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Presenter Instructions
The following ICD-10 slides and content was prepared by the CHIA Coding and Data Quality Committee as a tool and resource for the CHIA membership. The use of this ICD-10 101 material can be beyond that of HIM and Coding and this is encouraged. Having an ICD-10 101 information tool and document will help to promote awareness of implementation as well as promote consistency with messaging. (This slide would be deleted from the actual presentation)
Introduction
WHO (World Health Organization) owns & publishes ICD (International Classification of Diseases). WHO endorsed ICD-10 in 1990; members began using ICD-10 or modifications in 1994. U.S. is only industrialized country not using ICD-10, for morbidity reporting (coding diseases, illnesses, injuries in a healthcare setting). The U.S. has used ICD-10 for mortality reporting (coding of death certificates by Vital Statistics offices) since 1999. International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is a clinical modification of the World Health Organizations (WHO) ICD-10, which consists of a diagnostic classification system.
Introduction
The Final Rule for ICD-10 implementation in the Unites States was published in January 2009, giving a five year readiness timeline. ICD-10-CM (Diagnosis code set) includes the level of detail needed for morbidity classification and diagnostic specificity in the United States. It also provides code titles and language that complement accepted clinical practice in the United States. The Centers for Medicare & Medicaid Services (CMS) is driving the industry to upgrade core HIPAA transactions (5010) as well as diagnosis and procedure coding standards (ICD-10-CM/PCS)
PCS represents the procedural coding system to be used for hospital inpatient records
Most important:
Version 5010 also accommodates the use of the ICD-10 code sets, which are not supported by Version 4010/4010A1
Benefits to ICD-10
Enhanced system flexibility Better reflection of current medical terminology Expanded detail relevant to ambulatory and managed care encounters Incorporation of recommended revisions to ICD-9-CM that could not be accommodated
HIPAA criteria for code set standards are met Improved collection and tracking of new diseases and technologies Space to accommodate future expansion
ICD-10 Growth
80,000
Diagnosis
Procedure
70,000
60,000
30,000
20,000
10,000
11
ICD-10 CM Format
X X X X X X X
Category
Extension
ICD-10-CM code structure differs from ICD-9-CM in that it consists of three to seven characters, the first digit being an alpha character and second and third digits are numeric; the fourth and fifth digits may be alpha (not case sensitive) or numeric with a decimal after the third character.
Based on the 2010 versions of ICD-9-CM and ICD-10-PCS. To be used only for hospital inpatient medical records.
The procedure coding system for ICD-10-PCS will be used only on inpatient hospital stays. Outpatient surgery and physician outpatient coding will continue to use Current Procedural Terminology (CPT) for procedure coding. There are seven characters in each ICD-10-PCS (Procedural Coding System). In each section of PCS, the characters have slightly different meanings to relate to that particular section.
ICD-10 Impact
People and Business Communications with both internal and external key stakeholders Regarding preparation activities Human resource strategy, change management, organizational research and communication should come together. Process and Technology
Address and align technology and employee behavior with business needs. Monitor vendor readiness and compliance Analyze end-to-end information and data flow Impact all aspects of healthcare business and all settings:
Assessed Changed Tested and made ready
Key Stakeholders
HIM IT PFS/Billing Case Mgmt. and UR Decision Support Contracting Educators Compliance Physicians Clinical Documentation Improvement (CDI) staff Payers Vendors Revenue Cycle/Finance
Inventory of reports (digital and analog), and reporting to outside agencies and registries.
The four core health science competency areas for ICD10 are:
Medical Terminology Anatomy & Physiology Pathophys or Disease Process Pharmacology
Go-live and post go-live plans should also be in place as education and training will be needed.
AHIMA
AHIMA Certified Professionals are required by CCHIIM (Commission on Certification for Health Informatics and Information Management) to participate in a predetermined number of mandatory baseline educational experiences specific to ICD-10-CM/PCS. These ICD-10-CM/PCS specific CEUs will count as part of all AHIMA certificants total CEU requirements for the purpose of recertification. Stated differently, the following CEU requirements will be included as part of each certificants total, required CEUs, by credential, per CEU Cycle. The total number of ICD-10-CM/PCS continuing education units (CEUs) required, by AHIMA credential, is as follows: CHPS 1 CEU CHDA 6 CEUs RHIT 6 CEUs RHIA 6 CEUs CCS-P 12 CEUs CCS 18 CEUs CCA 18 CEUs Certificants who hold more than one AHIMA credential will only report the highest number of CEUs from among all credentials held. For example, if a certificant has both an RHIA and CCS, the certificant would normally report 40 (30 CEUs for RHIA and an additional 10 CEUs for CCS) CEUs per recertification cycle, and 18 of these CEUs will be required to cover ICD-10-CM/PCS.
Source: AHIMA ICD-10 website
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Documentation Assessment
Clinical documentation is critical today and will continue with ICD-10, thus engage Physicians and other clinicians is important to successful implementation A documentation assessment will be helpful
Conduct a review of actual medical records Identify gaps (ie nonspecific diagnostic or procedure terms)
Remember: Coders are required to code to the highest degree of specificity, but the quality of the physician documentation HAS to be there in the medical record before coding can be achieved. Expect an increase in the # of physician queries that will be generated from ICD-10. Existing physician queries will most likely have to be updated as you will be asking for different documentation to capture specificity.
Budgeting
Consider the following:
Coding/HIM Assessment Coding/HIM Prerequisite coursework ICD-10 coding education/training Coverage for coding staff while in education/training Productivity decrease and coverage IT assessment Documentation assessment
Other Resources
AHIMA.org CHIA.org
Acknowledgement
We wish to acknowledge and thank the California Health Information Management Association Coding and Data Quality Committee. Especially Monica Leisch, Chantel Susztar, Gloryanne Bryant and Elaine Lips for their input and assistance in developing this ICD-10 101 presentation.