ICD-10: Prepare for the Unexpected

Presented by
Denise Cawley, MHA, CPC
Brigette LaBar

RBMA Spring Conference

May 22, 2012
 Disclosure:
Denise Cawley is the Vice President of Client Relations at GeBBS
Healthcare Solutions, a provider of RCM services.

Brigette LaBar is the Client Relations Director at GeBBS Healthcare

Solutions, a provider of RCM services.

This presentation does not intend to showcase GeBBS’ capabilities or solicit any
business.
 Learning Objectives:
• What impact ICD-10 will bring to our lives
• How Radiology Practice Management will be
impacted
• What you should do with the extra time until
implementation
What is the implementation date?
• October 1, 2013
• On February 16, 2012 HHS announced it delay
the implementation until some unknown date
• On April 12 HHS issued a notice of proposed
rulemaking (NPRM) to delay the final compliance
date for ICD-10-CM/PCS by one year, from
October 1, 2013, to October 1, 2014
• The proposed rule was officially published in the
Federal Register on April 17, 2012. There will be
a 30-day comment period
 Agenda

• What is ICD-10?
• Prepare to implement
• Question & Answer
 What is ICD-10?

• ICD-10-CM (Clinical Modification) is an updated

diagnosis code set, moving away from the 30-
year-old ICD-9 code set
– It contains over 65,000 diagnosis codes compared
to 4,000 ICD-9 codes
• ICD-10-PCS (Procedure Coding System)
consists of 72,081 codes
 Really??
ICD-10 Code W61.92
Struck by a bird
 How is it organized?
• ICD 10 codes are 3 to 7 characters, the first one is alphabetic, 2nd
through 7th are either alphabetic or numeric, with a decimal after 3
characters.
• These codes are arranged in chapters and sub-chapters with diseases
grouped by letter.
• ICD 10 codes are organized in 22 chapters

1. A00-B99 Infectious diseases 12. L00-L99 Skin

2. C00-D48 Neoplasms 13. M00-M99 Musculoskeletal
3. D50-D89 Blood & blood-forming organs 14. N00-N99 Genitourinary
4. E00-E90 Endocrine 15. O00-O99 Pregnancy & childbirth
5. F01-F99 Mental 16. P00-P96 Perinatal period
6. G00-G99 Nervous 17. Q00-Q99 Congenital
7. H00-H59 Eyes 18. R00-R99 Symptoms, signs etc.
8. H60-H95 Ear 19. S00-T98 Injury
9. I00-I99 Circulatory 20. V01-Y98 Morbidity & mortality
10. J00-J99 Respiratory 21. Z00-Z99 Health status
11. K00-K93 Digestive 22. U00-U99 Special codes
 REALLY????
• R46.1 is "bizarre personal appearance" vs. R46.0
is "very low level of personal hygiene"
• W22.02XA "walked into lamppost, initial
encounter“ and W22.02XD, "walked into
lamppost, subsequent encounter”
• American doctors whose patients run afoul of birds
will be able to select from nine codes for each
species
• There are separate codes for "bitten by turtle" and
"struck by turtle"
 Why change it?
Patient Benefits
• Enhance healthcare by tracking and trending diseases

Payer Benefits
• Enhance quality of care through utilization management
• Support innovation in payment design and contracting

Provider Benefits
• Improved care coordination
• More effective case management
• Improved utilization management
 ICD-10 Myths and Facts
MYTH: There will be no hard copy ICD-10-CM code books. All coding will need to
be performed electronically
FACT
ICD-10-CM code books are already available and are a manageable size

Myth: ICD-10-CM/PCS was developed a number of years ago, so it is probably

already out of date
FACT
ICD-10 has been updated annually since its creation

MYTH: Each payer will be required to develop their own mappings between ICD-9-
CM and ICD-10
FACT
General Equivalence Mappings (GEMs) are a crosswalk tool developed by CMS
and CDC for use by ALL HIPAA-covered providers, payers, and data users. The
mappings are free of charge and are in the public domain
ICD-9-CM to ICD-10-CM Mapping
CMS and CDC have developed a
crosswalk (or mapping) tool from ICD-9
to ICD 10-CM and PCS codes

http://www.cms.gov/ICD10
ICD-9-CM to ICD-10-CM Mapping
APPROXIMATE MATCH: 49%
Diagnosis has a direct 1 to 1 mapping, but the diagnosis text has changed slightly
EXACT MATCH: 24%
Diagnosis has a direct 1 to 1 mapping and the diagnosis text remains the same
MATCH w/MULTIPLE CHOICES: 19%
Diagnosis maps to a set of diagnoses, from which one should be chosen

NO MAPPING: 3%
Diagnosis does not exist in the ICD-10 code set
COMPLEX MAPPING: 3%
Diagnosis matches to multiple sets of ICD-10 diagnoses
1 TO MANY: 2%
1 diagnosis code map to 2 or more ICD-10 codes

Source: 2011 GEMS mapping, CMS

 Significant for Radiology
• ICD-10-PCS will be used for inpatient
hospital procedures, so Radiology practices
that validate charge capture will need to
! map ICD-10-PCS to CPT using the GEMs
(General Equivalence Mappings)
• Translation and Interface engines between
Radiology practices and physician EHR
systems will change
• Implementation is mandated for HIPAA
covered entities. Not all payers will adopt
ICD-10 on the same time schedule as
Federal and commercial payers
 Reality Check
• ICD-10 is like a phone book: It’s all
there, but you don’t use every phone
number
• We’ve been through this before
(Y2K, HIPAA, S-OX, 5010, etc.)
• We just got another year to prepare
 Agenda

• What is ICD-10?
• Prepare to implement
• Question & Answer
 You should already be doing…
• Inform key stakeholders of recent changes

• Create a governance structure

– Executive sponsor
– Project management team or interdisciplinary steering committee

• Evaluate the effect of ICD-10 on other projects

– Version 5010 transition
– Meaningful Use
– Clinical Documentation Improvement

• Complete an inventory of all databases

 Where do diagnosis codes live?
• In Print
– Practice workflows
– Clinical documentation
– Encounter/charge forms and Job Aides
– Training documents, tools, media etc.
– Payer Contracts

• In the Cloud: Information technology

– PACS
– RIS
– CAC
– Interface engines
– PMS
 Know your vendors’ plans
• Which of your vendors are impacted by ICD-10
• Do your vendors have a readiness plan
• What level of training support will be provided
• Will there be additional hardware/software retrofit requirements
• What support will be made available for data migration
• Will there be any assistance in practicing ICD-10 based workflows
• How will existing interfaces with other vendors be affected
• What additional configuration need to be done (claim rules, interfaces)
• What are the testing plans
• Currently, there is no single framework for testing between payers and
providers
 CDI – Clinical Documentation
Improvement
• Documentation to support clinical and reimbursement
needs, as well as ICD-10 specificity
• Evaluate medical records to determine whether the
documentation supports the level of detail found in ICD-10
• Implement documentation improvement strategies to address
the areas where documentation is found to be lacking.
Examples:
Additional specificity in coding injuries
More detail in fracture coding
 Know your practice
• Determine top 80% of ICD-9 codes by use and devise
cross-walks
• What are your most frequently denied ICD-9 codes?
• Estimate and secure budget including costs associated with
implementation such as software license costs, hardware
procurement, and staff training costs
• Review Payer contracts for language related to diagnosis
codes
– Exclusions
– Carve-outs
– Reporting requirements
 Knowledge Assessment
• Assess staff knowledge: Coders, Billing
editors, Denial resolution teams
• Perform parallel coding analyses to determine
productivity by team and individuals
• Determine potential for loss of productivity

Readiness Assessments & Online Focus Training Courses

• Coder Readiness Assessment
• Anatomy and Physiology
• ICD-10 Focus Course: Neoplasms
• Musculoskeletal, Circulatory, Central & Peripheral Nervous Systems
 Staff Training Plan
• Collect information from each department on current use of
ICD-9 and the number of staff members who need ICD-10
resources and training
• Who: RCM staff, coding staff, clinicians, management and
IT staff
• Provide individualized training based on knowledge gaps
• Anatomy, physiology etc.
• When? The actual "hands-on" staff training should start six
to nine months prior to implementation
• Educate staff on changes in documentation requirements
from health plans
 Resources
• ICD10Watch: http://www.icd10watch.com/
• CMS: https://www.cms.gov/ICD10/
• AAPC: http://www.aapc.com/ICD-10/
• AHIMA: http://www.ahima.org/ICD10/
• RBMA’s ICD-10-CM Toolkit
 Review Learning Objectives
• What impact ICD-10 will bring to our lives
• How Radiology Practice Management will
be impacted
• What you should do with the extra time
until implementation
Who thought of this?!
ICD-10 Code V95.44
Spacecraft fire injuring pilot
 Agenda

• What is ICD-10?
• Prepare to implement
• Question & Answer
ASRT Code:
VAD0052048

AAPC Code:
26352HFHTB