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ICD-­‐10	
  For	
  Clinical	
  Staff	
  
Clinicians	
  
	
  
Health	
  Data	
  Consul�ng	
  
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	
  
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	
  
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	
  
contact	
  us:	
  
ICD-­‐10@noworldborders.com	
  
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:	
  
ICD-­‐10@noworldborders.com	
  
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	
  
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	
  
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:	
  
ICD-­‐10@noworldborders.com	
  
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:	
  
ICD-­‐10@noworldborders.com	
  
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:	
  
ICD-­‐10@noworldborders.com	
  
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:	
  
ICD-­‐10@noworldborders.com	
  
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	
  this	
  presenta�on	
  contact	
  
us:	
  
ICD-­‐10@noworldborders.com	
  
“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	
  
“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	
  
“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	
  
“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:	
  
ICD-­‐10@noworldborders.com	
  
“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:	
  
ICD-­‐10@noworldborders.com	
  
“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:	
  
ICD-­‐10@noworldborders.com	
  
“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:	
  
ICD-­‐10@noworldborders.com	
  
“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	
  this	
  presenta�on	
  
contact	
  us:	
  
ICD-­‐10@noworldborders.com	
  
“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:	
  
ICD-­‐10@noworldborders.com	
  
“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:	
  
ICD-­‐10@noworldborders.com	
  
“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:	
  
ICD-­‐10@noworldborders.com	
  
“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:	
  
ICD-­‐10@noworldborders.com	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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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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	
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  presenta�on	
  
contact	
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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)	
  
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  a	
  complete	
  copy	
  of	
  this	
  presenta�on	
  
contact	
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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	
  
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  a	
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  copy	
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  this	
  presenta�on	
  
contact	
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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	
  
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  a	
  complete	
  copy	
  of	
  this	
  presenta�on	
  
contact	
  us:	
  
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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	
  
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  a	
  complete	
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  presenta�on	
  
contact	
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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	
  
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  a	
  complete	
  copy	
  of	
  this	
  presenta�on	
  
contact	
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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:	
  
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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	
  
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  a	
  complete	
  copy	
  of	
  this	
  presenta�on	
  
contact	
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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	
  
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:	
  
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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:	
  
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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:	
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  Data	
  Consul�ng	
  and	
  h�p://
www.noworldborders.com	
  
What’s	
  an	
  unspecified	
  code?	
  
For	
  a	
  complete	
  copy	
  of	
  this	
  presenta�on	
  
contact	
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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	
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  presenta�on	
  
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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	
  
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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:	
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  Data	
  Consul�ng	
  and	
  h�p://
www.noworldborders.com	
  
NEC	
  or	
  NOS?	
  
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  a	
  complete	
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  presenta�on	
  contact	
  
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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:	
  
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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:	
  
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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:	
  
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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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  
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	
  

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ICD-10 for physicians: its about good patient care and clinical documentation

  • 1. ICD-­‐10  For  Clinical  Staff   Clinicians     Health  Data  Consul�ng  
  • 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   contact  us:   ICD-­‐10@noworldborders.com  
  • 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:   ICD-­‐10@noworldborders.com  
  • 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:   ICD-­‐10@noworldborders.com  
  • 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:   ICD-­‐10@noworldborders.com  
  • 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:   ICD-­‐10@noworldborders.com  
  • 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:   ICD-­‐10@noworldborders.com  
  • 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:   ICD-­‐10@noworldborders.com  
  • 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  this  presenta�on  contact   us:   ICD-­‐10@noworldborders.com  
  • 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:   ICD-­‐10@noworldborders.com  
  • 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:   ICD-­‐10@noworldborders.com  
  • 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:   ICD-­‐10@noworldborders.com  
  • 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:   ICD-­‐10@noworldborders.com  
  • 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  this  presenta�on   contact  us:   ICD-­‐10@noworldborders.com  
  • 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:   ICD-­‐10@noworldborders.com  
  • 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:   ICD-­‐10@noworldborders.com  
  • 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:   ICD-­‐10@noworldborders.com  
  • 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:   ICD-­‐10@noworldborders.com  
  • 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