1 / 10

ICD-10

ICD-10. What’s Ahead. What is it?. A renovation of coding, requiring field size expansion, change to alphanumeric digits, and complete redefinition of code values and structure. Mandatory as of October 1, 2013. Overview: Diagnosis Codes. 68,000 alphanumeric diagnosis codes

ugo
Télécharger la présentation

ICD-10

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ICD-10 What’s Ahead

  2. What is it? • A renovation of coding, requiring field size expansion, change to alphanumeric digits, and complete redefinition of code values and structure. • Mandatory as of October 1, 2013

  3. Overview: Diagnosis Codes • 68,000 alphanumeric diagnosis codes • Always start with a letter, 3-7 digits • Examples: • J14 H. Flu Pneumonia • L23.2 Allergic Contact Dermatitis, Cosmetics • K11.20 Sialoadenitis, unspecified • L03.115 Cellulitis, right lower limb • S01.01xA Laceration scalp, w/o FB, Initial encounter

  4. Procedure Codes (PCS) • 72,000 alphanumeric codes, starting with a number or a letter, 7 characters • Example: Lysis of adhesions of pleura 0BNN0ZZ • Section (med/surg -0) • Body System (respiratory -B) • Root Operation (release -N) • Body Part (pleura -N) • Approach (open -0) • Device (no device -Z) • Qualifier (no qualifier -Z)

  5. GEMS • General Equivalence Mappings: designed to enable DRG formation before new system in place, and to allow data comparisons from year to year. • Problem: 68,000 diagnosis codes in ICD-10 mapping to 14,000 ICD-9 codes • 72,000 ICD-10 PCS procedure codes mapping to 4,000 ICD-9 codes • Not a one to one translation; not able to easily verify we were paid correctly

  6. Training considerations • HIM • Data Quality/Risk Management • IS • Compliance • Ancillary Services • Physician Practice Staff • Finance – case mix index • Physicians - documentation

  7. Impacts • Payers – ability to accept and recognize data, contract renegotiation • Providers – training and education of all who code, and all who read and write reports • Information Systems – interfaces to other systems, report-writing, testing of modules, maintaining of dual systems, computerized edits • Finance – budget projections, case mix index, annual comparisons of data • Software vendors – data realignments, code structure changes

  8. Also Affects Quality Improvement – HACs, comparisons of quality data; core measures • Human Resources - employee benefits & data to determine costs of insurance, WC • Clearinghouses – massage data from billing system to insurance companies • Laboratories, pharmacies • Audits, medical necessity, RAC • Division of Healthcare Finance & Policy

  9. What stays the same • CPT coding on hospital outpatients, physician office billing • Need for better documentation • Need for trained coders

  10. Next Steps • ICD-10 Task Force to determine needs • Sub-committees to work on special tasks such as working with vendors to identify changes needed, assessing flow of coded data, assessing financial impact of changes. • Educate physicians on specificity of documentation needed – they are affected as well.

More Related