ICD-10 staff awareness

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ICD -10 STAFF AWARENESS
WHAT IS THIS COURSE?
This course is designed to provide a basic
awareness and understanding of ICD-10
and why it is so critical to our organization.
1
WHAT IS ICD-10?
We have all been hearing the whispers … and
screams … about the transition to ICD-10.
For many of you, you may know all too well what it
means and how it affects you in your job. For
others, you may not know much about ICD-10 and
what the fuss is all about.
2
INTERNATIONAL CLASSIFICATION
OF DISEASES (ICD)
• ICD-9 is currently the official system of
assigning codes to diagnoses and procedures
associated with hospital, outpatient, clinical
and physician utilization in the United States
• We will be transitioning to the next version
of ICD codes – ICD-10
3
• The DIAGNOSTIC CODE is like the
rebar in the cement of a building
 You may not know it’s there, but it
provides the structure and it is
everywhere!
• Defines Patient Illness (diagnosis,
signs, symptoms, diseases, disorders,
treatment, and medication)
 Provides for Billing and Reimbursement
 Measure Quality of Care
 Facilitates Clinical Research
 Determines Medical Necessity
 Captures Data for Reporting
https://www.whitecap.com/images/articles/rebar
/estimating-the-cost-for-rebar-materials-andlabor.jpg
4
FAREWELL ICD-9
• World Health Organization (WHO) took over responsibility for
ICD at its creation in 1948 in its Sixth Revision (ICD-6) to provide
a consistent way to monitor and trend diagnoses and diseases
• The United States has been using ICD-9 for over 30 years
• Payers cannot pay claims fairly using ICD-9, since the
classification does not accurately reflect current technology
• It is difficult to evaluate the outcome of new procedures and
emerging healthcare conditions when codes are not precise
 The healthcare industry cannot accurately measure
Quality of Care, particularly causes of mortality
 Clinical Research will be improved
 Impacts Billing and Reimbursement
ICD-9 Outdated
5
WORLDWIDE ICD-10 ADOPTION
The U.S. is one of the few developed nations that has
not transitioned to the ICD-10 system.
Germany
• Adopted in 1998
United Kingdom
Canada
• ICD-10-AM for morbidity
• Adopted in 1995
• Began adopting in 2001
• Implementation took 3
years
• Over 5-year
implementation
Russia
• ICD-10-CA for morbidity
• Adopted in 1999
• Coding is used for
statistical purposes
rather than for billing
China
• Adopted in 2002
Australia
Brazil
France
• Adopted in 1998
• Adopted in 1996
• Adopted in 1998
• Implementation took 2
years
• 2 years from decision to
change to actual
implementation was
insufficient lead time to
build the classification and
educate users
South Africa
• Adopted in 1996
Countries who have adopted ICD-10
SOURCE:
http://www.who.int/classifications/icd/en/
6
WHEN DOES THE CHANGE
FROM ICD-9 TO ICD-10 HAPPEN?
The deadline for
organizations to convert
from ICD-9 codes to ICD-10
codes is October 1, 2015
7
BENEFITS OF ICD-10
• We will be able to capture more detailed data to
support clinical research, quality outcomes, and
patient care
• For an academic organization, ICD-10 will
accommodate data capture of new technologies
and procedures and allow us to better define the
complexity of care provided
• ICD-10 data will be more easily retrieved in
electronic format, resulting in less manual work
in reporting, quality reviews, and auditing
8
BENEFITS OF ICD-10 (CONT’D)
• ICD-10 was designed with the idea that
healthcare delivery and technology are not
static, but constantly changing. It has far
greater granularity, specificity, and more
current healthcare information
• An important benefit and result: The
widespread efforts within our organization to
prepare for ICD-10 will yield improved
workflows, improved efficiency, and greater
organizational integration and teamwork
9
HOW DO WE MAKE THIS
CHANGE HAPPEN?
• There are seven UAHN - ICD-10 teams who will be
leading the implementation effort:
 Clinical Documentation Team – responsible for facilitating effective
clinical documentation
 Coding Team – responsible for transition to new ICD-10 codes
 Education Team – responsible for staff training
 Revenue Cycle Team – responsible for redesign of revenue cycle
processes
 Reimbursement/Finance Team – responsible for ensuring payer
and contract readiness, reimbursement and financial reporting
 Technology Team – responsible for remediation and integration of
IT systems for ICD-10 implementation
 The Health Plan – responsible for implementation as a payer
10
INTEGRATION WITH EPIC
• The Physician Advisory and
Executive Steering committees
oversee the ICD-10
implementation
 The Physician Advisory Committee
also provides oversight for the
Epic Project
• ICD-10 teams and Epic teams are
integrated
 Enables both projects to be in sync
with one another
11
ICD-10 IMPLEMENTATION
PROCESS
• Education needs are based on the staff member’s
position within the organization
• Several different forms of training will be used:
learning modules via HealthStream, posters,
group forums, etc.
• Coordination with Epic team
Epic includes both ICD-9 and -10 for dual coding options
ICD-10 tools are embedded in Epic to facilitate the
transition
12
WHAT CHANGES CAN
WE EXPECT?
• The number of diagnostic codes will increase
from approximately 17,000 today to 140,000
after ICD-10 is implemented
• Clinical documentation will require greater
specificity
• All providers and staff involved in documentation
and coding must have a thorough understanding
of ICD-10
• UAHN systems and workflows will need to be
modified to include ICD-10
13
NEXT STEPS
• The ICD-10 Teams will coordinate with the
departments impacted by the change
• Additional implementation training for
providers and staff directly affected by ICD-10, will
be rolled out through September, 2015
• An ICD-10 information site can be accessed via the
intranet
 From the home page, click on Departments and ICD-10
• Regular communications will keep everyone
informed of project progress
14
IN SUMMARY…
• ICD-10 is a significant change, but we are all
used to BIG and constant changes
• ICD-10 impacts all of us in some way, making it
vital that we understand what it is and how it
will change our industry
• Thorough preparation for
ICD-10 will allow for a
successful transition
15
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