ICD-10 is Coming
Ready or Not
Dr. Thomas Ayoub
Norwalk Hospital
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ICD - International Classification of Diseases
– Issued by World Health Organization (WHO)
– Used world-wide as tool to classify diseases and other
health problems
USA is the only country to use ICD codes for
billing purposes
3/4/2014
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Change is long overdue
• USA is the last country to implement ICD-10
• ICD-9 been in use in the USA since 1979
• HHS proposed change to ICD-10 in 2008
• Original start date 2011 – there will be no more delays
3/4/2014
IT Issues
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Effects include:
• Clinical documentation/EHR systems
• Encounter forms/Superbills
• Practice management systems
• Contracts
• Public health and quality reporting tools
Much worse than Y2K
3/4/2014
How Can Physicians Prepare
March 4, 2014
Most Common ICD-9
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CMS recommends that offices start by:
• listing their most commonly used ICD-9 codes
• becoming familiar with corresponding ICD-10
codes
3/4/2014
Majority Rules
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Start with highest volume codes
The vast majority of practices use very few
codes…
5% of codes account for about 70% of the
volume
3/4/2014
Top Norwalk Hospital OB/GYN Diagnoses in ICD-9
Principal Diagnosis
SCREEN MAMMOGRAM NEC
ROUTINE GYN EXAMINATION
SCREEN MAMMOGRAM HI RISK
PREG STATE, INCIDENTAL
ABN FINDING-BREAST NEC
ICD-9
V76.12
V72.31
V76.11
V22.2
793.89
8
%
30%
12%
8%
4%
3%
The top 5 codes account for 57% of the volume.
3/4/2014
Translate ICD-9 to ICD-10
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Use free internet sites like
http://www.icd10data.com
or download free apps
3/4/2014
Example: OB/GYN Most Common Codes
ICD-9 Description
SCREEN
MAMMOGRAM NEC
ROUTINE GYN
EXAMINATION
ICD-9
Code
V76.12
V72.31
SCREEN
MAMMOGRAM HI RISK V76.11
PREG STATE,
INCIDENTAL
V22.2
ABN FINDING-BREAST
NEC
793.89
ICD-10
Code
10
ICD-10 Description
Encounter for screening mammogram
1:1 Match
Z12.31 for malignant neoplasm of breast
Encounter for gynecological examination
Z01.411 (general) (routine) with abnormal findings
Encounter for gynecological examination
Z01.419 (general) (routine) without abnormal findings
Encounter for screening mammogram for
1:1 Match
Z12.31 malignant neoplasm of breast
1:1 Match
Z33.1 Pregnant state, incidental
Other abnormal and inconclusive findings on
1:1 Match
R92.8 diagnostic imaging of breast
4 of top 5 codes have a direct, 1 to 1 Match
3/4/2014
Example: OB/GYN Most Common Codes
ICD-9 Description
SCREEN MAL NEOPCERVIX
SUPERVIS OTH
NORMAL PREG
LUMP OR MASS IN
BREAST
INCONCLUSIVE
MAMMOGRAM
VAGINITIS NOS
ICD-9
Code
V76.2
V22.1
ICD-10
Code
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ICD-10 Description
Encounter for screening for malignant neoplasm
Z12.4 of cervix
Encounter for supervision of other normal
Z34.80 pregnancy, unspecified trimester
611.72
N63Unspecified lump in breast
793.82
R92.2 Inconclusive mammogram
616.10
N76.0 Acute vaginitis
N76.1 Subacute and chronic vaginitis
N76.2 Acute vulvitis
N76.3 Subacute and chronic vulvitis
3/4/2014
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The good news
Unspecified codes exist for many diagnoses
The documentation may already include ICD-10
level specificity
Most of the code volume relates to musculoskeletal
anatomy
I am available for on-site help but will need to start
with your top volume codes via email
susan.herson@norwalkhealth.org
3/4/2014
Colorectal Surgery Crosswalk
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3/4/2014
Resources
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Specialty Societies for guidance & billing forms
Websites and apps
www.cms.gov/icd10
www.roadto10.org
precyse app
stat ICD10 app
On site physician training
3M handouts in 18 subspecialties
1-hour training sessions in April with HC-Pro
3/4/2014
www.roadtoicd10.org
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3/4/2014
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3/4/2014
ICD-10 – changes to Office Process
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How does the office process change
as a result of ICD-10
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Office Issues
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Staffing: ½ of billers are expected to retire or change jobs
Productivity: may drop as much as 50%
Dual systems: required from several months prior to
several months after…maybe longer
Delayed Payments: the industry is expecting significant
delays
Cash Flow: CMS & Insurers will not accept bills after Oct 1,
2014 in ICD-9 format
3/4/2014
Be prepared for disrupted cash flow
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• Even if your practice is fully prepared for ICD-10,
be sure you prepare for cash flow disruption
• The chances that every major payer will be able
to handle new codes is slight
• Make arrangement for potential cash flow
disruptions starting in November 2014 which may
last up to 6 months
• Practical course of action
– Secure line of credit for working capital to be drawn
down if and when cash flow needs arise
3/4/2014
Practices based on paper superbill
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• Remember only the ICD-9 diagnosis codes are changing
not the CPT-4 procedure codes
• If your practice has a superbill with pre listed ICD-9
codes
– The superbill will have to redesigned with ICD-10 codes
• If Superbill ICD-9 code field is free text
– If you write a diagnosis narrative, how will your staff be
able to convert the narrative to an ICD-10 code
– Will your narrative contain enough specificity
– If you write in a diagnosis ICD-9 code, how will you know
what ICD-10 code to write in
3/4/2014
ICD-10 Implementation – Outpatient
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Outpatient – script from the ordering physician is key
(for example Lab, Rad or specialist referral )
Physician Office
Physician
Physician
Script / Referral
ICD-9 / ICD-10
Patient
Norwalk Hospital
Critical to both Physician Office and Hospital
Hospital bills can confuse patients
3/4/2014
ICD-10 Scripts – the Patient Experience
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Code is not clear
Physician
Script / Referral
Patient
Norwalk Hospital
Physician Office
•
If the code is not clear, will result in phone calls to physician
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Re-work for physician
•
Extends waiting time for patient
3/4/2014
ICD-10 Script Process
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• ICD-10 requires new Specificity
• Work in partnership with Physician
offices on Process
• Will result in best process by doing
parallel
• Goal for all – document most accurate
Code
• Best clarity – share same ICD-10 alphanumeric Code
3/4/2014
ICD-10 Summary
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ICD-10 drives same results for Physician Office and Hospital:
Bottom Line – if we don’t do ICD-10 correctly,
we cannot bill!!
3/4/2014
How can we help
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Tables today were set up to talk about:
Getting Started
Office Staff Training
Physician Training
Vendor Information
NHP&S: Compare Notes with another practice
3/4/2014