source:
Health
Data
Consul�ng
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
26. Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Why
is
good
documenta�on
important?
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
27. Documenta�on
1889
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
28. Documenta�on
1889
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
29. Documenta�on
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
1889
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
30. Documenta�on
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
1889
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
31. Documenta�on
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
2013
Progress?
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
32. Documenta�on
Supports
proper
payment
reduced
denials
Assures
accurate
measures
of
quality
and
efficiency
Assures
accountability
and
transparency
Captures
the
level
of
risk
and
severity
Provides
be�er
business
intelligence
Supports
clinical
research
Enhances
communica�on
with
hospital
and
other
providers
It’s
just
good
care!
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Why
is
it
important?
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
33. Documenta�on
Quality
Poor
quality
documenta�on
is
bad
for
Providers,
Payers
and
Pa�ents
ü Billing
accuracy
ü Quality
measures
ü Popula�on
management
ü Risk
management
ü Healthcare
analy�cs
ü Pa�ent
history
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Everyone
loses…
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
34. Coding
–
The
Pa�ent
Interface
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Where
it
all
begins
History
Physical
Exam
Internal
Record
Review
External
Record
Review
Assessment/Diagnosis
Studies
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
35. Ge�ng
to
the
Code
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
A
Necessary
Evil?
Back-‐office
Coding
The
“Super
Bill”
Back
to
the
Doctor?
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
36. The
Super
Bill
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Not
That
Super
Really…
[Note]
For
all
codes
related
to
fractures
of
the
radius:
• ICD-‐9
codes
=
33
• ICD-‐10
codes
=
1818
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
37. Medical
Concepts
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Medical
Scenario:
A
[27
year
old]
[male]
pa�ent
is
seen
in
[follow-‐up]
for
a
[Smith’s
fracture]
on
the
[right]
that
was
exposed
through
an
[open
wound]
with
[minimal
opening
and
minimal
�ssue
damage].
The
fracture
has
[not
healed
a�er
6
months].
Though
not
explicitly
stated
in
this
scenario
certain
expressions
imply
other
concepts:
“Smith’s
fracture”
>>
[fracture],
[radius],
[distal],
[dorsal
angula�on],
[extra-‐
ar�cular],
[displaced]
“minimal
opening
and
minimal
�ssue
damage”
>>
[Gus�lo
classifica�on
I]
“not
healed
a�er
6
months”
>>
[nonunion]
Expressing
the
pa�ent
condi�on
in
codes.
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
38. Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
39. New
Concepts
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Parameters
of
Severity
and
risk
Co-‐morbidi�es
Manifesta�ons
E�ology/causa�on
Complica�ons
Detailed
anatomical
loca�on
Sequelae
Degree
of
func�onal
impairment
Biologic
and
chemical
agents
Phase/stage
Lymph
node
involvement
Lateraliza�on
and
localiza�on
Procedure
or
implant
related
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
40. New
Concepts
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Open
Fracture
Classifica�on
ü Gus�llo
Classifica�on
I,II,IIIa,IIIb,IIIc
Growth
Plate
Injury
Classifica�ons
ü Sal�er
Harris
I
–IV
Fracture
Displacement
ü Displaced,
non-‐displaced
Joint
Involvement
ü Intraar�cular,
extrar�cular
Healing
Level
ü Rou�ne
healing,
delayed
healing,
nonunion,
malunion
Fracture
type
ü Segmental,
oblique,
pathologic,
stress,
stability,
avulsion,
torus
Severity
(Fracture
Example)
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
41. Documenta�on
Requirements
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Recurring
Concepts
Concept
Number
of
Codes
Right
12,704
Le�
12,393
Unilateral
127
Bilateral
821
Laterality
Concept
Number
of
Codes
Rou�ne
Healing
2,913
Delayed
Healing
2,913
Nonunion
2,895
Malunion
2,595
Healing
Concept
Number
of
Codes
Ini�al
Encounter
13,932
Subsequent
Encounter
21,389
Sequela
11,974
Encounter
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
42. Documenta�on
Requirements
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Recurring
Concepts
Concept
Number
of
Codes
Transverse
690
Oblique
522
Spiral
522
Torus
198
Greens�ck
54
Displaced
5,298
Nondisplaced
5,253
Comminuted
660
Simple
42
2-‐part
42
3-‐part
or
4-‐part
21
Segmental
522
Open
Fracture
Pa�erns
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
43. Coding
ICD-‐10
CM
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Diabetes
Concepts
Diabetes
=
276
ICD-‐10
Codes
/
83
ICD-‐9
Codes
Unique
concepts
within
in
ICD-‐10
codes
=
62
Diabetes
Type
Pregnancy
Neurologic
complica�ons
Type
1
diabetes
First
trimester
Neurological
complica�on
Type
2
diabetes
Second
trimester
Neuropathy
Underlying
condi�on
Third
trimester
Mononeuropathy
Drug
or
chemical
induced
Childbirth
Polyneuropathy
Pre-‐exis�ng
Puerperium
Autonomic
(poly)neuropathy
Gesta�onal
Antepartum
Amyotrophy
Poisoning
by
insulin
and
oral
hypoglycemic
Postpartum
Coma
Adverse
effect
of
insulin
and
oral
hypoglycemic
Underdosing
of
insulin
and
oral
hypoglycemic
Neonatal
Secondary
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
44. Coding
ICD-‐10
CM
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Diabetes
Concepts
Lab
Findings
Renal
complica�ons
Ophthalmologic
Complica�ons
Ketoacidosis
Nephropathy
Re�nopathy
Hyperosmolarity
Chronic
kidney
disease
Macular
edema
Hypoglycemia
Kidney
complica�on
Cataract
Hyperglycemia
Ophthalmic
complica�on
Mild
nonprolifera�ve
re�nopathy
Moderate
nonprolifera�ve
re�nopathy
Severe
nonprolifera�ve
re�nopathy
Prolifera�ve
re�nopathy
Background
re�nopathy
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
45. Coding
ICD-‐10
CM
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Diabetes
Concepts
Vascular
Complica�ons
Skin
Complica�ons
Joint
Complica�ons
Circulatory
complica�ons
Derma��s
Neuropathic
arthropathy
Peripheral
angiopathy
Foot
Ulcer
Arthropathy
Gangrene
Skin
complica�ons
Skin
ulcer
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
46. Coding
ICD-‐10
CM
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Diabetes
Concepts
Oral
Complica�ons
Diabe�c
Control
Encounter
Other
Concepts
Oral
complica�ons
Diet-‐controlled
Ini�al
encounter
Complica�ons
Periodontal
disease
Insulin
controlled
Subsequent
encounter
Right
Uncontrolled
Sequela
Le�
Controlled
Accidental
Inten�onal
self-‐harm
Assault
Family
history
Personal
history
Screening
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
47. Good
pa�ent
data
1. Complete
observa�on
of
all
objec�ve
and
subjec�ve
facts
relevant
to
the
pa�ent
condi�on
2. Documenta�on
of
all
of
the
key
medical
concepts
relevant
to
pa�ent
care
currently
and
in
the
future
3. Coding
that
includes
all
of
the
key
medical
concepts
supported
by
the
coding
standard
and
guidelines
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
It’s
all
about
good
pa�ent
care…
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
48. Ge�ng
Specific
When
is
unspecified
OK?
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
49. Good
pa�ent
data
1. Complete
observa�on
of
all
objec�ve
and
subjec�ve
facts
relevant
to
the
pa�ent
condi�on
2. Documenta�on
of
all
of
the
key
medical
concepts
relevant
to
pa�ent
care
currently
and
in
the
future
3. Coding
that
includes
all
of
the
key
medical
concepts
supported
by
the
coding
standard
and
guidelines
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
It’s
all
about
good
pa�ent
care…
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
50. Coding
specificity
What
makes
a
code
unspecified?
Is
“not
elsewhere
classified”
unspecified?
Does
the
use
of
codes
with
3-‐4
characters
mean
that
they
are
less
specified
than
codes
with
7
characters?
Does
the
use
of
the
term
“unspecified”
mean
that
the
code
is
not
specific
to
the
nature
of
the
condi�on
as
observed?
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
What’s
an
unspecified
code?
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
51. Coding
specificity
Does
specificity
require
more
than
one
code?
When
is
unspecified
the
right
choice?
When
should
unspecified
change
to
specified?
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
What’s
an
unspecified
code?
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
52. Poorly
Specified
Coding
“Coding
that
does
not
fully
define
important
parameters
of
the
pa�ent
condi�on
that
could
otherwise
be
defined
given
informa�on
available
to
the
observer
(clinician)
and
the
coder.”
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
A
proposed
defini�on
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
53. Coding
specificity
NOS
(Not
Otherwise
Specified)
means
that
the
code
selected
does
not
specify
some
level
of
detail
that
may
be
available
for
similar
condi�ons.
ü In
ICD-‐10
NOS
is
referred
to
as
“Unspecified”
NEC
(Not
Elsewhere
Classified)
means
that
the
code
selected
does
is
not
defined
in
any
ICD
classifica�on.
ü In
ICD-‐10
NEC
is
referred
to
as
“Other”
or
“Other
Specified”
While
in
theory
there
is
a
difference
between
the
two,
from
data
perspec�ve
either
code
is
not
specific.
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
NEC
or
NOS?
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
54. Coding
specificity
3
characters
,but
specific:
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
More
characters
–
be�er?
J60
-‐
Coalworker's
pneumoconiosis
7
characters
,but
less
specific:
S069X9A
-‐
Unspecified
intracranial
injury
with
loss
of
consciousness
of
unspecified
dura�on,
ini�al
encounter
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
55. Coding
specificity
The
use
of
the
term
“unspecified”
may
simply
refer
to
one
concept
of
several
concepts
about
a
condi�on.
For
example:
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Does
the
term
“unspecified”
mean
less
specific.
S82202J
–
Unspecified
[fracture]
of
[sha�]
of
[le�
�bia
],
[subsequent
encounter
]
for
[open
fracture
]
[type
IIIA,
IIIB,
or
IIIC
]
with
[delayed
healing
]
In
this
case,
mul�ple
details
in
[red]
about
this
fracture
are
specified
and
the
only
thing
not
specified
is
the
type
of
fracture
(displaced,
non-‐displaced,
spiral,
oblique
…)
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
56. Coding
specificity
The
fact
that
the
descrip�on
does
not
use
the
term
unspecified,
does
not
mean
the
code
is
specific.
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
No
term
“Unspecified”?
C7641
-‐
Malignant
neoplasm
of
right
upper
limb
M4837-‐
Trauma�c
spondylopathy,
lumbar
region
R6889
-‐
Other
general
symptoms
and
signs
R45.2
-‐
Unhappines
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
57. Coding
specificity
Beyond
the
primary
code,
accurate
representa�on
of
the
pa�ent’s
health
condi�on
may
require
other
codes
to
represent:
ü Causa�on
ü Infec�ous,
chemical,
physical
or
other
agents
ü Loca�on
of
Injury
ü External
causes
of
injury
ü Manifesta�ons
ü Comorbid
condi�on
or
contribu�ng
factors
ü Sequela
ü Findings
ü Mul�ple
other
factors
associated
with
the
primary
condi�on
being
treated
or
evaluated
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
More
than
one
code.
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
58. Coding
specificity
Some�mes
unspecified
makes
sense…
ü The
pa�ent
may
be
early
in
the
course
of
evalua�on
ü The
claim
may
be
coming
from
a
provider
who
is
not
directly
related
to
diagnosis
of
the
pa�ents
condi�on
ü The
clinician
seeing
the
pa�ent
may
be
more
of
a
generalist
and
not
able
to
define
the
condi�on
at
a
level
of
detail
expected
by
a
specialist
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
A
place
for
“unspecified”
codes
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
59. Coding
specificity
If
there
is
sufficient
informa�on
available
to
more
accurately
define
the
condi�on
For
basic
concepts
such
as:
ü Laterality
(Right,
Le�,
Bilateral,
Unilateral)
ü Anatomical
loca�ons
ü Trimester
ü Type
of
diabetes
ü Known
complica�ons
or
comorbidi�es
ü Descrip�on
of
severity,
acute
or
chronic
or
other
known
parameters…
Where
care
is
implemented
that
demands
a
more
specific
level
of
detail
At
specialty
level
that
should
be
able
to
define
the
detail
required
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
No
place
for
“unspecified”
codes
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
60. Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Analy�cs
Issues
with
transi�on
Ge�ng
the
most
of
ICD-‐10
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
61. Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Repor�ng
and
Analy�cs
Historical
Data
During
the
Transi�on
ICD-‐9
ICD-‐10
ICD-‐9
ICD-‐10
ICD-‐9
ICD-‐10
Early 2015
Late 2015
Early 2014
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
62. Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Coding
Quality
Accurate
and
Consistent
Assuring
accuracy
and
consistency
in
repor�ng
and
decision
making.
Consistent
Accurate
Accurate
&
Consistent
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
63. Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Quality
Measures
Challenges
to
measuring
performance
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
64. Quality
Measures
Impacts
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
AMI
example
Defini�on
of
acute
myocardial
infarc�on
(MI)
has
changed
ü ICD-‐9
–
Eight
weeks
from
ini�al
onset
ü ICD-‐10
–
Four
weeks
from
ini�al
onset
Subsequent
vs.
Ini�al
episode
of
care
ü ICD-‐9
–
Fi�h
character
defines
ini�al
vs.
subsequent
episode
of
care
ü ICD-‐10
–
No
ability
to
dis�nguish
ini�al
vs.
subsequent
episode
of
care
Subsequent
(MI)
ü ICD-‐9
–
No
ability
to
relate
a
subsequent
MI
to
an
ini�al
MI
ü ICD-‐10
–
Separate
category
to
define
a
subsequent
MI
occurring
within
4
weeks
of
an
ini�al
MI
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
65. Fraud
Waste
and
Abuse
If
you
can’t
stop
expenditures
upfront
…
Source:
$60,000,000,000/Year
Fraud,
Waste
and
Abuse
Enough
money
to
take
care
of
a
lot
of
need.
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
66. Fraud,
Waste
and
Abuse
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Medicare
Defini�on
Source:
CMS
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
67. Fraud,
Waste
and
Abuse
With
increasing
challenges
to
control
cost,
the
intensity
of
audits
related
to
fraud,
waste
and
abuse
is
increasing.
In
the
“Jus�fica�on
of
Es�mates
for
Appropria�ons
Commi�ees”
CMS
states:
“Although
the
ICD-‐10
code
set
will
not
eliminate
all
fraud,
waste,
and
abuse,
CMS
believes
that
its
increased
specificity
will
make
it
much
more
difficult
for
fraud,
waste
and
abuse
to
occur.”
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Don’t
get
caught
in
the
trap…
Source:
CMS
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
68. Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
4
Billion
Recovered
in
2010
Fraud,
Waste
and
Abuse
Don’t
get
caught
in
the
trap…
Source:
CMS
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
69. Healthcare
on
the
“RAC”
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Ge�ng
�ghter…
FY
-‐2010
FY
-‐2011
FY
-‐2012
Fy-‐2013
(Q1)
(Q1)X4
Series1
$75
$797
$2,291
$745
$2,979
$-‐
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
Correc�ons
in
Millions
Collected
Overpayments
Source:
CMS
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
70. Advantage
of
Moving
to
ICD-‐10
More
consistent
with
the
rest
of
the
world
ICD-‐9
is
30
years
old
We
are
already
using
ICD-‐10
for
mortality
repor�ng
Considerably
more
informa�on
per
code
More
clinically
relevant
Greater
expandability
in
and
flexibility
of
coding
structure
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
71. Advantage
of
Moving
to
ICD-‐10
Be�er
clarity
in
coding
guidelines
More
logical
tabular
structure
Be�er
defini�on
of
co-‐morbidi�es,
complica�ons
and
disease
manifesta�ons
Improved
support
for
analysis
related
to:
ü Predic�ve
modeling
ü Quality
and
cost
efficiency
analysis
ü Popula�on
based
research
ü Stra�fica�on
of
illness
ü Public
health
trending
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
72. Summary
ICD-‐10
will
be
a
substan�al
change
in
the
standard
for
defining
the
pa�ent’s
health
state
and
the
ins�tu�onal
procedures
performed
to
maintain
or
improve
that
health
state.
There
are
significant
impacts
to
both
the
clinical
and
business
side
of
the
prac�ce.
There
are
poten�al
impacts
to
Quality
and
Cost
metrics.
Documenta�on
is
a
cri�cal
requirement
for
proper
coding
and
billing
There
is
value
in
be�er
informa�on
based
on
be�er
coding
based
on
be�er
documenta�on
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Key
Points
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com
73. Summary
Focus
clinicians
on
the
need
for
good
documenta�on
Champion
the
value
of
ICD-‐10
in
a
new
environment
and
demonstrate
the
pi�alls
of
inadequate
documenta�on
and
coding
Provide
tools
and
templates
to
assist
in
documenta�on
and
coding
Collaborate
with
coding
professionals
Take
a
leadership
role
in
the
success
of
the
organiza�on
through
this
transi�on
Iden�fy
opportuni�es
to
collect
and
use
be�er
data
Get
started
now!!
Source:
Health
Data
Consul�ng
and
h�p://
www.noworldborders.com
Ac�on
Items
For
a
complete
copy
of
this
presenta�on
contact
us:
ICD-‐10@noworldborders.com