Presented by Sithara Satiyadev Africode Consulting. September 2013

Transcription

1 Presented by Sithara Satiyadev Africode Consulting September 2013

2 Agenda ICD-10 Background MIT Phase 3 Phase 4

3 Background to ICD-10 Owned by WHO Adopted by NDoH in 1997 Adopted by PHISC in 2000 Task Team (NTT) established in 2004 ICD-10 Implemente d in July 2005

4 Background to ICD-10 May 2011: DG TT March 2012: MoH: appointed ICD-10 TT 2000: Private stakeholders complaint to MoH Medical Schemes Act, Reg. 5 (f) 2001: MoH request CMS to investigate 2004-Feb 2011 NTT: auspice of CMS 2003: CMS report & recommen dation to MoH

5 MoH: Terms of Reference for the ICD-10 Task Team

6 Structure of ICD-10 Task Team Ministerial ICD- 10 Task team Participation from all healthcare stakeholders Chairperson NDoH: Secretariat and support to Task Team Communication & Monitoring sub-committee Privacy & Security subcommittee ICD-10 Morbidity sub-committee ICD-10 Mortality sub-committee Training subcommittee Advise and recommend ICD-10 standards: adopted as policy by the NDoH

7 ICD-10 MIT: Master Industry Table Failure to update systems with this file will lead to rejections of claims by medical aids and inaccurate health data collections Are about 1600 codes changes: added, deleted or modified Many more convention changes, e.g. notes, excludes, includes, etc Last file update was in 2007

8 ICD-10 MIT: Master Industry Table Examples of new codes J09: Influenza due to certain identified influenza virus new code to be used for swine flu & avian flu K02.5: Caries with pulp exposure G90.4: Autonomic dysreflexia

9 ICD-10 MIT: Master Industry Table Examples of Modified Codes Old: O60: Preterm labour and delivery: was valid for use New: O60: not valid O60.0: Preterm labour without delivery O60.1: Preterm spontaneous labour with preterm delivery O60.2: Preterm spontaneous labour with term delivery O60.3: Preterm delivery without spontaneous labour

10 ICD-10 MIT: Master Industry Table Old Version I70: Atherosclerosis I70.0: Atherosclerosis of aorta (was valid for use) New version I70.0: Atherosclerosis of aorta (not valid-need 5 th characters) I70.00:Atheroscleros is of aorta without gangrene I70.01:Atheroscleros is of aorta with gangrene

11 ICD-10 MIT: Master Industry Table Examples of deleted codes H54.7: Unspecified visual loss K35.0 Acute appendicitis with generalized peritonitis K35.9: Acute appendicitis, unspecified Above have been replaced with new codes

12 ICD-10 Coding Tools ICD-10 Browser NDoH/TT to go out on tender Current version: BHF/DXS 2007 (only valid until 31 May 2013) Secure SP Development to commence in 2013 Acquire from PMS or Private companies

13 SA ICD-10 Coding Standards Documents ICD-10 Coding Morbidity Coding Standards Document Policy Document Morbidity ICD-10 standards Z code (DSN 21) Review Codes proposed for deletion Default codes (overuse) Examples: Z01.6, Z01.7, Finalise standards Publish NDoH website

14 ICD-10 Mortality Coding Standards Document Version 1 of Standards Document Ready for sign off by DG Will be posted on NDoH website Outstanding standards/ Guidelines Circulated for comments Collated and published in next version

15 ICD-10 Implementation Phased Approach: Phase 1: 01/07/05 to 30/09/05-education Phase 2: 01/10/05 to 31/12/05-valid ICD-10 code Phase 3: 01/01/06 to date-validations Phase 4: to commence in 2014

16 Current Situation Implementation Phase 3: current phase: not fully implemented (private & public healthcare sectors) MoH/NDoH: phase 3 to be fully implemented nationally by 01/07/14 to support NHI and quality disease stats. The NDoH & CMS: all schemes and administrators to commence full scale phase 3 and phase 4.1. validations on 01/07/14 (CMS accreditation) Currently: only 3 schemes/administrators are doing primary ICD-10 code validations (Pdx) Hospitals: header level validation on all codes Drs and Allied Staff: line level validations on all codes Full scale ICD-10 phase 3 validations can lead to a great deal of claims rejections if providers are not compliant to phase 3

17 ICD-10 Technical User Guide ICD-10 Technical User Guide for Phase 3 Phase 3 Phase 4.1 NDoH website Funder messages : 01/06/13 Funder messages : 01/06/13 Implementation: 01/07/14 Phase 3 and 4.1 Non-compliance will result in claims rejections

18 ICD-10: Phase 3 Requirement Implementation date: 01 July 2014 S & T codes: Must have V,W,X,Y codes Correct 3, 4, 5 character Codes (all codes-pdx & sdx) Appropriate Pdx codes as Per MIT Dagger & Asterisk ICD- 10 MIT: Version 2007 (BHF) Update: June 2013 Sequelae Codes SA Coding Standards Version 5

19 ICD-10 Phase 4: Clinical Validation Phase 4.1 Implementation date: 01/07/14 Neoplasms to have morphology codes Age edits Gender edits ICD-O Morphology codes for all neoplasms

20 ICD-10 Phase 4: Clinical Validation Planned: 2015 Phase 4.2 Validation: examples Dagger & Asterisk mapping MP & Hospital code validations ICD-10 to pharmaceutical code validations SA Coding Stds (Enforce) Above details to be finalised by the ICD-10 Task Team in 2013

21 ICD-10 & Clinical Validations Current Situation: Clinical validations can ONLY take place within contractual agreements & for the management of PMBs. No other claims can be subject to clinical validation until phase 4.2 is implemented For PMBs: medical aids can do validations of codes between hospital and Dr, ICD-10 to CSSA/RPL validations, ICD-10 to lab and path code validations, ICD-10 to NAPPI validations

22 ICD-10 All the latest ICD-10 information can be obtained as follows: Documents prior to 2012:Council for Medical Schemes Website, under the ICD-10 portal Documents & circulars: and click on: Resource Centre - Legislation- Notice Contact Details: Africode Consulting Tel: Cell: sithara@africode.co.za; shawn@africode.co.za;info@africode.co.za Website: