ICD-10 OVERVIEW Philip Katzenberger Director of Health Information Services, SFGH

Transcription

1 ICD-10 OVERVIEW Philip Katzenberger Director of Health Information Services, SFGH WHEN October 1, 2014, the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) will convert from using the International Classification of Diseases, ninth Revision, Clinical Modification (ICD-9) to using the International Classification of Diseases, tenth Revision, Clinical Modification/Procedure Coding System (ICD-10). WHY First used by World Health Organization (WHO) member states in 1994, ICD-10 has been utilized globally by the majority of countries, but not in the U.S., to document and track various categories of disease. Due to advances in medical applications and the continuous development of new, innovative medical procedures, ICD- 9 can no longer meet the structural needs of increased healthcare data granularity. Under ICD-9-CM, approximately 17,000 codes are available for use; in contrast, ICD-10 will consist of more than 155,000 codes, accommodating the level of specificity demanded by diagnostic and procedural codes. BENEFITS Increased specificity of ICD-10 codes will help improve public healthcare polices Codes with more detail on socioeconomic, family relationships, ambulatory care conditions, problems related to lifestyle, and the results of screening tests Ability to enable providers to reveal more detail about diagnoses and procedures, resulting in fewer miscoded and rejected claims, leading directly to more accurate, timely payments The means for in-depth analysis of patient diagnosis, treatment and outcomes. Such analysis can directly contribute to improved patient outcomes, and will, if used effectively over time, lead to improved quality COMPARING ICD-9 TO ICD-10 Using the ICD-9 code set, a provider can report a diagnosis of a broken arm with limited detail. ICD-10 enables the provider to additionally identify the specific arm, bone broken and type of break. The provider can also note if the fracture is being treated for the first time, or if the encounter is a subsequent treatment for the facture. Using ICD-9, a renal dialysis patient who is non-compliant with medical treatment, has one code. The ICD-10 code set provides a number of categories for recording non-compliance, including dietary regimens, medication, renal dialysis and other clinical treatments. Where appropriate, a reason can be recorded for non-compliance, such as financial hardship, age-related debility, and if the non-compliance is intentional or unintentional. Such information can indicate additional services that might be needed to help manage a patient s care and restore the patient to health. DPH READINESS EFFORTS Since September 2011, the DPH Multidisciplinary ICD-10 Taskforce Group (appendix A) has created a transition plan (appendix B) to adapt the new coding system. There are three main areas of focus; 1) technology, 2) workforce training and education, and 3) systems to sustain the conversion changes.

2 TECHNOLOGY Existing Technology Core ICD-9 System Hardware Upgrades HIPAA 5010 Standard Transactions Coding Software upgrade New Technology ICD-10 Test Environment Hardware and Software Coding Simulator APR-DRG Grouper Coding Compliance CDI Query Module Workflow Management Data Analytics Physician Electronic Notes IMO Code Look-up = Completed = In progress TRAINING & EDUCATION General - awareness of ICD-10 knowledge (necessary for non-clinical staff). Moderate - specific knowledge of ICD-10 related to professional scope of service (for physicians and other clinical healthcare workers). Expert - required knowledge and/or extensive use of the new ICD-10 classification systems (inpatient /outpatient coders, clinical documentation improvement (CDI) staff and other Health Information Services staff). General Moderate Expert Clinical Users Nonclinical Documenters Patient Access Human Resources HIM Staff elearning Introduction to ICD-10 x x x x ICD-10 Coding x x x x Readiness Assessment x x ICD-10 A&P Basics/Advanced x x x x Clinical User Bundle x x x Documenter Bundle x x Physician Bundle x GEMS Bundle x x x x x x AHIMA Uplift (CM Only) * x AHIMA Uplift (CM/PCS) * x x x Virtual ICD-10 Coding Simulator x x Onsite Training Peer to Peer x x x x x Champion x x x x x Data Analytics x x x x x x Senior Mgmt Contract Mgmt IT/ IS Finance/PFS Physicians Nurses Case Managers Outpatient Coders Inpatient Coders CDI Professionals HIM & Coding Mgrs

3 SYSTEMS Monitoring and sustaining change Ongoing System Maintenance Physician Template Building Physician ICD-10 Feedback Coding Software Reviews Internal Reviews Staff Education Concurrent Reviews Internal Audits Data Analytics Ongoing Coding Physician Query Billing & Compliance CHALLENGES Increase in complexity will impact coder s and physician s productivity which could impact cash flow. Ensure timely vendor readiness. Keeping on schedule with implementing new technology. Monitoring training and education of the healthcare workforce. Allocating resources to manage the implementation process.

4 APPENDIX A ICD-10-CM/PSC taskforce committee members Primary Membership: Compliance Yvonne Lowe - DPH Maureen O Connor - SFGH Chona Peralta - CBHS Helen Storrs - LHH QM Michael Pfeffer - SFGH Sue Schwartz - SFGH Pro Fee Grace Fernandez - UCSF Trina Roberts - UCSF Others/Ad Hoc ED Dave Staconis - SFGH Providers Alice Chen - SFGH Heather Harris - SFGH William Huen - SFGH, Lisa Johnson COPC Toddy May, - SFGH Shannon Thyne - SFGH Colleen Riley - LHH Michael McShane - LHH Jenson Wong - DPH, Albert Yu COPC Nursing Leslie Dubbin SFGH HIS Michala Brown SFGH Mathew Cuenot - SFGH Susan David COPC Barbara Dimanlig - SFGH Shannon Huth SFGH CDI Philip Katzenberger SFGH Alice Lee - CBHS Louise Lee LHH Alicia Narayan SFGH Eric Shaffer SFGH CDI IS Hal Kress SFGH Donna Jacobs SFGH Fred MacGregor CBHS Kjeld Molvig DPH Phillip Weatherbee - SFGH Nancy Wong LHH PFS Ronnie Del Rosario COPC,LHH, SFGH Diana Guevara COPC,LHH, SFGH Vanda Mendoza-Baptista COPC,LHH, SFGH Veon Rafanan COPC,LHH, SFGH Executive Sponsors Valerie Inouye - SFGH Mike Llewellyn LHH Bill Blum COPC Marcelina Ogbu - CBHS Participation and collaboration from all areas of DPH is necessary for a successful conversion to ICD-10

5 APPENDIX B