ICD-10 and Final Rule Information

·     Why now?

·     ICD 9 is running out of codes fast

·     Lack of comparability of data with global health reporting for disease tracking and research

·     ICD 9 lacks sufficient flexibility to describe new diseases, new technologies and new treatments

·     ICD 9 does not support development of new DRGs with adequate specificity for new technologies or treatments

·     What are the benefits?

·     Improvements in specificity

·     Expandability for new advances in medicine and medical technology

·     Expandable for future coding needs

·     Supports laterality

·     Supports improved coding for primary care, external causes of injury, mental disorders and other areas

·     Supports comparability of data with other countries

·     What is CMS’s compliance approach

·     Big Bang (same true for HIPAA EDI 5010)

·     BUT CMS will not immediately adopt ICD 10 for actual basis of DRG assignment and severity adjustment until a few years later

·     Why Big Bang is better?

·     To avoid issues with “dual use” that would result in overlapping use of ICD 9 and ICD 10 by payers and providers that would be out of synch

·     To reduce burden on coders to maintain two systems of coding

·     To eliminate costs of maintaining production systems support two coding systems

·     To reduce costs of maintaining multiple edit systems

·     To prevent confusion over which coding system to use in filing claims or report data externally

·     Why Not Immediately Using for DRG Payment?

·     To avoid rework of MS-DRGs so soon after initial adoption

·     To build experience with ICD 10 coding usage to assess DRG classifications and severity adjustment impact on reimbursement

  

ICD 10 IMPACT ASSESSMENT PROCESS

·     Is this not just another version change for ICD? Why is this different?

·     Order of magnitude – far more than managing the usual code expirations and additions – whole new medical nomenclature type

·     No historical frame of reference for use of the medical code set values built up unlike with a normal version change

·     Significance of impact on clinical content, clinical coding, decision support and business logic within HIT applications to maintain par level function

·     Comparability of data disrupted without some means of supporting mapping

·     What must be inventoried?

·     Only Revenue Cycle?

·     Or all the systems that use coding data for diagnosis and procedures?

·     Given that CMS proposes a “big bang”, what all needs to be updated?

·     Obvious Stuff

·     Coding Systems

·     Patient Accounting Systems

·     Scrubbers

·     Groupers/Encoders

·     Contract Management Systems

·     Somewhat Obvious Stuff

·     Eligibility Management Systems with Medical Necessity components

·     Compliance editing within coding, claims management, scrubber and charge master systems

·     Estimated reimbursement modeling

·     Revenue Cycle reporting systems

·     Less Obvious Stuff

·     Acuity modeling systems/database

·     External regulatory reporting specifications (e.g. state discharge/public health reporting)

·     Visit coding tools

·     Clinical decision support systems and content

·     Clinical documentation systems – forms and templates

·     Quality Management data collection, abstraction and reporting systems and specifications

·     Stuff You May Not Think Of

·     Surgical Pick Lists

·     Specialty Scheduling Systems (Resourcing driven by Condition or Procedure requirements)

·     Patient Education Materials

·     Discharge Planning tools

·     Nurse Staff Scheduling Systems

·     ICU Morbidity and Mortality Modeling

·     Order Sets, Care Plans, Care Protocols

·     Etc, etc and so forth

Key Areas of Assessment
 

·     Search functions and validation routines

·     “Hardwiring”

·     Policies for effective date

·     Data Capture/Data Entry Edits and Formats

·     Any embedded referential integrity edits on code set values

·     Field lengths as entered or stored

·     Display of code descriptions

·     Need or Use of Mapping Between ICD 9 and ICD 10

·     Conversion of databases

·     Conversion of code set maps

·     Continuity of information

·     Dual Use

·     Preserve logic functioning around compliance date

·     Retain ability to use ICD 9 for older activity that predates compliance date

·     Documentation Forms

·     Any form presentation or selection driven by application logic

·     Predefined Reference Content/START

·     May be more a consideration for Bedrock

·     Decision Support Rules

·     Any embedded Discern Expert or Advisor rules – again may be addressed by Innovations

·     Workflow/Business Processing Rules

·     Application logic flows or user conversational flows driven by ICD 9 CM or PCS

·     Compliance Edits

·     Applied during processing beyond point of data capture

·     Printed or Outputted Materials or Notices

·     Patient Education Materials/Discharge Instructions

·     Reference Links

·     Reporting or Analytics

·     Use of diagnosis or procedure codes for selection, filtering, presentation or sorting

·     Interfaces/Third Party Embedded Solutions

·     To third party products used for support of application logic or function

·     In the transaction layout – especially for external regulatory reporting or for application to application interfacing

·     Within third party products

·     Modeling

·     Acuity/Staffing

·     Risk modeling

·     Preferences

·     Catch all for any other application behaviors

Output from Assessment - Core Guiding Principles for the vendors

·     Enable common use of a default nomenclature type

·     Enable common support for effective date policy

·     Enable use of mappings where appropriate to use case especially to assist in search

·     Eliminate any hardwiring tied to ICD 9

·     Provide ICD 10 enabled content

·     Do not attempt to convert but either enable general equivalency or allow selection of a more appropriate and specific code

·     Do not convert any stored activity or analytic data

·     Enable use of mappings as appropriate on abstracted data especially for analytics

  

Core Project Checklist Used to Evaluate Each Application

·     First Phase for any given IP team – Address basic behaviors and uses 

·     Search component – support a default vocabulary type (no hardwiring for ICD 9)

·     Search component – support effective date policy

·     Validation routines – support a default vocabulary type

·     Validation routines – support effective date policy

·     Displays of code set values – assure field length of 7 supported

·     Analytics/reporting – support use of diagnosis or procedure code concept – not hardwired reference to ICD 9

·     Second Phase for any IP team and for specific domain issues– Address more complex issues 

·     Enable a search assistant that uses forward map

·     ICD 10 enabled reference lists, pick lists, order sentences, documentation fragments and other displays of reference lists

·     Use effective date policy

·     Address any business logic hardwiring

·     Update use of mapping  for SNOMED to ICD 9 to SNOMED to ICD 10 (limited use currently – mainly to support problem list to diagnosis code selection)

·     Discretionary

·     Move to a common nomenclature routine

·      Adopt SNOMED to ICD 10 mapping to facilitate end use

·     Use of ICD 9 to ICD 10 mappings for any extracts for analytics 

Resources

 

·     ICD-10-CM (Diagnoses)

·     http://www.cms.hhs.gov/ICD10/02m_2009_ICD_10_CM.asp

·     ICD-10-PCS (Procedures)

·     http://www.cms.hhs.gov/ICD10/01m_2009_ICD10PCS.asp

·     GEMS

·     The CMS website has the GEMs and User’s Guides

·     http://www.cms.hhs.gov/ICD10/01m_2009_ICD10PCS.asp

·     http://www.cms.hhs.gov/ICD10/02m_2009_ICD_10_CM.asp

·     ICD-10 General Information

·     http://www.cms.hhs.gov/ICD10

·     ICD-10 Educational Resources

·     http://www.cms.hhs.gov/ICD10/05_Educational_Resources.asp

·     ICD-10 CMS Sponsored Calls

·     http://www.cms.hhs.gov/ICD10/07_Sponsored_Calls.asp

·     ICD-10 Final Rule

·     http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf

·     CDC

·     General ICD-10 information

·     http://www.cdc.gov/nchs/about/major/dvs/icd10des.htm

·     ICD-10-CM files, information and general equivalence mappings between ICD-10-CM and ICD-9-CM

·     http://www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm

·     AHIMA

·     Readiness checklist

·     http://www.ahima.org/icd10/ICD-10PreparationChecklist.mht