Update to
ICD 10 CM Diagnostic Code Set
Agenda
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Why ICD 10 CM?
Highlights of ICD 10 CM & ICD 10 PCS
Is it a big change?
Timeline
Make your Plans
We want your Feed back.
What are the Diagnostic Code Sets?
ICD 9 CM
 For Mortality &
Morbidity coding
 13,000 codes
ICD 10 AM
 For Morbidity &
Mortality coding
 15,000 codes
ICD 10
• For Mortality
coding
• 14,000 to 16,000
codes
ICD 10 CM
 For Morbidity &
Mortality coding
 68,000 codes
• Because Abu Dhabi continues to use version ICD-9, it
has difficulty comparing its health service utilization to
other countries.
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ICD-9-CM Limitations
• Space limitations
– Codes have already been assigned to
inappropriate sections
– Leads to challenges for coders
• Workarounds
– Use of ‘overflow’ chapters compromise the
structure of ICD-9-CM
• Emerging technology
– Not expandable nor detailed enough to capture
future healthcare information
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Why ICD-10-CM??
• Significant improvement in coding primary care
encounters, external causes of injury, mental
disorders, neoplasms, and preventative health
• Recognition of advances in medicine and technology
• More detail
• Addition of laterality (where the procedure or
disease is located)
• Expanded distinctions for ambulatory and managed
care encounters
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Highlights
In the US as of 2014
 ICD-10-CM (Diagnosis)
 Will affect inpatient
and outpatient
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ICD-10-PCS ( Procedures)
 Will only affect
inpatient in the U.S.
 NOT UAE -We have
CPT for outpatient
reimbursement
ICD-10-CM/PCS:
• Incorporates much greater specificity
and clinical information, which results
in:
Improved ability to measure health care
services;
• Increased sensitivity when
refining grouping and
reimbursement methodologies;
• Enhanced ability to conduct public
health surveillance; and
• Decreased need to include
supporting documentation with
claims;
•Includes updated medical terminology
and classification of diseases;
Highlights
In the US as of 2014
 All software will be ICD
10 based
 All certified coders will
be ICD 10 based
 All RVU’s will be ICD 10
based
 ICD 9 CM will no longer
be updated after 2012
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ICD-10-CM/PCS:
• Provides codes to allow
comparison of mortality and
morbidity data; and
• Provides better data for:
• Measuring care furnished to
patients;
•Designing payment systems;
• Processing claims;
•Providers making clinical
decisions;
• Tracking public health;
• Identifying fraud and abuse;
and
• Conducting research.
Why Upgrade to ICD 10 CM?
• A revised classification system that:
– permits international exchange of data for disease
prevention & advanced healthcare research;
– increases value of current clinical terminologies and
permits greater use of health information
technology to improve our health knowledge and
decision support while lowering the cost of
healthcare.
– gives more specificity to Payers to reduce denials
due to lack of information
Upgrade to ICD 10 CM
DSP
184
CCSC
092
Amend
decision to:
Implement
ICD 10 CM
one year
after
Implementat
ion in the
USA
Implement ICD 10 CM as
the Code Set for
Diagnostic coding one
year after implementation
the USA (which presently
means as of
Encounter.Start >=1 Oct
2015), contingent on
availability of DRG
grouper for pricing
minimum 12 months prior
to the implementation
date. Request DRG panel
to confirm the timeframe.
Daman: to
establish and
negotiate prices
Payers and
Providers will
need at least on
year after the
DRG grouper is
available for
pricing (not for
testing)
Is it a big change?
Comparison
ICD-10-CM
Mechanical complication of other vascular
grafts
156 codes, including
ICD-9-CM
Mechanical complication of
other vascular device,
implant and graft
1 code (996.1)
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T82.310 – Breakdown (mechanical) of aortic
(bifurcation) graft (replacement)
T82.311 – Breakdown (mechanical) of carotid arterial
graft (bypass)
T82.312 – Breakdown (mechanical) of femoral arterial
graft (bypass)
T82.318 – Breakdown (mechanical) of other vascular grafts
T82.319 – Breakdown (mechanical) of unspecified
vascular grafts
T82.320 – Displacement of aortic (bifurcation) graft
(replacement)
T82.321 – Displacement of carotid arterial graft (bypass)
T82.322 – Displacement of femoral arterial graft
(bypass)
T82.328 – Displacement of other vascular grafts
Comparisons
ICD-9-CM
14,025
ICD-9 Code Format
X
X
category
X
ICD-10-CM
68,069
Diagnosis Codes
X
ICD-10 Code Format
X
etiology,
anatomic site,
manifestation
X
X
X
category
X
X
X
X
extension
etiology,
anatomic site,
severity
Comparisons
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• Extensions
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•
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A = initial encounter
D = subsequent encounter
S = sequela (late effect)
Patient Case Scenario 1: Subarachnoid
Hemorrhage
• Patient is discharged with principal diagnosis of
nontraumatic subarachnoid hemorrhage,
commonly known as a stroke.
In ICD-9-CM there is one code: 430 Subarachnoid hemorrhage
In ICD-10-CM - twenty possible codes requiring detail of which artery
the hemorrhage came from for accurate code assignment.
right and left carotid siphon and bifurcation;
right and left middle cerebral;
right and left anterior communicating;
right and left posterior communicating;
basilar; right and left vertebral;
and other or unspecified intracranial arteries.
Patient Case Scenario 2: Fracture of the
Patella
• A patient is treated for fracture of the patella to
assign an accurate code, sixth and seventh
characters are needed in ICD-10-CM.
ICD-9-CM
822.0 - Fracture of patella, closed
ICD-10-CM
S82.021D - Fracture of patella, displaced longitudinal, right
patella - subsequent encounter for closed fracture with
routine healing
Tentative Timeline
Make Your Plan to ICD 10 CM
• Phase 1: Implementation plan development and
potential impact assessments
– Establish interdisciplinary steering committee to develop
ICD‐10 implementation strategy
– Development of potential impact assessments
• Phase 2: Implementation preparation
– Training/awareness on Codes and Code uses (data etc)
– Education on the available GEM and how to use
• Phase 3: “Go live” preparation
– Contracts
Make Your Plan to ICD 10 CM
• Impact assessment. The purpose of this assessment is
to anticipate who or what will be affected by the
transition to ICD-10-CM while determining the degree
of impact.
• An implementation budget must be created to address
the costs associated with upgrading technology and
training as well as the potential loss of productivity,
which can delay remittance.
• A systems inventory is necessary to identify systems
requiring modifications
– All processes and systems that pertain to ICD codes need to
be analyzed and modified to accommodate the expanded
alpha-numeric code structure of ICD-10.
Make Your Plan to ICD 10 CM
• Training: More intense training regarding the
specifics of the code set will be required for
those who use coded data for the purpose of
reimbursement, statistics, and/or research.
– Ahima estimates the training time for experienced
codes to be 16 hours with 10 hours practice)
– And we mustn’t forget the Documentation Training
required for doctors.
Make Your Plan to ICD 10 CM
•
•
GEMs
and the
multiple
of these
GEMs due
– to the
ICD-9-CM
to data
codeduses
under
ICD-10-CM
differences
in thefor
code
sets.
This will (exchange
impact reports
Maps
are created
many
purposes,
of
that for
compile
statistical
data foraccess
trend to
analysis.
data
patient
care purposes,
longitudinal
data, reimbursement, public health data reporting, and
Download
GEM from CMS website
KEH.
• Correct mapping requires a complete understanding of
http://www.cms.gov/Medicare/Coding/ICD10/2014-ICDhow data will be used.
10-CM-and-GEMs.html
– Even though standardized mappings will facilitate the process
of translating We
between
old feedback:
and new code sets, there will
wantthe
your
still be challenges connecting data coded under
HealthSystemFinance@haad.ae
•
• http://www.shafafiya.org/dictionary/portal/
• ccsc@haad.ae