ICD-10 101

CHIACoding and Data Quality Committee

2011

Developed October 2011

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 Organization’s (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

Introduction: Version 5010 New version of the HIPAA standards - Version

5010 includes: Technical Data content improvements The updated version is more specific in requiring the

data that is needed, collected, and transmitted in a transaction; its adoption will reduce ambiguities

Version 5010 addresses currently unmet business needs, including, for example, providing on institutional claims an indicator for conditions that were “present on admission” 

Most important: Version 5010 also accommodates the use of the ICD-10

code sets, which are not supported by Version 4010/4010A1

Today’s Uses of ICD-9-CM• In addition to HIM and Coding the ICD-9 code

set today is used in and for many others:▫ Reimbursement by payers▫ Medical necessity screening▫ Quality of care indicators▫ Outcome measurements▫ Medical care review▫ Method to index medical records▫ Storage and retrieval of dx data▫ Utilization patterns and review by payers▫ Research data▫ Statistics▫ Reasons for Denials▫ Monitoring and analyzing the incidence of disease and

other health problems▫ Identify health care trends and Future health care needs

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

Important ICD-10 Compliance Timeline• January 1, 2010 Payers and providers should begin internal

testing of Version 5010 standards for electronic claims

• December 31, 2010 Internal testing of Version 5010 must be complete to achieve Level I Version 5010 compliance

• January 1,2011 Payers and providers should begin external testing of Version 5010 for electronic claimsCMS begins accepting Version 5010 claimsVersion 4010 claims continue to be accepted

• December 31, 2011 External testing of Version 5010 must be complete to achieve Level II compliance

• January 1, 2012 All electronic claims must use Version 5010 Version 4010 claims are no longer accepted

• October 1, 2013 Claims for services provided on or after this date must use ICD-10-CM/PCS codes for medical diagnoses and inpatient procedures

ICD-9-CM & ICD-10 Code Freeze• Vendors, system maintainers, payers, and educators

requested a code freeze

• Last regular, annual updates to both ICD-9-CM and ICD-10 will be made on October 1, 2011

• On October 1, 2012 there will be only limited code updates to both ICD-9-CM & ICD-10 code sets to capture new technology and new diseases.

• On October 1, 2013 there will be only limited code updates to ICD-10 code sets to capture new technology and new diseases.

ICD-10 Code Freeze (con’t)• There will be no updates to ICD-9-CM on October 1, 2013

as the system will no longer be a HIPAA standard.

• On October 1, 2014 regular updates to ICD-10 will begin

• The ICD-9-CM Coordination & Maintenance Committee will continue to meet twice a year during the freeze

• The public will comment on whether new codes should be created during the freeze

• Any codes that do not meet the criteria of being a new technology or new disease will be held for consideration of inclusion in ICD-10 after the freeze ends

ICD-9-CM ICD-10-CM ICD-10 (WHO) ICD-9-CM ICD-10-PCS ICD-10 (WHO)0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

DiagnosisProcedure

ICD-10 GrowthDiagnosis Procedure

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Some Differences:Diagnosis Coding & DataICD-9-CM* ICD-10-CM*-3–5 characters in length -3–7 characters in length-14,315 diagnosis codes -69,101 diagnosis codes-Only V codes and E codes -ALL codes start with a letter start with a letter-Limited space for adding new codes -Flexible for adding new codes-Cannot identify laterality -Can identify laterality

* Based on the 2010 versions of ICD-9-CM and ICD-10-CM. ICD-10-CM will be used in all healthcare settings

ICD-10 CM Format

X X X X X X X

ExtensionEtiology, Anatomical site, SeverityCategory

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.

Why so Many Codes?• Greater specificity and detail in all diagnosis

codes:▫ 34,250 (50%) of all ICD-10-CM codes are related to

the musculoskeletal system▫ 17,045 (25%) of all ICD-10-CM codes are related to

fractures▫ 10,582 (62%) of fracture codes to distinguish ‘right’

vs. ‘left’▫ 25,000 (36%) of all ICD-10-CM codes to distinguish

‘right’ vs. ‘left’

Some Differences:Procedure Coding & DataICD-9-CM* ICD-10-PCS*-3–4 digits -7 alphanumeric

characters-3,838 procedure codes -71,957 procedure codes-Lacks detail -Very specific-Limited space for adding new codes -Flexible for adding

new codes-Generic terms for body parts -Specific terms for

body parts

• Based on the 2010 versions of ICD-9-CM and ICD-10-PCS.

• To be used only for hospital inpatient medical records.

Format of ICD-10 PCS

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.

Why so Many Codes?• Seven Character Alphanumeric Code:

▫ All procedure codes will be seven characters long▫ “I” and “O” (letters) are never used

• 34 possible values for each character▫ Digits 0 – 9▫ Letters A-H, J-N, P-Z

• A character is a stable, standardized code component▫ Holds a fixed place in the code▫ Retains its meaning across a range of codes

• A value is an individual unit defined for each character:▫ Section Body Root Body Approach▫ Device Qualifier System Operation Part

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

Implementation and Planning for ICD-10

• Establish an ICD-10 Steering Committee• Members should be multidisciplinary and are

key stakeholders• Establish a leader for implementation. HIM

and IT may want to co-lead the Steering Committee

• The plan should have a charter with goals, objectives, deliverables and timelines.

• Preparation is key!

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

ICD-10 System Readiness• Making sure that ALL systems that touch or use

ICD-9-CM codes today are ready for ICD-10 is critical.

• Have an inventory of all systems

• IT will lead the communicate with external users, vendors and payers in assessing their readiness

• Testing of systems prior to 10/1/2013 should be built into the implementation plan.

• Inventory of reports (digital and analog), and reporting to outside agencies and registries.

Education and Training• Education and Training is large component to ICD-10

implementation.

• Although HIM and Coding staff are the main target for Education and training due to the impact of ICD-10 to their work, others will also need education and training.

• Use “role based” education and training

• Consider conducting an assessment in the core areas for preparation of ICD-10.▫ This should have occurred by now (2011)

• The four core health science competency areas for ICD-10 are:▫ Medical Terminology▫ Anatomy & Physiology▫ Pathophys or Disease Process▫ Pharmacology

Education and Training•Provide education in the four core competency

areas based upon the assessment findings.

•Actual ICD-10 training should be delivery in 2013.▫AHIMA estimates approximately 16 hours of coding

training is needed for outpatient coders and 50 hours for inpatient coders.

•Go-live and post go-live plans should also be in place as education and training will be needed.

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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

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”.

BudgetingConsider 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

Use the CMS ICD-10 Website

AppendixICD-10 Myths & Facts

Myth: The Oct. 1, 2013 date for implementation should be considered a flexible date.

Fact: All HIPAA covered entities MUST implement the new code sets with dates of service, or date of discharge for inpatients, that occur on or after Oct. 1, 2013.

Myth: Implementation planning should be undertaken with the assumption that HHS will grant an extension.

Fact: HHS has no plans to extend compliance date for implementation of ICD-10-CM/PCS; covered entities should plan to complete steps required to implement on Oct. 1, 2013.

AppendixICD-10 Myths & Facts (con’t)

Myth: There will be no hard-copy code books and all coding will need to be performed electronically.

Fact: ICD-10-CM and ICD-10-PCS code books are already available and are a manageable size. The use of ICD-10-CM is not predicated on the use of electronic hardware and software.

AppendixICD-10 Myths & Facts (con’t)

Myth: The increased number of codes will make ICD-10-CM/PCS impossible to use.

Fact: Just as the size of a dictionary doesn’t make it more difficult to use, a higher number of codes doesn’t necessarily increase the complexity of the coding system –in fact, it makes it easier to find the right code.

Fact: Greater specificity and clinical accuracy make ICD-10 easier to use than ICD-9-CM.

Fact: Because ICD-10-CM/PCS is much more specific, is more clinically accurate, and uses a more logical structure, it is much easier to use than ICD-9-CM.

AppendixICD-10 Myths & Facts (con’t)

Myth: The increased number of codes will make ICD-10-CM/PCS impossible to use (con’t).

Fact: Just as it isn’t necessary to search the entire list of ICD-9-CM codes for the proper code, it is also not necessary to conduct searches of the entire list of ICD-10 codes.

Fact: The Alphabetic Index and electronic coding tools will continue to facilitate proper code selection.

Fact: It is anticipated that the improved structure and specificity of ICD-10-CM/PCS will facilitate the development of increasingly sophisticated electronic coding tools that will assist in faster code selection.

AppendixICD-10 Myths & Facts (con’t)

Myth: ICD-10-CM/PCS was developed without clinical input.

Fact: The development of ICD-10-CM/PCS involved significant clinical input. A number of medical specialty societies contributed to the development of the coding systems.

AppendixICD-10 Myths & Facts (con’t)

Myth: ICD-10-CM-based super bills will be too long or too complex to be of much use.

Fact: Practices may continue to create super bills that contain the most common diagnosis codes used in their practice. ICD-10-CM-based super bills will not necessarily be longer or more complex than ICD-9-CM-based super bills. Neither currently-used super bills nor ICD-10-CM-based super bills provide all possible code options for many conditions.

ICD-10 Web Resourceshttp://edocket.access.gpo.gov/2009/pdf/E9-743.pdf

http://www.cms.hhs.gov/apps/media/fact_sheets.asp

http://www.cms.hhs.gov/ICD10/01_Overview.asp

http://www.cms.hhs.gov/ICD10/03_ICD_10_CM.asp#

http://www.hhs.gov/news/press/2008pres/2008.html

http://www.cdc.gov/nchs/about/major/dvs/icd10des.htm

http://www.cdc.gov/nchs/about/otheract/icd9/abticd10.htm

http://www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm

http://www.ahacentraloffice.org/ICD-10

Other Resources

www.AHIMA.org

www.CaliforniaHIA.org

AcknowledgementWe 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.