Ben Quirk spoke to the South Florida medical group community about the impact of ICD-10 on the healthcare industry. It was a very informative talk that covered a lot of need-to-know details, including how ICD-10 relates to Meaningful Use and SNOMED.
1. ICD-‐10
Disclaimer:
Nothing
that
we
are
sharing
is
intended
as
legally
binding
or
prescrip7ve
advice.
This
presenta7on
is
a
synthesis
of
publically
available
informa7on
and
best
prac7ces.
2. About
Quirk
Healthcare
Solu8ons
Based
in
South
Florida,
we
partner
with
healthcare
providers
and
organiza8ons,
helping
them
develop
strategies
and
systems
for
naviga8ng
the
new
landscape
of
the
healthcare
industry.
Our
clients
have
enjoyed
remarkable
success,
including
award
of
the
Medicare
Advantage
5-‐star
ra8ng
by
the
Centers
for
Medicare
&
Medicaid
Services
(CMS).
4. Quick
Overview
October
1,
2014
hard
cut-‐off
Affects
all
en88es
covered
by
HIPAA
14,000
ICD-‐9
codes
grow
to
68,000
ICD-‐10
codes
Version
5010
standards
Significant
changes
to
clinical
and
revenue
cycle
systems
• Complex
conversion
to
updated
codes
• System
upgrades
to
expand
data
fields
for
longer
codes
• Staff
retraining
on
new
versions
and
codes
•
•
•
•
•
5. The
Healthcare
World
Ends
in
the
Second
Half
of
2014
9/30/14
–
MU
A`esta8on
Period
Ends
For
Providers
Who
Have
Not
A`ested
for
MU
10/1/14
–
ICD10
Implementa8on
12/31/14
–
MU
A`esta8on
Period
Ends
For
Providers
Who
Have
A`ested
Before
6. In
Addi8on…
• Affordable
Care
Act
–
High
deduc8bles
already
increasing
importance
of
self
pay
and
impac8ng
prac8ces’
bo`om
lines
• Medicare
Reimbursement
Cuts
• Sequestra8on
• PQRS
Penal8es
and
Scoring
Publica8on
9. ICD-‐10
Regulatory
Mandates
Federal
Mandate
Department
of
Health
and
Human
Services
Final
Rule
CMS-‐0013-‐F
Published
January
2009
HIPAA
5010
Transac8on
formats
for
payors
and
providers
January
1,
2012
ICD-‐10
Diagnosis
and
procedure
codes
for
clinical
transac8ons
October
1,
2014
10. What
are
ICD-‐10
Codes?
• Granular
code
set
developed
by
WHO
for:
– Increased
clinical
accuracy
– Improved
disease
tracking
– Disease
trending
• More
ICD-‐10
codes
compared
to
ICD-‐9
ICD-‐9
14,000
diagnosis
codes
4,000
procedure
codes
5
digit
numeric
codes
ICD-‐10
68,000
diagnosis
codes
87,000
procedure
codes
7
digit
alphanumeric
codes
11. Anatomy
of
ICD-‐10
Diagnosis
Codes
•
•
•
•
•
•
3–7
digits
Digit
1
is
alpha,
including
O
and
I
but
no
U
Digit
2
is
numeric
Digits
3–7
are
alpha
(not
case
sensi8ve)
or
numeric
Decimal
is
aker
third
digit
Examples:
– A78
–
Q
fever
– A69.21
–
Meningi8s
due
to
Lyme
disease;
and
– S52.131a
–
Displaced
fracture
of
neck
of
right
radius,
ini8al
encounter
for
closed
fracture
14. What
is
SNOMED?
• Acronym
for
Systema8zed
Nomenclature
Of
Medicine
–
Clinical
Terminology
• Interna8onal
standard
for
comprehensive
clinical
terminology
• Available
at
no
cost
through
the
Na8onal
Library
of
Medicine
• Enables
providers
and
EHRs
to
communicate
in
common
language
– Increased
quality
of
pa8ent
care
across
special8es
– Improved
accuracy
of
pa8ent
data
analysis
15. What
is
SNOMED?
Con7nued
• Structured
into
19
“hierarchies”
which
define
the
clinical
concept
• Broken
down
into
increasing
granularity
• Very
specific
clinical
concepts
to
define
pa8ent
condi8on
• More
complex
than
ICD-‐10
hierarchy
16. Why
is
it
important?
• MU2
criteria
expands
upon
MU1
requirements
to
improve
and
u8lize
HIT
and
EHRs
– Provides
consistent,
collabora8ve
care
– Interoperability
between
EHRs
and
need
for
understanding
each
other
• Use
of
common
language
• Problem
list
17. The
ICD-‐10
/
SNOMED
Rela8onship
• SNOMED
CT
has
be`er
clinical
coverage
than
ICD
• Number
of
codes:
– SNOMED
CT
(Clinical
finding):
100,000
– ICD-‐9-‐CM:
14,000
– ICD-‐10-‐CM:
68,000
• ICD
focus
is
sta8s8cal
– Less-‐common
diseases
subsumed
under
general
categories
– Aker-‐the-‐fact
codes
• SNOMED
CT
is
clinically-‐oriented
– Used
during
care
– Clinical
relevance
and
user-‐friendliness
• Clinically
coded
data
generates
ICD-‐10
code
for
billing
19.
Leverage
the
Resources
Available
to
You
• Navicure’s
Free
ICD10
Comparison
Tool
• AMA
and
MGMA
Offering
Training
Guides
and
Classes
• Intelligent
Medical
Objects
ICD9
to
ICD10
Conversion
for
Exis8ng
Problem
Lists
20. Op8mal
Plan
for
2014
• Developing
a
plan
for
2014
is
impera8ve
Q1
-‐
Finalize
Plan
for
2014
-‐
Upgrade
to
ICD10
and
MU2
2014
Complaint
Version
-‐
Implement
PQRS
-‐
Review
Budget
to
Ensure
You
Have
Reserves
for
ACA
and
ICD10
Impacts
Q2
-‐
Test
ICD10
with
Clearinghouse
and
Payers
-‐
First
Try
at
MU
for
2014
Q3
-‐
Train
Providers
and
Staff
on
ICD10
-‐
Make
Up
Quarter
for
MU
Q4
-‐
ICD10
Implementa8on
-‐
Increase
CBO
Staffing
for
Managing
Resolu8on
of
Payer
Issues
21. Op8mal
Plan
for
ICD10
Impact
Analysis
Needs
Assessment
Project
Plan
Budget
Conversion
• Iden8fy
current
systems
and
work
processes
that
use
ICD-‐9
codes
• Talk
with
payers
about
effect
of
ICD-‐10
implementa8on
on
provider
contracts
• Workflow
and
business
process
changes
• Staff
training
• Prac8ce
management
vendor
accommoda8ons
• Implementa8on
plan
with
clearinghouses,
billing
services,
and
payers
• Inventory
systems
and
workflows
• Con8ngency
plan
for
failed
go-‐live
• Time
and
costs
related
to
implementa8on
• Training
• IT/IS
upgrade
• Assistance
from
outside
vendor/consultant
• Poten8al
produc8vity
loss
• Transac8on
tes8ng
using
ICD-‐10
codes
• Historic
data
conversion
• Review
coded
data
for
claims
reimbursement
consistent
with
ICD-‐9
rates
22. Project
Considera8ons
External
tes8ng
Internal
tes8ng
Provider
training
Review
system
customiza8ons
Core
team
training
23.
Training
• AHIMA
recommenda8on:
begin
no
more
than
six
months
before
compliance
deadline
• Approximately
16
hours
for
ambulatory
coders
and
50
hours
for
hospital
coders
– Physician
prac8ce
coders
should
learn
ICD-‐10
diagnosis
coding
only
– Hospital
coders
should
learn
both
ICD-‐10
diagnosis
and
ICD-‐10
inpa8ent
procedure
coding
• Specialty-‐specific
ICD-‐10
training
• ICD-‐10
coding
training
integrated
into
creden8al
maintaining
CEUs
• ICD-‐10
resources
and
training
materials
available
through
CMS,
professional
associa8ons,
and
socie8es
24.
Best
Prac8ces
• Find
diagnosis
search
tools
(in
EHR
or
Intelligent
Medical
Objects).
Paper
Superbills
and
Cheat
Sheets
will
no
longer
work.
• Begin
coding
in
ICD10
before
the
deadline
and
let
Navicure
downcode
for
you.
• Keep
in
close
contact
with
payers
who
aren’t
ready.
Work
with
Navicure
to
con8nue
downcoding
aker
10/1/14
for
these
payers.
• Understand
that
not
all
payers
will
be
ready
and
your
A/R
will
be
impacted.