2. Cortnie R. Simmons, MHA, RHIA, CCS
Director of ICD-10 Program
Kforce Healthcare
Cortnie R. Simmons, MHA, RHIA, CCS is the Director if ICD-10 for Kforce Healthcare
where she is responsible for implementing ICD-10 CM/PCS related technology and
service offerings for healthcare payers and providers and oversees the rollout of
ICD-10 CM/PCS training and education to more than 500 Kforce Consultants.
Ms. Simmons has 11 years of HIM consulting and coding experience in healthcare.
Ms. Simmons is a graduate of Florida A&M University’s Health Information Management program. She
completed her Masters in Health Administration at University of Maryland University College and also has
her certificate in Healthcare Informatics from St. Petersburg College.
She has held various roles in HIM and coding with both hospital systems and healthcare vendors. She began
her career as a coding consultant in a large consultant firm where she perfected her skills in ICD-9 CM and
CPT coding as a coding auditor and CDI specialist. Ms. Simmons has also spent several years working for
Hospital Corporation of America where she was responsible for coding and HIM support for several
facilities, which included training and education, auditing, risk reduction, and results reporting. Ms.
Simmons currently serves as the Florida Health Information Management Association Chair for ICD-10 as
well as a member of the AHIMA Clinical Terminology and Classification Practice Council. She also is an
adjunct instructor for a Coding and Healthcare Informatics program.
Ms. Simmons has experience conducting educational presentations on ICD-9, CPT and ICD-10 to various
organizations and healthcare facilities across the country including speaking engagements at AHIMA,
NCHIMA, FHIMA, and other State Association meetings, workshops, and/or roundtables. In 2010, Ms.
Simmons became an AHIMA Certified Train the Trainer for ICD-10 CM and ICD-10 PCS. She has
authored several coding and compliance-related articles for AHIMA, HCPro and other publications on
ICD-10 and other coding topics.
3. Agenda
Brief “baseline” overview of ICD-10
Why is it important?
What is it?
Comprehensive Preparedness
Assessments and why they are important
Documentation Challenges in ICD-10 CM/PCS
Preparing for Challenges
5. CMS Goals for ICD-10 CM/PCS
Measure quality, safety and efficacy of care
Reduce need for attachments to explain patient’s condition
Design payment systems and process claims for reimbursement
Conduct research, epidemiological studies and clinical trials
Set health policy
Operational and strategic planning
Design health care delivery systems
Monitor report utilization
Improve clinical, financial and administrative performance
Prevent and detect health care fraud and abuse
Track public health and health risks
4
6. Myths vs. Facts
MYTH FACT MYTH FACT
• Unnecessarily • As with ICD-9- • The • The greater
detailed CM, ICD-10- increased number of
medical record CM/PCS codes number of codes in ICD-
documentation should be based codes in ICD- 10-CM/PCS
will be on medical 10-CM/PCS make it easier
required when record will make the to find the
ICD-10- documentation. new coding right code.
CM/PCS is system
implemented. impossible to
use.
5
7. Why is Preparing for ICD-10 Important?
ICD-10 is the biggest change to healthcare providers
since the creation of Medicare in 1965
Implementing ICD-10 will impact every IT system,
process and transaction that contains or uses a
diagnosis or procedure code
The devotion of time and resources will be greater
than that required for Y2K or MS-DRG
readiness
8. What Entities are Impacted?
Payers
Reimbursement systems
Contracts
Claim systems
Providers
Hospitals
Physicians
HHA’s, Rehabs, SNFs, LTACs
Clearinghouses, Vendors, Employers
Source: American Hospital Association
9. Who Needs to be Trained?
Stakeholders L M H
Coders – inpatient and outpatient √
Physicians and Mid Levels √
Clinical documentation specialists √
Case management / UR √
Decision support √
IT professionals √
Patient access and PFS personnel √
Researchers (if applicable) √
Administration √
8
10. Educational Tiers/Levels
Staff that require familiarity &
Tier 1- awareness of impact of the changes
between the two code sets (e.g.,
Low physicians)
Staff that require a moderate
Tier 2- understanding to interpret & use
ICD‐10 CM/PCS ( e.g., quality
Medium management, UR, compliance)
Staff that require a detailed or expert
Tier 3- understanding to apply & interpret
ICD‐10‐ CM/PCS (e.g., coders, coding
High auditors, clinical documentation
specialists)
11. Education & Training
Extensive Stakeholder Training will be required throughout the organization
700
5,434 Hours Total Hours: 15,554
600
9,224 Hours Total Count: 1,084
500
Number of Staff
400
300
200
100
896 Hours
0
Tier 1/ Low (457) Tier 2/Medium (608) Tier 3/High (19)
12. Systems Requiring Assessment for ICD-10 Compliance
Accounting Systems Medical necessity software
Clinical systems Test-ordering systems
Physician practice management Clearinghouse EDI systems
systems Medical record abstracting
Aggregate data reporting Utilization management
Decision-support systems Clinical protocols
Provider profiling systems Payer claims adjudication systems
Billing systems All Custom Reporting systems,
Disease management systems Interface Engine coding,
Quality management Data Extracts & Custom Data Bases
Case management Clinical reminder systems
Encoding software Performance-measurement systems
Registration and scheduling All systems sending and receiving
systems clinical information to/from external
Case-mix systems resources
11
13. What Could Happen?
Failure to successfully implement could cause
cash flow reductions and /or delays through:
Coding and billing backlogs (i.e. DNFB)
Increased claims “downgrades” and rejections
Payer contacts at risk due to poor quality ratings
Permanent loss in coder productivity (20 – 50%)
increasing costs (Also consider coder cost
premium near go live)
Substantial cost to remediate / replace IT
systems
14. Organizational Cost
Projected Organizational Cost by Bed Size
Bed Size Projected Organizational Cost
400+ $1,000,000 – 5,000,000
100 – 400 $500,000 – 1,500,000
<100 $100,000 – 250,000
American Society of Clinical Oncology 13
17. ICD-9 CM vs. ICD-10 CM
Similarities Differences
• Index Abbreviations • 3 to 7 characters
• Punctuations • First character alpha
• Coding Conventions • Excludes 1 and Exclude
• Include Notes/Inclusion 2
Notes • 21 Chapters
• All Categories are 3 • Combination codes
characters • Laterality
• Guidelines (coding, • Episode of Care
chapter specific) • Expanded codes
• Trimester codes
• Changes in timeframe
18. ICD-9 CM vs. ICD-10 PCS
Similarities Differences
• Used for reporting • Codes are arranged
inpatient services into tables
and procedures • Codes contain 7
characters
• Codes are
alphanumeric
• Root operations
• Each character has
a specific meaning
1
7
20. One ICD-9 Code….. Multiple ICD-10 Codes
ICD-10-PCS
0H96X0Z Drainage of Back
Skin with Drainage
Device, External Approach
0H96XZZ Drainage of Back
Skin, External Approach
Plus 264 other codes
8 6 0 4 specifying location
(e.g. Left upper
extremity, elbow, abd
omen, genitalia, etc.),
Other incision with depth (e.g. skin or
subcutaneous tissue)
drainage of skin and approach (e.g.
external, open
subcutaneous tissue , percutaneous, percu
taneous
endoscopic), and
drainage device
23. Why are Many Providers not Prepared?
Management on overload. Focusing on more immediate
priorities e.g. meaningful use, HIE, cost reduction, etc.
Easy for management to think there is plenty of time to
address ICD-10, “10/1/13 right?”
Most industry surveys find less than 10% of providers
have started
Hospital management is too narrowly focused on coder
training as the issue and not the training needs of others
as well as the significant process and IT system changes
that are required and financial planning matters
24. Thoughts on Preparedness
Get organized – Form a Multi-disciplinary
Steering Committee (consider a PMO)
Develop a comprehensive approach that
includes Operations, IT and Finance
Develop a “Roadmap” of key projects and
project owners that covers now through 2013
Think past October 2013 as there will be much
to do after “go live”
25. ICD-10 Program Roles
Executive
Management
Sponsor
Operations
Steering
Committee
Program
Management
Office
Team Team Team Team External
Leader Leader Leader Leader Consultants
26. Operations Steering Committee Members
VP Compliance CIO
Lead Coder HIS Director
Case Management
IT Director
Director
CDI Team Leader Controller
Process Improvement
Multi-Disciplinary Team for 280 Bed Hospital
27. 280 Bed Hospital Work Streams and Projects
Work Streams Individual Projects
Operations 18
Information Technology 27
Finance 5
Total 50
Does not include 16 additional modules
related to Meditech 6.0 Upgrade
28. Implementation Hours by Quarter
9,000
8,000
7,000
6,000
5,000
4,000 PMO/PM Hrs
3,000 Total Hours
2,000
1,000
35,357 Total Hrs
-
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
'11 '12 '12 '12 '12 '13 '13 '13 '13
* Does not include Meditech 6.0 implementation
30. Budget by Quarter
$350,000
$300,000
$1.603 Million
$250,000
$200,000
$150,000
$100,000
$50,000
$0
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
'11 '12 '12 '12 '12 '13 '13 '13 '13
* Does not include Meditech 6.0 implementation
31. Other Considerations
Parallel Coding
When?
What % of accounts and which accounts?
CDI Program
More Staff?
Internally
Staff Augmentation
33. ICD-10 CM Code Structure
ICD-9-CM ICD-10-CM
3-4 characters 3-7 characters
All characters are 1st character is alpha
numeric (except E and
V Codes) 2nd character is numeric
All codes have at least All letters used except U
3 characters (digits) Decimal after 1st 3
characters
32 32
34. The Entire Code Structure Changes!
Diagnosis Code:
ICD-9-CM (3 – 5 numbers)
821.01 = Closed Fracture of shaft of femur
ICD-10-CM (3 – 7 alpha/numeric characters)
S72.344 = Displaced spiral fracture of
shaft of right femur
33
35. ICD-10 PCS Code Structure
ICD-9 CM ICD-10 PCS
ICD-9-CM has 3-4 ICD-10-PCS has 7
characters characters
All characters are Each can be either alpha
numeric or numeric
All codes have at least Numbers 0-9; letters A-
3 characters H, J-N, P-Z
Alpha characters are not
case-sensitive
Each code must have 7
characters
34 34
37. ICD-10 PCS Coding Example
Posterior spinal fusion of the posterior
column at L2-L4 levels with BAK
cage, interbody fusion device, open
38. ICD-10 PCS Coding Example (cont.)
0: MEDICAL AND SURGICAL
S: LOWER JOINTS
G: FUSION: Joining together portions of an articular body part rendering the articular body part immobile
Body Part Approach Device Qualifier
Character 4 Character 5 Character 6 Character 7
0 Lunbar Vertebral Joint 0 Open 3 Interbody Internal 0 Anterior Approach, Anterior
1 Lumbar Vertebral Joints, 2 3 Percutaneous Fixation Device Column
or more 4 Percutaneous 4 Internal Fixation Device 1 Posterior Approach, Posterior
3 Lumbosacral Joint Endoscopic 7 Autologous Tissue Column
Substitute J Posterior Approach, Anterior
H Interbody Synthetic Column
Substitute K Lateral Transverse Process
J Synthetic Substitute Approach, Posterior Column
K Nonautologous Tissue
Substitute
N Interbody Nonautologous
Tissue Substitute
Z No Device
5 Sacrococcygeal Joint 0 Open 4 Internal Fixation Device Z No Qualifier
6 Coccygeal Joint 3 Percutaneous 7 Autologous Tissue
7 Sacroiliac Joint, Right 4 Percutaneous Substitute
8 Sacroiliac Joint, Left Endoscopic J Synthetic Substitute
K Nonautologous Tissue
Substitute
Z No Device
9 Hip Joint, Right 0 Open 4 Internal Fixation Device Z No Qualifier
B Hip Joint, Left 3 Percutaneous 5 External Fixation Device
C Knee Joint, Right 4 Percutaneous 7 Autologous Tissue
D Knee Joint, Left Endoscopic Substitute
F Ankle Joint, Right J Synthetic Substitute
G Ankle Joint, Left K Nonautologous Tissue
Subsitute
Z No Device
H Tarsal Joint, Right
J Tarsal Joint, Left
K Metatarsal-Tarsal Joint,
Right
L Metatarsal-Tarsal Joint,
Left
M Metatarsal-Phalangeal
Joint, Right
N Metatarsal-Phalangeal
Joint, Left
P Toe Phalangeal Joint, Right
Q Toe Phalangeal Joint, Left
39. ICD-10 PCS Example Answer
0 S G 1 0 3 1
Section: Body Root Body Approach: Device: Qualifier:
Med/Surg System: Operation: Part: Open Interbody Posterior
Lower Fusion Lumbar Internal Approach,
Joints Vertebral Fixation Posterior
Joints Device Column
38
40. Polling Question
Have you or your facility participated in any
coding or documentation assessments to
prepare you for ICD-10?
Yes
No
No but they are
in the plans
41. Assessments – Are they Important?
Coding Assessments
Assess current knowledge
Anatomy, Physiology, Pathophysiology, and Terminology
Determine areas that need additional focus
Clinical Documentation Assessments
Determine the full extent of documentation reviews that will
be performed during the course of the ICD‐10 transition.
Operational Assessments
Determine who is affected by ICD-10 and what education
is needed
IT Technology Assessments
Determine what software/hardware upgrades will be
necessary
44. Documentation Assessments
Quality clinical documentation is a key factor in reporting
accuracy & ICD-10-CM/PCS code assignment.
Documentation assessments will provide insight into how
ICD-9-CM codes will map to ICD-10-CM/PCS & how
changes will affect your current high-volume/dollar cases.
Assess the current level of specificity & quality of physician
clinical documentation practices
Review top diagnosis codes, procedure codes &/or MS-
DRGs.
45. Documentation Assessments
Determine how frequently unspecified &/or non-descriptive
codes were used in the current ICD-9 system.
Determine if the documentation required to appropriately
assign diagnosis & procedure codes in ICD-10-CM/PCS is
present in the medical records reviewed.
Findings provide recommendations for documentation
improvement and assist in designing the physician
education program for your facility &/or organization.
46. Operational Assessments for Education &
Training
Stakeholder Training Count Hours
Unemployed Physician Office Staff 399 4,389
Other Staff 320 6,655
(Admissions, Registration, Nursing, e
tc.)
Unemployed Physicians 266 2,926
Employed Physicians 38 418
IT 24 72
Hospitalists 18 198
Coders 16 800
Clinical Documentation Improvement 3 96
Total 1,084 15,554
47. Technology Assessments
IT Assessment
Identified gaps in overall ICD-10 product/system readiness. 27
products/systems impacted by ICD-10 with significant implementation overlap
requiring careful critical path & resource management
• Product Readiness represents the state of IT readiness
to implement. Out of 100 IT products used at
Product Readiness Parkview, 27 products identified as ICD-10 impacted
• Assessed / Analyzed vendor readiness based upon
Vendor Readiness products impacted
• Two major clusters observed – cluster/dependencies
Roadmap & Budget within groups of products & clusters around Meditech
Planning upgrade
48. Polling Question
What do you believe the hardest transition
to ICD-10 will be?
Supporting documentation
Understanding the ICD-10 codes
ICD-10 code and guideline changes
50. A Few Documentation Challenges
Diabetes Mellitus
AMI
Pregnancy
Cerebral Infarctions
Injuries
Fractures
Respiratory/Vents
Drug Underdosing
ICD-10 PCS
51. New Documentation Requirements for ICD-10
Changes in Combination
Laterality
Timeframes Codes
Inclusion of
Greater Episode of
trimesters in
Specificity Care
OB Codes
50
52. There are More Codes and More Detail
Unstable Angina
ICD-9-CM – 1 CODE ICD-10-CM - 9 CODES
411.1 Intermediate Coronary I20.0 Unstable Angina
Syndrome, including
I25.700 Atherosclerosis of coronary
Unstable Angina artery bypass graft(s), unspecified
with unstable angina pectoris
I25.710 Atherosclerosis of
autologous vein coronary artery
bypass graft(s) with unstable angina
pectoris
I25.720 Atherosclerosis of
autologous artery coronary bypass
graft(s) with unstable angina
pectoris
I25.730 Atherosclerosis of
nonautologous biological coronary
artery bypass graft(s) with unstable
angina pectoris
51
53. There are More Codes and More Detail
Acute Bronchitis
ICD-9-CM – 1 CODE ICD-10-CM - 9 CODES
466.0 Acute Bronchitis J20.0 Acute bronchitis due to Mycoplasma
pneumoniae
J20.1 Acute bronchitis due to streptococcus
J20.3 Acute bronchitis due to
coxsackievirus
J20.4 Acute bronchitis due to parainfluenza
virus
J20.5 Acute bronchitis due to respiratory
syncytial virus
J20.6 Acute bronchitis due to rhinovirus
J20.7 Acute bronchitis due to echovirus
J20.8 Acute bronchitis due to other
specified organisms
J20.9 Acute bronchitis, unspecified
52
54. Diabetes Mellitus
ICD-9 CM ICD-10 CM
Categories 249-250 (59 Codes) Categories E08-E13 (200+ Codes)
4th and 5th digit identify Combination codes used to identify
manifestation, complication, or type manifestation and complication
Additional code for manifestation Type of diabetes is separated by
categories in ICD-10 (E10 Type 1, E11
Type 2)
Additional code for insulin Z79.4 used for long term insulin use
dependency V58.67
Drug induced goes to Drug Code/DRG
Inadequately controlled, poorly controlled,
out of control are assigned to diabetes by
type with hyperglycemia
55. Myocardial Infarction
ICD-9 CM ICD-10 CM
Categories 410, 414, and 412 Categories I21 and I22
4th and 5th digit identify location and I21- is used for NSTEMI and STEMI
episode of care
Acute is defined as symptoms lasting I22- was created for subsequent MI
less than 8 weeks (occurring within 4 weeks of initial)
Acute period changed to 4 weeks or
less
I22 has to be used with I21;
sequencing depends on reason for
admission
In the event of an untreated or unaddressed MI prior to admission, physicians will
need to determine and document when this occurred. This is particularly important
when addressing re‐infarctions or complication of AMI.
54
56. Pregnancy
ICD-9 CM ICD-10 CM
Categories 630-679 Categories O00-O9A
Code identifies trimester
Code identifies the number of
fetuses
Placeholders are often used in this
chapter
55
57. Pregnancy, Childbirth and Puerperium
On pregnancy, childbirth and puerperium charts
the episode of care (delivered, antepartum,
postpartum) are no longer the axis of classification
in assigning diagnosis codes.
The trimester in which the condition occurred is
now the driving factor.
1st trimester less than 14 weeks
2nd trimester 14 weeks to less than 28 weeks
3rd trimester 28 weeks to delivery
56
58. Ulcers
Ulcers (non pressure) documentation should
state the deepest tissue layer exposed (i.e.
fat layer, necrosis, necrosis of muscle or skin
breakdown only)
For pressure ulcers the site, laterality and
severity are specified in a single code in ICD-
10
More specific codes for bilateral pressure
ulcers of the same site
Added new codes for head, sacral, and
contiguous sites
57
59. Pressure Ulcers– What a Difference!
ICD-9 CM ICD-10 CM
9 location codes, 125 possible codes
second code showing more specific
shows stages, location as well as
depth
15 codes total
Example: Pressure
ulcer of right lower
back, stage III
58
60. Cerebral Infarctions
Greater Specificity Required
Specific artery involvement
Vertebral artery
Carotid artery
Cerebellar artery
tPA (rtPA) given in a different facility within 24 hours
Glasgow Coma Scale
Laterality
5
9
61. Trauma Documentation Requirements
Assigned separately for each Require laterality and specific
injury location
Have a 7th character Cord injuries of the neck
extension to identify the require specific type and the
encounter type, with “A” as specific level of the cervical
initial encounter and “D” for vertebra involved
subsequent encounter
Internal Organ Lacerations/
Lacerations reported as with Contusions
and without foreign body Minor – length and depth –
less than 1 cm spleen
Puncture wounds are
reported separately with and Moderate – length and depth
without foreign body -1 to 3 cm spleen
Infected lacerations are Major – length and depth –
reported as both a laceration greater than 3 cm
and a wound infection
60
62. Fractures
ICD-9 CM ICD-10 CM
Categories 800-829 Default is displaced fracture
Fracture not indicated as open or Fracture not indicated as open or
closed should be classified as closed should be classified as
closed closed
Codes are organized by type of Gustilo-Anderson classification for
injury and then by site assigning the 7th character
extension for open fractures
Codes are organized by site and
then by type
Category M80 – non-traumatic
fractures
61
63. Hip and Knee Replacements
Type of implant for hip replacements need
to be documented (i.e. ceramic on
ceramic, ceramic on polyethylene, metal
on metal, metal on polyethylene)
62
64. Mechanical Ventilation
In ICD-10 mechanical ventilation is categorized by:
less than 24 hrs,
24 to 96 hrs and
greater than 96 hrs.
Length of stay assigned will more than likely be
sequenced by number of hours on vent.
63
65. Underdosing
New to ICD-10
Combination codes exist that can identify a
situation where a patient has taken less of a
medication than prescribed, as well as the
specific drug.
The medical condition is sequenced first with the
underdosing code listed as a secondary
diagnosis.
Intentional vs. unintentional
Underdosing of insulin due to an insulin pump
failure
66. Incision and Drainage
Document the following:
Site of drainage
Type of approach (i.e. open, percutaneous,
external)
Note if a drainage device was left
65
68. Current Challenges
Physician Documentation
Education & Training
Productivity
Payer Readiness
System Upgrades
69. Preparing for ICD-10 CM/PCS
Establish Documentation Assessment Methodology
Determine the full extent of documentation reviews that will be performed
during the course of the ICD‐10 transition.
Establish types of assessments/reviews
Establish timelines for the performance of the documentation
assessments
Transitional documentation needs:
Use of queries that use both ICD‐9‐CM terminology and ICD‐10
terminology (MI time frames and capture of OB/pregnancy trimester
information)
Template queries that contain multiple choice selections should be
cleansed to assure terminology that is obsolete in ICD‐10 (such as
urosepsis) is removed.
Cross‐coding of records in both ICD‐9‐CM and ICD‐10‐CM to allow
coders and CDS staff to determine if documentation is sufficient and to
allow appropriate training in coding
70. Preparing for ICD-10 CM/PCS
Where will the results be disseminated?
Senior leadership
Service line meetings
Senior Committee Meetings
CDS and coding staffs meetings
Utilize the assessment results
Physician education materials and Pocket cards
Educational presentations
What will be the effect on current physician orders,
protocols, etc?
71. What can you do to prepare?
Begin studying
Begin learning
PCS
about GEMs
definitions
Learn about Refresh
the Structure, knowledge of
Organization, biomedical
and Features sciences
Understand
the ICD-10
Next Learn the
fundamentals
of ICD-10 CM
Final Rule
Steps and PCS
system
72. Tips for Coders/CDI Specialists
Explore available resources like the MLN (Medicare Learning
Network) and CMS (Centers for Medicare and Medicaid Services) for
links, tips, and frequently asked questions.
Familiarize yourself with the new code set. The ICD-10 codes will
allow for greater clinical details in describing conditions and a great
test for any practice is to take some of your most common codes and
using these tools determine the difference ICD-10 will make with that
particular code.
Become a “coach” for your providers and see if they are coding
specific enough to allow for accuracy with the new set.
Be knowledgeable in coding, anatomy, and physiology.
Keep reminding everyone of these changes and help out where you
can.
73. General Equivalence Maps
GEMs – General Equivalence Maps exist to translate data from
ICD-9 to ICD-10 or vice versa
Bi-directional
Good for
• Databases used for multiple year analyses
• Trending
• Research studies
• Focusing on potential issues between 9 and 10
A single ICD-9 code disease or procedure may now be represented
by multiple ICD-10 codes
Cannot arbitrarily pick an ICD-10 code
• Might pick a code that does not represent complexity of service
you are providing or patients that you are seeing (e.g. an
“unspecified” ICD-10 code)– could result in underpayments
• Might pick a code that overstates patient complexity or services
provided
74. General Equivalence Mappings
Use the GEMs When…
You are translating lists of codes, code tables, or other
coded data
You are converting a system or application containing ICD-9-
CM codes
You are creating a “one-to-one” applied mapping (aka
crosswalk) between code sets that will be used in an
ongoing way to translate records or other coded data
You want to study the differences in meaning between the
ICD-9-CM classification systems and the ICD-10-CM/PCS
classification systems by looking at the GEMs entries for a
given code or area of classification
75. AHA Coding Clinics
Will they be published for ICD-10?
Will ICD-9 be converted to ICD-10?
76. Maintaining Certification through AHIMA’s
Begin earning ICD-10-CM/PCS specific CEUs during the
period of 01/01/11 – 12/31/13
CHPS – 1CEU
CHDA – 6 CEUs
RHIT – 6 CEUs
RHIA – 6 CEUs
CCS-P – 12 CEUs
CCS – 18 CEUs
CCA – 18 CEUs
****Note: Multiple credential-holders educate to the
highest CEU requirement
77. Maintaining Certification through AAPC
Testing 10/01/12 – 09/30/13
Must pass proficiency to maintain AAPC
certification (AHIMA has similar program)
Online, timed test
75 questions, open book
May utilize any resources available
$60 exam fee (take exam twice)
78. Training Considerations
Training Considerations o WHO?
Final Regulation states: • coders
16 hours ICD-10-CM • billing/compliance
(diagnosis) • physicians
24 hours ICD-10-PCS • data users
(procedures)
o WHAT?
10 hours additional
• diagnosis coding
practice
• procedure coding
Total training = o WHEN?
50 hours (Inpatient • start now
Coders) o HOW?
26 hours (Outpatient • in-house programs
Coders) • AHIMA certified trainers
Just as an increase in the number of words in a dictionary doesn’t make it more difficult to use, the greater number of codes in ICD-10-CM/PCS doesn’t necessarily make it more complex to use. In fact with the greater level of specificity it should make it easier.
Interviewed 20 departments….Reviewed roles and responsibilities
So no a lot of us have seen and or read about the differences in ICD-10 from ICD-9 but lets take a second to review these. 17 Chp in ICD-9 vs 21 in ICD-10
So we have talked about the differences and similarities in ICDCM but now lets examine ICD10PCS
Doesn’t differentiate between skin or subcutaneous tissueDoesn’t specify site (e.g. scalp, left arm, buttock, abdomen)
Add chart, training hours by quarter
Add chart, training hours by quarter
Chart, budget dollars by quarter and in total
SoWhats so hard about ICD-10? I wanted to take today and tomorrow to discuss some of the areas that I beliieve to be challenges for ICD-10. Before we get into detail lets talk a little bit about the sturcture of the codes.
The ICD-9 codes have are semi easy to remember- any coder that has been coding for even a little while has memorized several codes. In fact I as 10 year old coder think in codes. When someone tells me they have hypertension I immediately think 401.9 or CHF 428.0 or Respiratory Failure 518.81 or even Non-Compliance V15.81. License plate story!!!! Don’t ask me any of these in ICD-10! However, I will teach you all one code- The Code for Hypertension…..Any guesses? I10
Looking at an example in ICD-9 of Closed Fracture of the shaft of the femur we see that the code is 821.01…. Easy to remember. In ICD-10 however the same codes goes to S72.344. There is also additional detail provided to idetnify the type of fracture as well as the location or laterality of the fracture
In the ICD-10 PCS example we see even bigger changes. The code many of know for Lap Appendectomy 47.01 is now coded to ODTJ4ZZ. As you can see all characters are used and all charters identify the story of this code when you dive in deeper. One of the interesting things about PCS is that order in which the code is devised is completely different from what we know in ICD-9. We essentially build a code in ICD-10 PCS based on the documentation. Lets look at an example of this
So here is an example of The procedure Posterior spinal fusion of the posterior column at L2-L4 levels with BAK cage, interbody fusion device, open. Using your ICD-10 PCS code book you would locate the first 3 characters of the code by using the root operation as well as the body system . So we know by reviewing this procedure that the root operation is a fusion and the body system is located in the lower joints for the Lumbar area. If we had a code book in front of us right now we would be able to determine our first 3 characters are OSG.
After locating OSG in the index of the PCS book you can then locate the table for OSG in the back of the PCS book. You can see on this screen that I have provided an exmaple of this. OSG is located at the top of the table. From here you are building the code based on the documentations in the medical record. By our example description we know that the body part involved the lunbarveretbral joints at L2-L4. We also know that the procedure is open with an interbody in internal fixation device, and of the posterior column. You can see on the slide that I have circled all of the characters for you. It is important to note when building your code you always build the code to the right in the same row, For Example you would not have choosen Z no qualifier on row 2 because you started in the 1st row. Another important note and advantage of ICD-10 PCS is that once you know your root operation and body system you can go directly to the table in the back of the book to build the code. So you may not have memorized the whole code but if you know the first 3 characters you can go directly to the table. Lets look at the final code.0SG1031
Here is the answer. As you can see each character tells you a story……..
I am not going to turn it to Jessica for a polling question. Jessica………..
So how important are assessments? As Jessica is compiling the results lets talk a little about this. There are number of assessments that are of assistance in preparing for ICD-10. Coding Assessment, Doc Assessment. Operational Assessments, and IT Assessments. I wanted to talk a little about the importance each of these and provide you some examples. Coding Assessments will assist with determing the Familiarity with anatomy and medical terminology will help with selecting the correct root operations and body parts in ICD-10 PCS. Clin Doc Assessments can look at the current program to ensure that it is effective as well as what deficencies exist for the docuementation needed in ICD-10. Operational assessemtn can help to determine who is affected by ICD-10 and what eedcuatipn is needed. Who currently uses ICD-9 codes, how, and to what extent do they need to be prepared for ICD-10. And IT assessment can help determine what software and hardware updgrades are necessary of ICD-10; what systems are affected; where are the vendors on the being ready?Jessica, can you share the assessment results with us?Now lets look at some examples and talk about these more in detail
This slide indicates the overall assessment results of 500 coding professionals that have taken an ICD-10 assessment. The assessment is centered around A&P , term and patho. As you can see the overall score is at about 67% for 500 people and from a categorialpersspecitve A&P was the area in which most coders struggeled. They were given 100 questions aournd these areas and 1 hour to complete all questions. The hour was timed in order to guage their general knowledge on these elements. Lets look at the next slide for additional breakbown
This slide show results by credential. Interestingly the RHIA/RHIT credentialed professionals did better than CCS and CPC credetnailed professionals. All 500 people that took the assessment had one or more of the 6 credentials.
Doc Assessments are a key factor in preparing for ICD-10. Coders can be trained and ready but the documentaion must be supportive of their code assignment. Mu suggestion is to review……I would also suggest possbily doing more than one of these during the education and training stages of ICD-10. These can be done internally by Coding or CDI staff or outsourced.
Doc Assessments are a key factor in preparing for ICD-10. Coders can be trained and ready but the documentaion must be supportive of their code assignment. Mu suggestion is to review……I would also suggest possbily doing more than one of these during the education and training stages of ICD-10. These can be done internally by Coding or CDI staff or outsourced.
I wanted to give you an example the importance of understaind the operrations of the organizaiton. This is an example of the number of people determined to potentailly need education in at 250 bed facility. You can see the number of people and the associated recommeded hours to prepare these people for ICD-10
This is also an example of the outcomes from a IT assessment. For the 250 bed faciltiy it was determined the 27 prociducts or systems were impacted by ICD-10. Prior to the assessment the facility thought only 12 were impacted. You can see also that vendor readiness was assessed and analyzed based on the identifed systems.
I will turn it over to Jessica now for another polling quesitons.
Why are we waiting for the Poll results lets talk a little about the documenation challenges for ICD-10?
ICD‐10 will require more detailed information than ICD‐9‐CM to select the most accurate code. Physicians do not always provide this level of detail and CDCI™ programs do not query all payers and all diagnoses In some cases this lack of detail will negatively impact DRG assignment. I wanted to disucss some of the areas where major changes can be seen. These being…………… and ICD-10 PCS the entire system. Before we move on Jessica do we have the poll results?
Moving to ICD-10 is expected to impact all physicians. Due to the increased number of codes, the change in the number of characters per code, and increased code specificity, this transition will require significant planning, training, software/system upgrades/replacements, updating superbills/charge tickets as well as other necessary investments.
So lets look at a couple of quick examples. Here we have USA or Unstable Angina. As a coder we know this code as 411.1. In ICD-10 there are 9 codes to indicate USA. You can see that each code as a different meaining unlike ICd-9
Here is also an example of 466.0
Lets talk about Diabetes…..
Lets talk about Mi
In instances when a patient is admitted to a hospital for complications of pregnancy during one trimester and remains in the hospital into a subsequent trimester, the trimester character for the antepartum complication code should be assigned on the basis of the trimester when the complication developed, not the trimester of the discharge. oIf the condition developed prior to the current admission/encounter or represents a pre‐existing condition, the trimester character for the trimester at the time of the admission/encounter should be assigned.
This gives an idea of why more documentation is required.
Some additional code comparisons for fractures include the following:Index main term in ICD-9 = Reduction/ ICD-10 root operation is RepositionIn ICD-9One code includes both radius and ulna/ICD-10 radius and ulna are classified separatelyLaterality is not specified in ICD-9/ Body Part (Character 4) indicates lateralityAdditional documentation from physicians would include: site of reduction, including laterality; approach and specific type of internal fixation device
4 charts were reviewed (3 knee, 1 hip)Hip replacement lacked type of synthetic material used (i.e. ceramic, polyethylene or metal)
In ICD-9 mechanical ventilation was categorized by less than 96 hours and greater than 96 hours. In ICD-10 mechanical ventilation is categorized by less than 24 hours, 24 to 96 hours and greater than 96 hours.
Undersoding is new to ICD-10. This applies with a pattient………
Why are we waiting for the Poll results lets talk a little about the documenation challenges for ICD-10?
So we know there are challenges with ICD-10Productivity- there will be some loss. Some facilities are trying to lessen this blow with parallel coding before October 2013
So just a couple of tips to prepare for ICD-10 C and PCS
Understand the ICD-1Qfinal rule and itsimplications to your coding position.2. learn about the structure, organization,and unique features of ICD-1Q-CM andICD-1Q-PCS.3. Use assessment tools to identifyareas of strength/weakness in thebiomedical sciences (e.Jj., anatomy andpathOphysiOlogy).4. Review and refresh knowledge ofbiomedical sciences as needed basedon the assessment results.5. Begin studying ICD-1Q-PCSdefinitions(root operations and approaches).6. Begin learning about the generalequivalence mappings (GEMs) betweenBegin learning about the generalequivalence mappings (GEMs) betweenICD-9-CM, ICD-1Q-CM, and ICD-1Q-PCS.Seund Halfoj 2011 tkr~ 20121. ReView code structure and CodingIcCoDn-VJeDnt-iPonCsS. for ICD- J D-CM and2. Learn the fundamentals of thelCD-I D-CM and ICD-) D-PCS systems.3. Analyze and practice applying theGICUDid-)elinQe-sC.M and lCD-I D-PCS Coding4. Continue to study ICD>.1D-PCS definitions(memorize the definitions of approachesand root operations).5. COlltinue to review and refr~shknOWledge of anatomY'andphYSiology concepts. ~Explore available resources like the MLN (Medicare Learning Network) and CMS (Centers for Medicare and Medicaid Services) for links, tips, and frequently asked questions.Familiarize yourself with the new code set. The ICD-10 codes will allow for greater clinical details in describing conditions and a great test for any practice is to take some of your most common codes and using these tools determine the difference ICD-10 will make with that particular code.Become a “coach” for your providers and see if they are coding specific enough to allow for accuracy with the new set.Hone all your skills. Be knowledgeable in coding, anatomy, and physiology.Keep reminding everyone of these changes and help out where you can.
A couple of tips for coders and cdi to prepare for ICD-10 as well.Now I will turn it over to Jessica for questions.
GEMs- or General Equivalence Mapping are going to be imperative with the ICD-10 change. There are opportunities for us to get into analysis at facilities. Physicians and facilities can determine what codes they utilize the most (based on the diagnosis and procedures that they perform) to determine what codes ICD-10 codes map to the ICD-9 codes.
ICD-9 Coding Clinics have been around since 1984. The AHA will be publishing the coding clinic for ICD-10 CM and PCS however there are no plans to translate the previous issues to ICD-10
Regulations stated that a total of 50 hours are needed for training and education on ICD-10. Broken down into Who, what, when and how?