ICD-10 is Coming
Ready or Not
Dr. Thomas Ayoub
Norwalk Hospital
ICD-10 is NOT
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Punishment
…of doctors
…by the government
…for purposes of lowering reimbursements
This is not part of “Obama-care”.
10/1/2013
ICD-10
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• Derives from the World Health
Organization.
–
CMS is acting on behalf of the US government
• Links to quality of care
– Primary purpose is epidemiologic tracking of
illness and injury; worldwide outcomes data is
important
• Long overdue
– ICD-9 has been in use since 1979 and
medicine has changed
10/1/2013
ICD-10 adoption by other Countries
UK 1995
Nordic Countries 1994-7
France 1997
Australia 1998
Belgium 1999
Germany 2000
Canada 2001
United States Oct 1st, 2013 2014
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Another delay
will not occur
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ICD-10
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U.S. will be the only country to use ICD-10
for reimbursement.
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The Cost
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For a typical practice the total cost depends on the size:
• Small
$83,290
• Medium $285,195
• Large
$2.7 million
10/1/2013
IT Issues
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Much worse than Y2K; effects include:
• Clinical documentation/EHR systems
• Encounter forms/Superbills
• Practice management systems
• Contracts
• Public health and quality reporting protocols
10/1/2013
Other 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
10/1/2013
What Lies Ahead
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• An opportunity to bring physicians together
• I'll be more than happy to assist you in finding the help
you need to tackle this project.
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Resources
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• You can use our new website www.norwalkhospital/icd-10
with links to resources (try our QR logo on your invitation)
• You can contact Susan Herson, MD at
susan.herson@norwalkhealth.org
10/1/2013
How Can Physicians Prepare
Susan Herson, MD
Hospitalist
Documentation Improvement
ICD-10
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You’ve heard there will be a vast expansion in the
number of codes but…
• 60% of the new code volume pertains to
musculoskeletal system
• New coding system is logical
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Coding Classifications
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The new coding is logical because it
relates to treatment decisions.
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Most Common ICD-9
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CMS recommends that offices start by listing
their most commonly used ICD-9 codes and
becoming familiar with corresponding ICD10 codes
The best resource is www.CMS.gov/icd10
“Understanding the Basics”
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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 70% of the volume
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Example: GI Most Common Codes
ICD-9 Code & Description
# of
Encntrs
% of
Activity
4695
41%
V12.72 Prsnl hst colonic polyps
1214
11%
530.81 Esophageal Reflux
670
6%
569.3 Rectal & Anal Hemorrhage
451
4%
787.91 Diarrhea
396
3%
V76.51 Screen malig neop-colon
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ICD-10 Code & Description
Z12.11 Encounter for screening for malignant
neoplasm of colon
Z86.010 Personal history of colonic polyps
K21.9 Gastro-esophageal reflux disease
without esophagitis
K62.5 Hemorrhage of anus and rectum
K52.2 Allergic and dietetic gastroenteritis and
colitis
K52.89 Other specified non-infective
gastroenteritis and colitis
R19.7 Diarrhea, unspecified
Top 5 ICD-9 codes cover 64% of the Encounters
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Top GI Diagnosis in ICD-9
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Principal Diagnosis
ICD-9
Screen Malig Neop-Colon
V76.51
Prsnl Hst Colonic Polyps
V12.72
Esophageal Reflux
530.81
Rectal & Anal Hemorrhage
569.3
Diarrhea
787.91
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Translate ICD-9 to ICD-10
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Use free internet sites like
http://www.icd10data.com
or download free apps
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Start typing the ICD-9 text here
A broad search occurs; all yellow
highlights are possible matches.
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Or choose “Convert” to use the code instead of the text
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As you start typing the code here,
a list of options appear below
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Top GI Diagnosis now in ICD-10
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Principal Diagnosis
ICD-10
Encounter for Screening for Malignant
Neoplasm of the Colon
Z12.11
Personal history of Colonic Polyps
Gastro-Esophageal Reflux Disease without
Esophagitis
Z86.010
Hemorrhage of Anus and Rectum
K62.5
K21.9
Allergic and dietetic gastroenteritis and colitis K52.2
Other specified non-infective gastroenteritis
and colitis
K52.89
Diarrhea
R19.7
9/26/2013
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What we learned from the conversion process
3 out of 5 codes were direct conversions / perfect matches
2 out of 5 codes required more documentation
• GERD requires with or without esophagitis
The default will likely be “without”
• Diarrhea requires etiology
- due to infectious or non-infectious process
- due to diet
- due to allergy
We learned not only which diagnoses require more documentation
but exactly what type of documentation is required.
9/26/2013
Unspecified Codes still exist. However…
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Not all ICD 9 unspecified codes exist in ICD 10
e.g. CAD, unspecified the provider must choose native & graft vessel
Unspecified codes cause shifts in reimbursement
Unspecified codes may not capture relevant data reporting and
improved patient care.
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General Documentation Improvement Tips
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• Document Initial or Follow-up encounter for every visit
• Use adjectives like acute, chronic, or acute on chronic,
and mild, moderate, or severe, early onset, diffuse
• Link cause and effect with words like "due to"
• Specify anatomic site particularly left, right, bilateral
• Use exact dates of injury or disease onset
ICD-10 is like learning a new language
it is not intuitive but it is logical
9/26/2013
Resources
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Specialty Societies for guidance & billing forms
Internet tools and apps
www.CMS.gov/icd10
http://www.icd10data.com
Norwalk Hospital:
• 3M videos in 18 subspecialties
• 1-hour training sessions in April with HC-Pro
• Quarterly ICD-10 meetings
9/26/2013