HHS proposes a one-year delay of ICD-10 compliance date.

On April 17, 2012 the Department of Health and Human Services (HHS) published a proposed rule that would delay, from October 1, 2013 to October 1, 2014, the compliance date for the International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).

Per the CMS website, “The ICD-10 compliance date change is part of a proposed rule that would adopt a standard for a unique health plan identifier (HPID), adopt a data element that would serve as an “other entity” identifier (OEID), and add a National Provider Identifier (NPI) requirement. The proposed rule was developed by the Office of E-Health Standards and Services (OESS) as part of its ongoing role, delegated by HHS, to establish standards for electronic health care transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). OESS is part of the Centers for Medicare & Medicaid Services (CMS).”

HHS states that covered entities must be in compliance with ICD-10 on October 1, 2014. The statement was made that providers required the extra year to be adequately prepared for the transition.

Providers have outgrown the present ICD-9 CM system. That system is over 30 years old, implemented in 1979 and has no more room to handle needed codes for new medical conditions or technological advances. It is not always precise or unambiguous. Because the classification system is organized with specificity, each three-digit category can have only 10 subcategories and most of those numbers already have assigned diagnoses.

The ICD was developed in the late 1800s to collect data regarding mortality causes and rates. It is an international classification system endorsed by the World Health Organization (WHO) in 1994 and started to be used by WHO members in 1994. The WHO updates the classification usually every 10 years and is looking to beta test ICD- 11 next year.

ICD-10 is already being utilized in Asia, most of Europe and all of Canada and Australia enabling those 99 nations to share public health data. Implementing ICD-10 effective October 1, 2014 allows the USA to be aligned with those nations. ICD 10 is also available in 36 languages including English, Chinese, Arabic, Russian, and the Romance languages: French and Spanish. Improved clinically coded data is essential in this modern era.

Uses of the Clinically Coded Data

• Benchmarking and quality measurement: to improve quality and effectiveness of patient care

• Making clinical, financial, funding, expansion, and education decisions

• Healthcare policy

• Public health surveillance (increase ability to track and intervene if global health threats)

• Reimbursement

• Research- code analysis is crucial to research

• Increased specificity in data means more robust design of algorithms to predict outcomes and care

• Increased coding detail offers capability to find previously unrecognized relationships of diseases and variables

Why ICD-10-CM

• Bring US in alignment with worldwide coding system

• Greater coding specificity and accuracy with “full code definitions”

• Increased capability to measure healthcare quality, safety, and efficiency.
• Lower Costs through increased efficiencies
• Decreased reduction in additional information sent to payors
• Synergistic effects with the Electronic Health Record (EHR)
• Clearer recognition of medical advances
• Clearer recognition of technological advances

ICD-10 and better data for QI

• Decrease in complications and improved patient safety

• Improved patient outcomes

• Improved ability to reassure outcome efficiency and costs

There is also improved capability to determine disease severity for audit risk adjustment.

Benefits of ICD-10 CM

Organizational Monitoring

• Administrative efficiencies
• Cost containment
• More accurate trend and cost analysis as well as analyze trend and cost data

Improved coding accuracy and productivity

Reimbursement

• Increased accuracy
• Fairer reimbursement
• Improved justification for medical necessity
• Fewer errors and rejected claims

Reduced opportunities for fraud

• To handle the complexities and shear size of the number of codes ICD-10

requires expertise in

anatomy,

physiology, and

diagnostics

• Besides moving from 13,000 codes to 68,000 available codes
• ICD-10 allows laterality and bilaterality

ICD-10 specificity improves coding accuracy and richness of data for analysis

The Coding specificity is far greater than ICD-9-CM and the need to better understand A&P and diagnostics is vital. Improved education for coding specialists is necessary.

A Sample Coding Preparation Plan: Phase 1

• 2012-2013…Assess for coder gaps

as to body system anatomy 15 hrs

as to body system physiology 15 hrs

as to diagnostics/pathophysiology 20 hrs

as to diagnostics/pharmacology 20 hrs

as to medical terminology 10 hrs

A Sample Coding Preparation Plan: Phase 2

• Organizational leaders need to assess their

– Organizational readiness: forms, clinical software, documentation readiness

- Billing/Support system needs

- EHR system

- Support systems

- Case management processes

- Disease management

- Compliance software

A Sample Coding Preparation Plan: Phase 3

There needs to be:

• Testing of Coding by parallel Coding  ICD-9 and ICD-10 CM

• Testing of Billing System for smooth transition

• Look for misinterpretation by auditors/payors

Be certain everyone has past training goals i.e. understands documentation of medical necessity to code

Sample Coding Preparation Plan: Phase 4

• Go Live

• Evaluate processes

• Evaluate Coding
• Evaluate Billing

In Phase 1 there is a need to fully review each body system.

• Choose 2-3 body systems for assessment of need such as:

• Cardiovascular System

Identify the Anatomy and Physiology of the heart. Prepare pre/post tests.

Identify the Anatomy of the circulatory system and the role of each vessel type

Review categories 100-109 in ICD-10-CM Chapter 9, “Diseases of the Circulatory System.”

• Explain ICD-10-CM terminology related to diseases of the circulatory system

• Create scenarios and have coding team gatherings where learning can be fun

These scenarios will allow you to assess gaps and needs

• Consider use of webinars

• AHIMA or like courses

• Online self study may fit certain lifestyles better

• Have videos/PowerPoints of body systems available

Look at workshops, seminars, lunch and learn sessions

Each body system should be reviewed, such as below:

• The Heart
  • Has three layers:  endocardium, myocardium, and epicardium
    • Endocardium – membrane lining interior wall
    • Myocardium – thick, middle, muscular layer
    • Epicardium – thin outer layer

• Pericardium – 3 layer sac that surrounds and protects the heart
• Route of Blood Flow Through the Heart
  • Blood enters the right atrium from the inferior and superior vena cavas (veins)
  • Blood leaves the right atrium to the right ventricle through the tricuspid valve
  • Blood leaves the right ventricle through the pulmonary semilunar valve to the pulmonary artery to the lungs

Unoxygenated blood

• Route of Blood Flow Through the Heart
  • Blood leaves the lungs via the pulmonary veins to the left atrium
    • Oxygenated blood
• Blood leaves the left atrium through the mitral valve to the left ventricle
• Blood leaves the left ventricle through the aortic semilunar valve out to the body
• A series of 20-30 slides could be developed to review the Cardiovascular System

These types of reviews could be excellent resources also for specific component answers such as Cardiac conduction

• Route of Blood Flow Through the Heart
  • Blood leaves the lungs via the pulmonary veins to the left atrium
    • Oxygenated blood
• Blood leaves the left atrium through the mitral valve to the left ventricle

Blood leaves the left ventricle through the aortic semilunar valve out to the body

• Cardiac Conduction
  • Sinoatrial node (SA node, called the pacemaker of the heart) à Atrioventricular node (AV node) à Bundle of His à right and left bundle branches à Purkinje fibers

SA node (pacemaker) is located in the upper part of the right atrium below opening of the superior vena cava

• Discuss disease processes such as:

CAD

CHF

Heart Failure

Use specific terms and processes in the discussions

• Discuss diagnostic and intervention procedures as well as pharmacology
• Have teams participate in establishing education plan after gaps have been identified
• Make certain some kind of training takes place each month, even if it is only a memo about a specific aspect of ICD-10

Keep ICD-10 in front of everyone. Remember, you only have until 2014. Let’s get started!