Presentation Transcript

1. Physician Councils ICD-10 Update Donna Finley Director, Patient Financial Services
2. ICD-10 Compliance DateOctober 1, 2014 Final Rule Announced by DHHS August 24, 2012 HIPAA covered entities are required to comply with new code set Providers Health Plans Clearinghouses International Classification of Diseases, 10th Revision (ICD-10) Clinical Modifications (ICD-10-CM) Diagnosis Code Set Procedure Coding System (ICD-10-PCS) Hospital Procedure Coding System
3. Why are we doing this? ICD-10 CM & PCS is an adaptation of World Health Organization’s ICD-10 for use in the USA. WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries, and monitoring and assessing health trends. In the 21st century, health is a shared responsibility, involving equitable access to essential care and collective defense against transnational threats.
4. Slide Courtesy of UnitedHealthcare
5. W58.11XA Bitten by crocodile, initial encounter W58.01XA Bitten by alligator, initial encounter Slide Courtesy of UnitedHealthcare
6. Significant Documentation Changes for Physicians Among the changes: A move toward anatomy as the primary axis of diagnosis classification Increased focus on laterality (left, right, bilateral) Substantial increase in documentation requirements around substance abuse and tobacco dependence Greater detail about complications and quality of care Combination codes for certain conditions and common associated symptoms and manifestations Combination codes for poisonings and their associated external cause Obstetric codes identify trimester instead of episode of care Greater specificity includes the inclusion of clinical concepts not previously reported (under-dosing, blood type, blood alcohol level) Significantly expanded groups of codes (injuries, diabetes) Avoidance of umbrella terms , such as anemia – supply specific disease names, etiology, and locations Operative reports for inpatient procedures must contain anatomical, device, and approach specificity
7. Physician Documentation Changes Examples: C50.511 – Malignant neoplasm if lower-outer quadrant of right female breast K57.21– Diverticulitis of large intestine with perforation and abscess with bleeding T42.3x2S – Poisoning by barbiturates, intentional self-harm, sequela O26.02 – Excessive weight gain in pregnancy, second trimester T15.02xD – Foreign body in cornea, left eye, subsequent encounter Z67.40 – Type O blood, Rh positive T10.610 – Type 1 diabetes mellitus with diabetic neuropathic arthropathy. D78.21 – Postprecedural hemorrhage and hematoma of spleen following a procedure on the spleen. M05.621 – Rheumatoid arthritis of right elbow with involvement of other organs and systems T7501xD – Shock due to being struck by lightning, subsequent encounter.
8. Training Opportunities Focused Education for all Service Lines Training Roll Out starts January 2014 High Risk areas to be Identified Meanwhile: Develop New Documentation Awareness Be a champion for your specialty!
9. Confusing and Conflicting Messages Not going to happen in 2014. Not to worry because the hospital will take care of it. ICD-10 is solely a payment system. ICD-10 only affects reimbursement Only need to change Superbill. Buy our Health Mgmt product and it will solve your problem.
10. ICD-10 Organization
11. Steering Committee Members Project Lead Donna Finley Project Management Paula Jones Clinical Informatics RobinLang Compliance Lois Helms Lynda Hammett Medical Records Jan Baucom Prissy Curtis CaroMont Medical Group Daniel Tuffy, Joan Ballard, Kellie Grahl Gina Robinson Clinical Performance Improvement Christina Huitt Information Systems Mike Johnson Tom Parnell Patient Financial Services Myra Taylor
12. Planning Planning Communications Testing Implement Steering Committee Project Plan Risk Analysis Benchmarks Budget Needs Assess Business Associates
13. Communications & Training Planning Communications Testing Implement Senior Management Coders Physicians Data Users Patients Business Associates
14. Testing Planning Communications Testing Implement Systems Medical Documentation Forms, Reports, and Databases Coders Claims Reimbursement
15. Planning Communications Testing Implement Comply Date – October 1, 2014 Monitor Continue Steering Committee Share Information Resolve Issues Implementation
16. ICD-10 Risks
17. Risks Possible Reimbursement & Cash Flow Impact MS DRG: no clear idea of how ICD code changes will impact Delays in Reimbursement Payment Denials due to coding issues Payers not ready to pay based on ICD-10 codes will require backwards mapping (ICD-10 back to ICD-9) Limited ability to predict future financial impacts Lower than expected coding accuracy rate Documentation does not meet new standard of specificity Actual coding does not reflect the correct amount of detail Dual Coding may be a resource drain Decreased physician productivity Increased documentation requirements
18. ICD-10 Benefits
19. Benefits Provide more detailed data to better analyze disease patterns and track and respond to public health outbreaks. Improve operational processes across the health care industry by classifying detail within codes to accurately process payments and reimbursements. ICD-10 better reflects current medical practice and provides more specific data than ICD-9. Structure accommodates addition of new codes while the current coding system is running out of capacity and cannot accommodate future state of health care. Enhance coding accuracy and specificity to classify anatomic site, etiology, and severity. Support refined reimbursement models to provide equitable payment for more complex conditions. Provide opportunities to develop and implement new pricing and reimbursement structures including fee schedules and hospital and ancillary pricing scenarios based on greater diagnostic specificity.
20. Opportunity ICD-10 data can be used to drive organizational change for quality improvement: Providers and payers can more easily identify patients in need of disease management Organizations can develop more effective and tailored disease management programs Existing technologies, systems, and processes can be evaluated and redesigned to enhance patient care
21. Discussion/Questions? Donna Finley donna.finley@caromonthealth.org 704-834-2174