Surviving and Thriving in the ICD-10 Transition

Imagine that. Ingenious.

Surviving and Thriving in the ICD-10 Transition

Joy C. Burnette, RN, BSN, AACC, CHTS-IM, CPHIMSFebruary 2014

Introduction

• Hard deadline of October 1, 2014• Two perspectives- clinical and

administrative• Steps for ICD-10 transition• Benefits beyond the ICD-9 sunset• Transform data into information• Information translation to business and

clinical practice

ICD Past, Present and Future

• 1853- First International Statistical Congress• 1893- First International List of Causes of

Death- U.S., Canada and Mexico• 1948 World Health Organization International

Statistical Classification of Diseases (ICD)• 1976- ICD revision 9• 1989- ICD revision 10• October 1, 2014- U.S adoption of ICD-10

Why Not ICD-11?

• Web based• Multi-purpose• Coherent classification across nations• Function in the EHR/EMR environment• Different from ICD-10

– Definition of disease– Descriptive characteristics

Two Perspectives

• Administrative– Required to process bills– Business intelligence reporting

• Clinical– Required for bill processing and payment– Increased documentation– Increased time for administrative duties

Workgroup for Electronic Data Interchange (WEDI) ICD-10

• Survey since 2009- status of industry readiness

• October 2013• Reasons for delay

– Change in compliance date– Competing priorities– Other regulatory mandates– Staffing– Vendor readiness

Workgroup for Electronic Data Interchange (WEDI) ICD-10

Completed impact as-sessment

50%

Impact as-sessment in

201450%

Provider Readiness

Internal testing67%

External testing 33%

Health Plan Readiness

Half-way with product de-velopment

20%

Beta testing60%

Product Ready20%

Vendor Readiness

Benefits of ICD-10

• Consistent with current clinical practices• Room for additional codes, identifying clinical diagnoses

and modes of care• Better data

– Measure quality, safety, and efficacy of care– Reduce need for attachments– Conducting research– Setting health policy– Designing health care delivery systems– Resource utilization– Detect fraud and abuse– Track public health risks

• Move beyond compliance to competitive advantage

Patient Benefits of ICD-10

• Improve patient outcomes• Best of care- evidence based medicine• Financial fitness- decrease risk of fraud• Healthcare delivery systems

improvements• Public health

Steps to ICD-10

• Form a multi-disciplinary leadership team- align expectations• Impact assessment- workflow perspective• Reach out to the vendor(s)

– Software tools– Internal testing– External testing

• Training plan• Change management

– Additional coder time– Additional IT support

• Documentation, coding and business analytics• Post transition surveillance

Transition Method

• Clinician bills with ICD-9 and billers code ICD-10 (25% of WEDI)– Learning curve initially on the biller side– Clinicians lag in specificity of documentation– Clinician learning curve postponed– Increased communication for clarifications– Increased time to process claims– Potential to lengthen revenue cycle

• Clinicians bill with ICD-10 (50% of WEDI)– Learning curve is shared by clinician and biller– Documentation issues resolved jointly

ICD-10 Code Capture

• Paper superbill• Data abstract• Electronic charge/bill capture

– EHR– Billing charge capture

Develop protocols for clinical data capture and documentation

After the ICD-9 Sunset

• Benefits of ICD-10– Patient– Clinician– Institution

• Big data analytics– Avoid data paralysis– Start small, well defined question– Prospective vs. retrospective

• Data transformed into information• Information translated to clinical practice• Business intelligence

Post-implementation

• Surveillance• Continuing process of improving clinical

documentation• Business analytics• Clinical outcomes monitoring

– Readmissions– Mortality

• Change management

Canadian Experience with ICD-10

• 10 year experience• Improvements in care

– Diabetes– Acute myocardial infarction– Injury prevention

• GEMS as a tool for ICD-9 to ICD-10– The GEMS shortcuts made learning curve longer– Not a long-term solution

Summary

• Start the ICD-10 transition planning now• Budget requirements• Milestones- anticipate roadblocks and pitfalls• Contingency plans• Training- ongoing process• Post implementation surveillance• Analytics

– Business– Clinical

…An ounce of planning is more valuable than a pound of procrastination