1. Moving Towards ICD-10
What you don’t know will hurt you!

2. Cortnie R. Simmons, MHA, RHIA, CCS
Director of ICD-10 Program
Kforce Healthcare
Cortnie R. Simmons, MHA, RHIA, CCS is the Director if ICD-10 for Kforce Healthcare
where she is responsible for implementing ICD-10 CM/PCS related technology and
service offerings for healthcare payers and providers and oversees the rollout of
ICD-10 CM/PCS training and education to more than 500 Kforce Consultants.
Ms. Simmons has 11 years of HIM consulting and coding experience in healthcare.
Ms. Simmons is a graduate of Florida A&M University’s Health Information Management program. She
completed her Masters in Health Administration at University of Maryland University College and also has
her certificate in Healthcare Informatics from St. Petersburg College.
She has held various roles in HIM and coding with both hospital systems and healthcare vendors. She began
her career as a coding consultant in a large consultant firm where she perfected her skills in ICD-9 CM and
CPT coding as a coding auditor and CDI specialist. Ms. Simmons has also spent several years working for
Hospital Corporation of America where she was responsible for coding and HIM support for several
facilities, which included training and education, auditing, risk reduction, and results reporting. Ms.
Simmons currently serves as the Florida Health Information Management Association Chair for ICD-10 as
well as a member of the AHIMA Clinical Terminology and Classification Practice Council. She also is an
adjunct instructor for a Coding and Healthcare Informatics program.
Ms. Simmons has experience conducting educational presentations on ICD-9, CPT and ICD-10 to various
organizations and healthcare facilities across the country including speaking engagements at AHIMA,
NCHIMA, FHIMA, and other State Association meetings, workshops, and/or roundtables. In 2010, Ms.
Simmons became an AHIMA Certified Train the Trainer for ICD-10 CM and ICD-10 PCS. She has
authored several coding and compliance-related articles for AHIMA, HCPro and other publications on
ICD-10 and other coding topics.

3. Agenda
 Brief “baseline” overview of ICD-10
 Why is it important?
 What is it?
 Comprehensive Preparedness
 Assessments and why they are important
 Documentation Challenges in ICD-10 CM/PCS
 Preparing for Challenges

4. ICD-10 BASELINE OVERVIEW
3

5. CMS Goals for ICD-10 CM/PCS
 Measure quality, safety and efficacy of care
 Reduce need for attachments to explain patient’s condition
 Design payment systems and process claims for reimbursement
 Conduct research, epidemiological studies and clinical trials
 Set health policy
 Operational and strategic planning
 Design health care delivery systems
 Monitor report utilization
 Improve clinical, financial and administrative performance
 Prevent and detect health care fraud and abuse
 Track public health and health risks
4

6. Myths vs. Facts
MYTH FACT MYTH FACT
• Unnecessarily • As with ICD-9- • The • The greater
detailed CM, ICD-10- increased number of
medical record CM/PCS codes number of codes in ICD-
documentation should be based codes in ICD- 10-CM/PCS
will be on medical 10-CM/PCS make it easier
required when record will make the to find the
ICD-10- documentation. new coding right code.
CM/PCS is system
implemented. impossible to
use.
5

7. Why is Preparing for ICD-10 Important?
 ICD-10 is the biggest change to healthcare providers
since the creation of Medicare in 1965
 Implementing ICD-10 will impact every IT system,
process and transaction that contains or uses a
diagnosis or procedure code
 The devotion of time and resources will be greater
than that required for Y2K or MS-DRG
readiness

8. What Entities are Impacted?
 Payers
 Reimbursement systems
 Contracts
 Claim systems
 Providers
 Hospitals
 Physicians
 HHA’s, Rehabs, SNFs, LTACs
 Clearinghouses, Vendors, Employers
Source: American Hospital Association

9. Who Needs to be Trained?
Stakeholders L M H
 Coders – inpatient and outpatient √
 Physicians and Mid Levels √
 Clinical documentation specialists √
 Case management / UR √
 Decision support √
 IT professionals √
 Patient access and PFS personnel √
 Researchers (if applicable) √
 Administration √
8

10. Educational Tiers/Levels
 Staff that require familiarity &
Tier 1- awareness of impact of the changes
between the two code sets (e.g.,
Low physicians)
 Staff that require a moderate
Tier 2- understanding to interpret & use
ICD‐10 CM/PCS ( e.g., quality
Medium management, UR, compliance)
 Staff that require a detailed or expert
Tier 3- understanding to apply & interpret
ICD‐10‐ CM/PCS (e.g., coders, coding
High auditors, clinical documentation
specialists)

11. Education & Training
Extensive Stakeholder Training will be required throughout the organization
700
5,434 Hours Total Hours: 15,554
600
9,224 Hours Total Count: 1,084
500
Number of Staff
400
300
200
100
896 Hours
0
Tier 1/ Low (457) Tier 2/Medium (608) Tier 3/High (19)

12. Systems Requiring Assessment for ICD-10 Compliance
 Accounting Systems  Medical necessity software
 Clinical systems  Test-ordering systems
 Physician practice management  Clearinghouse EDI systems
systems  Medical record abstracting
 Aggregate data reporting  Utilization management
 Decision-support systems  Clinical protocols
 Provider profiling systems  Payer claims adjudication systems
 Billing systems  All Custom Reporting systems,
 Disease management systems  Interface Engine coding,
 Quality management  Data Extracts & Custom Data Bases
 Case management  Clinical reminder systems
 Encoding software  Performance-measurement systems
 Registration and scheduling  All systems sending and receiving
systems clinical information to/from external
 Case-mix systems resources
11

13. What Could Happen?
 Failure to successfully implement could cause
cash flow reductions and /or delays through:
 Coding and billing backlogs (i.e. DNFB)
 Increased claims “downgrades” and rejections
 Payer contacts at risk due to poor quality ratings
 Permanent loss in coder productivity (20 – 50%)
increasing costs (Also consider coder cost
premium near go live)
 Substantial cost to remediate / replace IT
systems

14. Organizational Cost
Projected Organizational Cost by Bed Size
Bed Size Projected Organizational Cost
400+ $1,000,000 – 5,000,000
100 – 400 $500,000 – 1,500,000
<100 $100,000 – 250,000
American Society of Clinical Oncology 13

15. 14

16. Significant Increase in Clinical Granularity
ICD-10-CM
ICD-9 CM (Diagnosis) (Diagnosis)
5 Digits numeric 7 Alphanumeric
>14,000 unique codes Characters
>68,000 unique codes
ICD-10-PCS
(Procedure)
ICD-9-CM (Procedure) 7 Alphanumeric
5 Digits Characters
>4000 unique codes >72,000 unique
codes
15

17. ICD-9 CM vs. ICD-10 CM
Similarities Differences
• Index Abbreviations • 3 to 7 characters
• Punctuations • First character alpha
• Coding Conventions • Excludes 1 and Exclude
• Include Notes/Inclusion 2
Notes • 21 Chapters
• All Categories are 3 • Combination codes
characters • Laterality
• Guidelines (coding, • Episode of Care
chapter specific) • Expanded codes
• Trimester codes
• Changes in timeframe

18. ICD-9 CM vs. ICD-10 PCS
Similarities Differences
• Used for reporting • Codes are arranged
inpatient services into tables
and procedures • Codes contain 7
characters
• Codes are
alphanumeric
• Root operations
• Each character has
a specific meaning
1
7

19. One ICD-9 Code….. Multiple ICD-10 Codes
 OSRB07Z
 OSRB0KZ
 OSRB0J7
 OSRB0J8
8 1 5 1  OSRB0J6
 OSRB0J5
Total Hip Replacement  OSRB0JZ
 OSR907Z
 OSR90KZ
 OSR90J7
 OSR90J8
 OSR90J6
 OSR90J5
 OSR90JZ

20. One ICD-9 Code….. Multiple ICD-10 Codes
ICD-10-PCS
 0H96X0Z Drainage of Back
Skin with Drainage
Device, External Approach
 0H96XZZ Drainage of Back
Skin, External Approach
 Plus 264 other codes
8 6 0 4 specifying location
(e.g. Left upper
extremity, elbow, abd
omen, genitalia, etc.),
Other incision with depth (e.g. skin or
subcutaneous tissue)
drainage of skin and approach (e.g.
external, open
subcutaneous tissue , percutaneous, percu
taneous
endoscopic), and
drainage device

21. 5010 / ICD-10 Timeline
Jan 1, 2009 Jan 1, 2010 Jan 1, 2011 Jan 1, 2012 Jan 1, 2013
Phase 1 Phase 2 Phase 3 Phase 4
Phase 1 Phase 2 Phase 3 Phase 4
• Organize steering • Conduct IS inventory • Outline specific tasks/monitor • Evaluate software
committee • Assess vendor readiness timeline for completion upgrades
• Select leader • Conduct staff • Review budget requirements • Review quality of
• Develop meeting awareness sessions • Develop metrics and coded data
schedule • Assess/plan for staff monitoring progress • Conduct additional
• Identify required training needs • Routine reporting of progress staff training
tasks/develop • Identify necessary tools towards completion • Reinforce physician
timelines • Identify areas requiring • Implement changes to system documentation
• Assign tasks/ operational/policy design/development training
responsibilities changes • Test/validate of system changes • Assess case mix
• Evaluate health plan • Conduct staff training impact
contract implications • Conduct physician training/
• Budget planning address documentation gaps
• Identify gaps in health
record documentation
• 5010 testing
Source: American Hospital Association, HIPAA Code Set Rule: 20
ICD-10 Implementation, Executive Briefing Copyright © 2011 by
American Hospital Association.

22. HOW TO PREPARE
21

23. Why are Many Providers not Prepared?
 Management on overload. Focusing on more immediate
priorities e.g. meaningful use, HIE, cost reduction, etc.
Easy for management to think there is plenty of time to
address ICD-10, “10/1/13 right?”
 Most industry surveys find less than 10% of providers
have started
 Hospital management is too narrowly focused on coder
training as the issue and not the training needs of others
as well as the significant process and IT system changes
that are required and financial planning matters

24. Thoughts on Preparedness
 Get organized – Form a Multi-disciplinary
Steering Committee (consider a PMO)
 Develop a comprehensive approach that
includes Operations, IT and Finance
 Develop a “Roadmap” of key projects and
project owners that covers now through 2013
 Think past October 2013 as there will be much
to do after “go live”

25. ICD-10 Program Roles
Executive
Management
Sponsor
Operations
Steering
Committee
Program
Management
Office
Team Team Team Team External
Leader Leader Leader Leader Consultants

26. Operations Steering Committee Members
VP Compliance CIO
Lead Coder HIS Director
Case Management
IT Director
Director
CDI Team Leader Controller
Process Improvement
Multi-Disciplinary Team for 280 Bed Hospital

27. 280 Bed Hospital Work Streams and Projects
Work Streams Individual Projects
Operations 18
Information Technology 27
Finance 5
Total 50
Does not include 16 additional modules
related to Meditech 6.0 Upgrade

28. Implementation Hours by Quarter
9,000
8,000
7,000
6,000
5,000
4,000 PMO/PM Hrs
3,000 Total Hours
2,000
1,000
35,357 Total Hrs
-
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
'11 '12 '12 '12 '12 '13 '13 '13 '13
* Does not include Meditech 6.0 implementation

29. Implementation Cost/Hours by Work Stream
External Cost Parkview Hours
Work Incremental Cost Consulting
(Consulting/Vendor (Hours – Salaried
Stream (Parkview) Hours Staff)
)
Finance $0 $0 0 63
Operation 1,040**
$210,600 $588,810** 16,634
s +Fixed Cost
IT $0 $431,300 2,724 8,140
PMO $0 $372,000 2,120 4,636
Totals $210,600 1,392,110 5,884 Hrs 29,473 Hrs
$1,603,000 35,357 Hrs

30. Budget by Quarter
$350,000
$300,000
$1.603 Million
$250,000
$200,000
$150,000
$100,000
$50,000
$0
Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
'11 '12 '12 '12 '12 '13 '13 '13 '13
* Does not include Meditech 6.0 implementation

31. Other Considerations
 Parallel Coding
 When?
 What % of accounts and which accounts?
 CDI Program
 More Staff?
 Internally
 Staff Augmentation

32. WHAT’S SO HARD ABOUT
ICD-10?
31

33. ICD-10 CM Code Structure
ICD-9-CM ICD-10-CM
 3-4 characters  3-7 characters
 All characters are  1st character is alpha
numeric (except E and
V Codes)  2nd character is numeric
 All codes have at least  All letters used except U
3 characters (digits)  Decimal after 1st 3
characters
32 32

34. The Entire Code Structure Changes!
Diagnosis Code:
ICD-9-CM (3 – 5 numbers)
821.01 = Closed Fracture of shaft of femur
ICD-10-CM (3 – 7 alpha/numeric characters)
S72.344 = Displaced spiral fracture of
shaft of right femur
33

35. ICD-10 PCS Code Structure
ICD-9 CM ICD-10 PCS
 ICD-9-CM has 3-4  ICD-10-PCS has 7
characters characters
 All characters are  Each can be either alpha
numeric or numeric
 All codes have at least  Numbers 0-9; letters A-
3 characters H, J-N, P-Z
 Alpha characters are not
case-sensitive
 Each code must have 7
characters
34 34

36. The Entire Code Structure Changes
Procedure Code:
ICD-9-CM (3 -4 numbers)
47.01 Laparoscopic appendectomy
ICD-10-PCS (7 alphanumeric characters)
ODTJ4ZZ Laparoscopic appendectomy
35

37. ICD-10 PCS Coding Example
 Posterior spinal fusion of the posterior
column at L2-L4 levels with BAK
cage, interbody fusion device, open

38. ICD-10 PCS Coding Example (cont.)
0: MEDICAL AND SURGICAL
S: LOWER JOINTS
G: FUSION: Joining together portions of an articular body part rendering the articular body part immobile
Body Part Approach Device Qualifier
Character 4 Character 5 Character 6 Character 7
0 Lunbar Vertebral Joint 0 Open 3 Interbody Internal 0 Anterior Approach, Anterior
1 Lumbar Vertebral Joints, 2 3 Percutaneous Fixation Device Column
or more 4 Percutaneous 4 Internal Fixation Device 1 Posterior Approach, Posterior
3 Lumbosacral Joint Endoscopic 7 Autologous Tissue Column
Substitute J Posterior Approach, Anterior
H Interbody Synthetic Column
Substitute K Lateral Transverse Process
J Synthetic Substitute Approach, Posterior Column
K Nonautologous Tissue
Substitute
N Interbody Nonautologous
Tissue Substitute
Z No Device
5 Sacrococcygeal Joint 0 Open 4 Internal Fixation Device Z No Qualifier
6 Coccygeal Joint 3 Percutaneous 7 Autologous Tissue
7 Sacroiliac Joint, Right 4 Percutaneous Substitute
8 Sacroiliac Joint, Left Endoscopic J Synthetic Substitute
K Nonautologous Tissue
Substitute
Z No Device
9 Hip Joint, Right 0 Open 4 Internal Fixation Device Z No Qualifier
B Hip Joint, Left 3 Percutaneous 5 External Fixation Device
C Knee Joint, Right 4 Percutaneous 7 Autologous Tissue
D Knee Joint, Left Endoscopic Substitute
F Ankle Joint, Right J Synthetic Substitute
G Ankle Joint, Left K Nonautologous Tissue
Subsitute
Z No Device
H Tarsal Joint, Right
J Tarsal Joint, Left
K Metatarsal-Tarsal Joint,
Right
L Metatarsal-Tarsal Joint,
Left
M Metatarsal-Phalangeal
Joint, Right
N Metatarsal-Phalangeal
Joint, Left
P Toe Phalangeal Joint, Right
Q Toe Phalangeal Joint, Left

39. ICD-10 PCS Example Answer
0 S G 1 0 3 1
Section: Body Root Body Approach: Device: Qualifier:
Med/Surg System: Operation: Part: Open Interbody Posterior
Lower Fusion Lumbar Internal Approach,
Joints Vertebral Fixation Posterior
Joints Device Column
38

40. Polling Question
Have you or your facility participated in any
coding or documentation assessments to
prepare you for ICD-10?
 Yes
 No
 No but they are
in the plans

41. Assessments – Are they Important?
 Coding Assessments
 Assess current knowledge
Anatomy, Physiology, Pathophysiology, and Terminology
 Determine areas that need additional focus
 Clinical Documentation Assessments
 Determine the full extent of documentation reviews that will
be performed during the course of the ICD‐10 transition.
 Operational Assessments
 Determine who is affected by ICD-10 and what education
is needed
 IT Technology Assessments
 Determine what software/hardware upgrades will be
necessary

42. Coding Assessment Results
Results by Category
76.00%
73.76%
74.00%
72.00%
70.00% 69.64%
68.00%
67.27%
66.00%
64.00% 65.81%
62.00%
60.00%
A&P Terminology Pathophysiology Overall

43. Coding Assessment Results
Results by Credential
72.00% 70.55%
70.00%
69.38%
68.00%
66.00%
64.00%
62.00%
60.92%
60.00%
58.00%
56.00%
CCS/CCS-P RHIA/RHIT CPC/CPC-H

44. Documentation Assessments
 Quality clinical documentation is a key factor in reporting
accuracy & ICD-10-CM/PCS code assignment.
Documentation assessments will provide insight into how
ICD-9-CM codes will map to ICD-10-CM/PCS & how
changes will affect your current high-volume/dollar cases.
 Assess the current level of specificity & quality of physician
clinical documentation practices
 Review top diagnosis codes, procedure codes &/or MS-
DRGs.

45. Documentation Assessments
 Determine how frequently unspecified &/or non-descriptive
codes were used in the current ICD-9 system.
 Determine if the documentation required to appropriately
assign diagnosis & procedure codes in ICD-10-CM/PCS is
present in the medical records reviewed.
 Findings provide recommendations for documentation
improvement and assist in designing the physician
education program for your facility &/or organization.

46. Operational Assessments for Education &
Training
Stakeholder Training Count Hours
Unemployed Physician Office Staff 399 4,389
Other Staff 320 6,655
(Admissions, Registration, Nursing, e
tc.)
Unemployed Physicians 266 2,926
Employed Physicians 38 418
IT 24 72
Hospitalists 18 198
Coders 16 800
Clinical Documentation Improvement 3 96
Total 1,084 15,554

47. Technology Assessments
IT Assessment
Identified gaps in overall ICD-10 product/system readiness. 27
products/systems impacted by ICD-10 with significant implementation overlap
requiring careful critical path & resource management
• Product Readiness represents the state of IT readiness
to implement. Out of 100 IT products used at
Product Readiness Parkview, 27 products identified as ICD-10 impacted
• Assessed / Analyzed vendor readiness based upon
Vendor Readiness products impacted
• Two major clusters observed – cluster/dependencies
Roadmap & Budget within groups of products & clusters around Meditech
Planning upgrade

48. Polling Question
 What do you believe the hardest transition
to ICD-10 will be?
 Supporting documentation
 Understanding the ICD-10 codes
 ICD-10 code and guideline changes

49. DOCUMENTATION
CHALLENGES
48

50. A Few Documentation Challenges
 Diabetes Mellitus
 AMI
 Pregnancy
 Cerebral Infarctions
 Injuries
 Fractures
 Respiratory/Vents
 Drug Underdosing
 ICD-10 PCS

51. New Documentation Requirements for ICD-10
Changes in Combination
Laterality
Timeframes Codes
Inclusion of
Greater Episode of
trimesters in
Specificity Care
OB Codes
50

52. There are More Codes and More Detail
Unstable Angina
ICD-9-CM – 1 CODE ICD-10-CM - 9 CODES
 411.1 Intermediate Coronary  I20.0 Unstable Angina
Syndrome, including
 I25.700 Atherosclerosis of coronary
Unstable Angina artery bypass graft(s), unspecified
with unstable angina pectoris
 I25.710 Atherosclerosis of
autologous vein coronary artery
bypass graft(s) with unstable angina
pectoris
 I25.720 Atherosclerosis of
autologous artery coronary bypass
graft(s) with unstable angina
pectoris
 I25.730 Atherosclerosis of
nonautologous biological coronary
artery bypass graft(s) with unstable
angina pectoris
51

53. There are More Codes and More Detail
Acute Bronchitis
ICD-9-CM – 1 CODE ICD-10-CM - 9 CODES
 466.0 Acute Bronchitis  J20.0 Acute bronchitis due to Mycoplasma
pneumoniae
 J20.1 Acute bronchitis due to streptococcus
 J20.3 Acute bronchitis due to
coxsackievirus
 J20.4 Acute bronchitis due to parainfluenza
virus
 J20.5 Acute bronchitis due to respiratory
syncytial virus
 J20.6 Acute bronchitis due to rhinovirus
 J20.7 Acute bronchitis due to echovirus
 J20.8 Acute bronchitis due to other
specified organisms
 J20.9 Acute bronchitis, unspecified
52

54. Diabetes Mellitus
ICD-9 CM ICD-10 CM
Categories 249-250 (59 Codes) Categories E08-E13 (200+ Codes)
4th and 5th digit identify Combination codes used to identify
manifestation, complication, or type manifestation and complication
Additional code for manifestation Type of diabetes is separated by
categories in ICD-10 (E10 Type 1, E11
Type 2)
Additional code for insulin Z79.4 used for long term insulin use
dependency V58.67
Drug induced goes to Drug Code/DRG
Inadequately controlled, poorly controlled,
out of control are assigned to diabetes by
type with hyperglycemia

55. Myocardial Infarction
ICD-9 CM ICD-10 CM
Categories 410, 414, and 412 Categories I21 and I22
4th and 5th digit identify location and I21- is used for NSTEMI and STEMI
episode of care
Acute is defined as symptoms lasting I22- was created for subsequent MI
less than 8 weeks (occurring within 4 weeks of initial)
Acute period changed to 4 weeks or
less
I22 has to be used with I21;
sequencing depends on reason for
admission
In the event of an untreated or unaddressed MI prior to admission, physicians will
need to determine and document when this occurred. This is particularly important
when addressing re‐infarctions or complication of AMI.
54

56. Pregnancy
ICD-9 CM ICD-10 CM
Categories 630-679 Categories O00-O9A
Code identifies trimester
Code identifies the number of
fetuses
Placeholders are often used in this
chapter
55

57. Pregnancy, Childbirth and Puerperium
 On pregnancy, childbirth and puerperium charts
the episode of care (delivered, antepartum,
postpartum) are no longer the axis of classification
in assigning diagnosis codes.
 The trimester in which the condition occurred is
now the driving factor.
1st trimester less than 14 weeks
2nd trimester 14 weeks to less than 28 weeks
3rd trimester 28 weeks to delivery
56

58. Ulcers
 Ulcers (non pressure) documentation should
state the deepest tissue layer exposed (i.e.
fat layer, necrosis, necrosis of muscle or skin
breakdown only)
 For pressure ulcers the site, laterality and
severity are specified in a single code in ICD-
10
 More specific codes for bilateral pressure
ulcers of the same site
 Added new codes for head, sacral, and
contiguous sites
57

59. Pressure Ulcers– What a Difference!
ICD-9 CM ICD-10 CM
 9 location codes,  125 possible codes
second code showing more specific
shows stages, location as well as
depth
15 codes total
Example: Pressure
ulcer of right lower
back, stage III
58

60. Cerebral Infarctions
Greater Specificity Required
 Specific artery involvement
 Vertebral artery
 Carotid artery
 Cerebellar artery
 tPA (rtPA) given in a different facility within 24 hours
 Glasgow Coma Scale
 Laterality
5
9

61. Trauma Documentation Requirements
 Assigned separately for each  Require laterality and specific
injury location
 Have a 7th character  Cord injuries of the neck
extension to identify the require specific type and the
encounter type, with “A” as specific level of the cervical
initial encounter and “D” for vertebra involved
subsequent encounter
 Internal Organ Lacerations/
 Lacerations reported as with Contusions
and without foreign body  Minor – length and depth –
less than 1 cm spleen
 Puncture wounds are
reported separately with and  Moderate – length and depth
without foreign body -1 to 3 cm spleen
 Infected lacerations are  Major – length and depth –
reported as both a laceration greater than 3 cm
and a wound infection
60

62. Fractures
ICD-9 CM ICD-10 CM
Categories 800-829 Default is displaced fracture
Fracture not indicated as open or Fracture not indicated as open or
closed should be classified as closed should be classified as
closed closed
Codes are organized by type of Gustilo-Anderson classification for
injury and then by site assigning the 7th character
extension for open fractures
Codes are organized by site and
then by type
Category M80 – non-traumatic
fractures
61

63. Hip and Knee Replacements
 Type of implant for hip replacements need
to be documented (i.e. ceramic on
ceramic, ceramic on polyethylene, metal
on metal, metal on polyethylene)
62

64. Mechanical Ventilation
 In ICD-10 mechanical ventilation is categorized by:
 less than 24 hrs,
 24 to 96 hrs and
 greater than 96 hrs.
 Length of stay assigned will more than likely be
sequenced by number of hours on vent.
63

65. Underdosing
 New to ICD-10
 Combination codes exist that can identify a
situation where a patient has taken less of a
medication than prescribed, as well as the
specific drug.
 The medical condition is sequenced first with the
underdosing code listed as a secondary
diagnosis.
 Intentional vs. unintentional
Underdosing of insulin due to an insulin pump
failure

66. Incision and Drainage
 Document the following:
Site of drainage
Type of approach (i.e. open, percutaneous,
external)
Note if a drainage device was left
65

67. PREPARING FOR CHALLENGES
66

68. Current Challenges
 Physician Documentation
 Education & Training
 Productivity
 Payer Readiness
 System Upgrades

69. Preparing for ICD-10 CM/PCS
 Establish Documentation Assessment Methodology
 Determine the full extent of documentation reviews that will be performed
during the course of the ICD‐10 transition.
 Establish types of assessments/reviews
 Establish timelines for the performance of the documentation
assessments
 Transitional documentation needs:
 Use of queries that use both ICD‐9‐CM terminology and ICD‐10
terminology (MI time frames and capture of OB/pregnancy trimester
information)
 Template queries that contain multiple choice selections should be
cleansed to assure terminology that is obsolete in ICD‐10 (such as
urosepsis) is removed.
 Cross‐coding of records in both ICD‐9‐CM and ICD‐10‐CM to allow
coders and CDS staff to determine if documentation is sufficient and to
allow appropriate training in coding

70. Preparing for ICD-10 CM/PCS
 Where will the results be disseminated?
 Senior leadership
 Service line meetings
 Senior Committee Meetings
 CDS and coding staffs meetings
 Utilize the assessment results
 Physician education materials and Pocket cards
 Educational presentations
 What will be the effect on current physician orders,
protocols, etc?

71. What can you do to prepare?
Begin studying
Begin learning
PCS
about GEMs
definitions
Learn about Refresh
the Structure, knowledge of
Organization, biomedical
and Features sciences
Understand
the ICD-10
Next Learn the
fundamentals
of ICD-10 CM
Final Rule
Steps and PCS
system

72. Tips for Coders/CDI Specialists
 Explore available resources like the MLN (Medicare Learning
Network) and CMS (Centers for Medicare and Medicaid Services) for
links, tips, and frequently asked questions.
 Familiarize yourself with the new code set. The ICD-10 codes will
allow for greater clinical details in describing conditions and a great
test for any practice is to take some of your most common codes and
using these tools determine the difference ICD-10 will make with that
particular code.
 Become a “coach” for your providers and see if they are coding
specific enough to allow for accuracy with the new set.
 Be knowledgeable in coding, anatomy, and physiology.
 Keep reminding everyone of these changes and help out where you
can.

73. General Equivalence Maps
GEMs – General Equivalence Maps exist to translate data from
ICD-9 to ICD-10 or vice versa
 Bi-directional
 Good for
• Databases used for multiple year analyses
• Trending
• Research studies
• Focusing on potential issues between 9 and 10
 A single ICD-9 code disease or procedure may now be represented
by multiple ICD-10 codes
 Cannot arbitrarily pick an ICD-10 code
• Might pick a code that does not represent complexity of service
you are providing or patients that you are seeing (e.g. an
“unspecified” ICD-10 code)– could result in underpayments
• Might pick a code that overstates patient complexity or services
provided

74. General Equivalence Mappings
Use the GEMs When…
 You are translating lists of codes, code tables, or other
coded data
 You are converting a system or application containing ICD-9-
CM codes
 You are creating a “one-to-one” applied mapping (aka
crosswalk) between code sets that will be used in an
ongoing way to translate records or other coded data
 You want to study the differences in meaning between the
ICD-9-CM classification systems and the ICD-10-CM/PCS
classification systems by looking at the GEMs entries for a
given code or area of classification

75. AHA Coding Clinics
 Will they be published for ICD-10?
 Will ICD-9 be converted to ICD-10?

76. Maintaining Certification through AHIMA’s
 Begin earning ICD-10-CM/PCS specific CEUs during the
period of 01/01/11 – 12/31/13
CHPS – 1CEU
CHDA – 6 CEUs
RHIT – 6 CEUs
RHIA – 6 CEUs
CCS-P – 12 CEUs
CCS – 18 CEUs
CCA – 18 CEUs
****Note: Multiple credential-holders educate to the
highest CEU requirement

77. Maintaining Certification through AAPC
 Testing 10/01/12 – 09/30/13
 Must pass proficiency to maintain AAPC
certification (AHIMA has similar program)
 Online, timed test
 75 questions, open book
 May utilize any resources available
 $60 exam fee (take exam twice)

78. Training Considerations
Training Considerations o WHO?
 Final Regulation states: • coders
 16 hours ICD-10-CM • billing/compliance
(diagnosis) • physicians
 24 hours ICD-10-PCS • data users
(procedures)
o WHAT?
 10 hours additional
• diagnosis coding
practice
• procedure coding
 Total training = o WHEN?
 50 hours (Inpatient • start now
Coders) o HOW?
 26 hours (Outpatient • in-house programs
Coders) • AHIMA certified trainers

79. References and resources
 http://www.cms.hhs.gov/ICD10
 http://www.ahima.org/ICD10/
 www.contexomedia.com
 www.hcpro.com
 http://www.cdc.gov/nchs/icd/icd10cm.htm
 http://www.who.int/classifications/icd/en/
 Final Rule (CMS-0013)
http://edocket.access.gpo.gov/2009/pdf/E9-
743.pdf

80. For More Information Contact:
CSimmons2@Kforce.com

81. Thanks for Coming!