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ICD-10-CM/PCS Implementation

ICD-10-CM/PCS Implementation. Senior Managers date Presented By: ____. The 5 Things You Need to know TODAY about ICD-10. This is a complete re-write of the coding system. Anyone who codes a diagnosis or procedure on a patient chart needs to understand the new coding system.

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ICD-10-CM/PCS Implementation

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  1. ICD-10-CM/PCS Implementation Senior Managers date Presented By: ____

  2. The 5 Things You Need to know TODAY about ICD-10 • This is a complete re-write of the coding system. • Anyone who codes a diagnosis or procedure on a patient chart needs to understand the new coding system. • This affects any information technology system that uses an ICD diagnosis or procedure code. • The implementation date is firm. • We need your help to make it happen at (hospital name).

  3. ICD-10-CM/PCS Overview: • Used for reporting health care diagnoses and inpatient procedures • Replaces ICD-9-CM/PCS • ICD – International Classification of Diseases • CM – Clinical Modification for the US (diseases) • PCS – Procedural Classification System (for inpatient surgical procedures ONLY) • Requires claims transaction changes • Version 4010 to 5010 for expansion of code sets

  4. Why change to ICD-10? • United States is behind the rest of the world • United Kingdom went live with ICD-10 in 1995 • ICD-9: • Outdated – unable to accept new codes • Lacks detail to describe symptom, diagnosis, or procedure. • ICD-10 codes provides more precise information to better evaluate the type and cost of services used for a specific diagnosis. • Restricts bio-surveillance/epidemic capabilities

  5. ICD Codes Used by/for: • Healthcare providers in every health care setting – Hospitals, Physician offices, Health Dept., Clinics, etc. • Health Plans – Our healthcare insurance • Insurance claims submission – Patient Accounts • Healthcare Clearinghouses • Research – Cancers, heart disease, others • Quality measures and initiatives – QRM • Utilization/Case Management – Care Coordination • Data Reporting and Analysis – QRM, HIM, KHA, AMA

  6. ICD-10-CM Structure: CPT & HCPCS codes are not affected!

  7. Examples:

  8. The implementation date is firm! • October 1, 2014 – Single implementation date for all users • Date of service on or after 10/1/2014 for ambulatory and physician reporting will use ICD-10-CM diagnosis codes • Date of discharge for hospital claims for inpatient discharges occurring on or after 10-1-2014 will use ICD-10-CM and ICD-10-PCS codes • ICD-9 codes will not be accepted on claims for services on or after 10/1/2014 • Medical Necessity: We’ll need to use ICD-10 for checking necessity for exams scheduled after 10/1/2014, even if they are scheduled beforehand!

  9. This affects manyinformation technology systems (sample page with own page to do) Hospital • Clinics • NextGen • DME • BrightTree • Hospice • CareAnywhere • MEDITECH • Abstracts • Billing • MDS for Skilled Care • 3M Encoder • SSI • Iatric Systems • Medical Necessity Checking • NextGen: ExpressCare What are we missing???

  10. Education • Anyone who touches an ICD diagnosis or procedure code needs to understand the new coding system. • This means anatomy & patho-physiology education prior to training on the code system itself. • This education needs to be in your budget for 2012 through 2014.

  11. ICD-10 Organizational Chart (sample and do your own) Subcommittees/dept Subcommittees/dept

  12. Project Phases • Phase 1: Planning • Project Charter – What, why, who, when, and how much? • Project Plan – Develop tasks and assign resources • Readiness and risk assessments • Departmental and vendor questionnaires • Develop departmental budgets • Phase 2: Implementation • Analysis/Develop action plan of departmental and vendor impact assessments • Phase 3: Go-Live preparation then GO-LIVE • Develop Go-Live plan • Training • Internal/External software modifications and testing • Phase 4: Post Go-Live • Code charts, complete/submit claims, evaluate payments, audit

  13. Processes, Systems, Operational and Financial Impacts • Modified IT systems. • Requires greater detail in clinical documentation to code with ICD-10 (affects entire healthcare team). • Budgets • 2012-2013: Anatomy & Patho-physiology Training • 2014: ICD-10 CM & PCS Training • Decreased coding productivity = less claims = decreased revenue. • Complete halt of revenue if project not implemented.

  14. We need your help to make it happen at (HOSPITAL NAME)! • Commitment • Communication • Planning • Complete tasks and responsibilities on time • Assessments • What systems to you have that utilize ICD-9 codes? • What is the base level of knowledge in your staff? • Training • Thorough testing

  15. Questions?

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