ICD-10 Diagnosis Coding

1. ICD-10 Diagnosis Coding • In use by majority of developed nations for years • Goes into effect in 12 months (Oct. 1, 2014) • Will require considerable adjustment in coding • Need to start preparation & begin testing

2. ICD-10 Diagnosis Coding • ICD-10 better provides for improvements in… • Quality Measurements –healthcare successes on specific diagnoses • Public Health – worldwide sharing of diagnostic data • Research – analysis using more precise diagnoses • Reimbursement – refined “pay for performance” • Cost containment – lower insurance premiums

3. ICD-10 Diagnosis Coding • ICD-10 captures documentation that ICD-9 omits, such as: • Initial vs. Subsequent Encounter vs. Sequelae • Acute or Chronic Condition • Right or Left (1/3 of ICD-10 code descriptions are identical except for indicating laterality) • Normal Healing, Delayed Healing

4. ICD-10 Diagnosis Coding CMS: No Clear Mapping Between ICD-9-CM and ICD-10-CM Code Sets.  There are • one-to-one correspondences, • one-to-many, • many-to-one, • many-to-many, or • no correspondence at all.

5. ICD-10 Diagnosis Coding CMS:GEMs (General Equivalency Mapping) • The GEMs are to assist with converting large ICD-9 databases to ICD-10 • The GEMs are not a substitute for learning how to use ICD-10-CM • Providers’ coding staff should assign individual codes from the ICD-10 code books

6. Senile Cataract ICD-9 Source

7. Senile Cataract ICD-10

8. Senile Cataract ICD-9 Source

9. Senile Cataract ICD-9 Source Source ICD-10 Pseudoexfoliation of the lens w/o GLC does not exist in ICD-10

10. Senile Cataract ICD-10 Pseudoexfoliation of the lens w/o GLC does not exist in ICD-10 Pseudoexfoliation of lens capsule convert 366.11 to ICD-10 Source Source

11. ICD-9 Glaucoma 365.52 365.72 Currently must file two lines of code for GLC patient

12. ICD-10 Glaucoma You only file one code, but you have to chose one of 20 codes

13. ICD-10 Diagnosis Coding CMS: No Clear Mapping Between ICD-9-CM and ICD-10-CM Code Sets.  There are • one-to-one correspondences, • one-to-many, • many-to-one, • many-to-many, or • no correspondence at all.

14. ICD-10 Diagnosis Coding • Doctors and staff will be faced with learning curve • Learning curves slow down production • Learning “on-the-fly” will be disastrous • Outline a plan, step by step, your practice intends to follow

15. ICD-10 Diagnosis Coding • To Help Staff Understand the Complexities of the Switch to ICD-10… • Make a table of the top 20+ diagnoses currently used by your office • Using ICD-10*, make a table of these same diagnoses, but with the ICD-10 coding *ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2014/

16. ICD-10 Diagnosis Coding • Establishing a transition plan • All current use ICD-9 will be affected by the transition. • Thus, identify everywhere that your practice uses ICD-9. • Decide who needs training, what type of training they need, and when they need it. • Schedule staff training on a regular basis for questions and feedback

17. ICD-10 Diagnosis Coding • Establishing a transition plan • Share your plan with your EHR vendors and billing services. • Set up time for software vendors to train your staff on computer system changes (whether using EHR or non-EHR software systems). • Coordinate carefully with Billing Service and Clearinghouse vendors

18. ICD-10 Diagnosis Coding • Establish a training plan • Anyone who will test ICD-10 systems before the transition will need training way in advance • Others who use ICD codes can be trained 6 to 9 months before the October 1, 2014, transition • Doctors and staff should become well versed in the multiple changes in diagnosis coding

19. ICD-10 Diagnosis Coding • Other suggestions from CMS • Communicate with your peers, especially those using the same software, clearinghouses, etc. • Set aside a contingency fund for preparation costs and for possible unforeseen implementation hang-ups.

20. ICD-10 Diagnosis Coding In Summary, • Educate All Personnel • Prepare for Changes • Communicate with Vendors • Test