Provider presentation #1 icd 10

3/28/2014 3
Documenting Health Care Interventions
1. ICD-9-CM (International Classification of
Diseases).
– Volumes 1 and 2 of this code set deal with diagnoses.
– Volume 3 covers procedures with a focus on inpatient
procedures.
2. CPT® (Current Procedure Terminology) describes
outpatient procedures and inpatient services
reported directly by physicians.
– The CPT is owned by the American Medical
Association.

3/28/2014 4
History
The International Classification of
Diseases (ICD) is a common framework
and language to report, compile, use and
compare health information:
•In 1893, the first edition was adopted,
known as the International Cause of
Death;
•In 1948, the World Health Organization
(WHO) took responsibility for ICD with the
sixth revision;
•WHO updates the ICD periodically to
reflect current epidemiology and medical
understanding of disease (i.e., ICD-7
through 10).

3/28/2014 5
Why change?
• The current revision of ICD used in the United States is
obsolete. ICD-9 no longer supports advances in
medicine and new procedures. It does not have the
capacity to expand and incorporate new codes.
• The detail in the codes is expected to streamline claims
for payers to clearly understand the purpose of the
patient visit.
• The United States is the last developed country to
implement ICD-10 which restricted our ability to track
and respond to disease patterns (e.g. H1N1) and
epidemics on a worldwide basis.

3/28/2014 7
Timelines
In the late 1970s, the United States developed a clinical modification of this code set (ICD-9-
CM) and mandated its use for all diagnoses (Volumes 1 and 2 of ICD-9-CM). A third volume
of ICD-9-CM was developed for procedures.
In 1993, ICD-10 was issued and it, too, was clinically modified to produce ICD-10-CM. A new
standard, ICD-10-PCS (ICD-10, Procedure Classification System), was developed at the same
time to succeed ICD-9-CM, Volume 3.

3/28/2014 8
– January 1, 2014: After 30 years of providing ICD-9-
CM coding advice, the AHA Central Office will shift its
attention to ICD-10-CM/PCS and will no longer accept
nor respond to requests for ICD-9-CM coding advice.
– First Quarter 2014: Last issue of Coding Clinic for
ICD-9-CM will be published. First issue of Coding
Clinic for ICD-10-CM and ICD-10-PCS will be
published.
– October 1, 2014: Compliance date for
implementation of ICD-10-CM and ICD-10-PCS.
ICD-9-CM codes will not be accepted for services
provided on or after October 1, 2014.
<http://www.ahacentraloffice.org/codes/ICD10.shtml>
Timelines

3/28/2014 9
Comparing the versions

3/28/2014 10
Comparative Anatomy

3/28/2014 11
ICD-10 Conversion and Mapping

3/28/2014 12

3/28/2014 13

3/28/2014 14

3/28/2014 17
There’s a code for that?
V95.43XA - Spacecraft Collision Injuring Occupant.
Initial encounter.

3/28/2014 18
There’s a code for that?
W56.42XA – Struck by a shark. Initial encounter.

3/28/2014 19
There’s a code for that!

3/28/2014 22
5 Benefits of ICD-10 for Physicians
1.Grow compensation and reimbursement.
ICD-9 codes were not originally developed with
reimbursement in mind. ICD-10, however, offers a
more decisive system to determine payments by
offering greater detail on the quality of the care
provided. In turn, government payers, insurers,
hospitals, health systems, medical groups and
others will use ICD-10’s granular data to determine
accurate and fair physician compensation and
reimbursement for goods and services.

3/28/2014 23
2. Determine Severity and Prove Medical
Necessity. As a general rule, sicker patients are
more expensive to treat because they utilize more
resources, have a higher rate of complications, and
predictably, have worse outcomes. ICD-10 codes
will support documented Severity of Illness data
capture and reporting, because ICD-10 codes carry
much more descriptive information than ICD-9
codes.

3/28/2014 24
3. Ensure Your Strong Reputation. With the advent
of healthcare industry changes brought on by
Value-Based Purchasing, documentation becomes
akin to a physician’s social media page. “Everybody”
sees it. Once the care has been provided,
documentation becomes the basis for the ICD-10
codes, which will more accurately reflect the quality
of care provided by a physician.

3/28/2014 25
4. Reduce the hassle of audits. ICD-10 codes will
allow the physician’s documentation to be
translated into a more accurate clinical picture,
thereby reducing the chances of misinterpretation
by third parties, auditors, payers and attorneys.
Insufficient documentation, on the other hand, may
lead to scrutiny and potentially a take-back by CMS
or other payer.

3/28/2014 26
5. Gain access to better clinical information. ICD-
10 will trigger a deeper level of clinical detail in the
medical record. This information can be used to
reduce errors, impact multidisciplinary care, and
provide improved assurance of appropriate
reimbursement. It also offers significant data mining
and research opportunities

3/28/2014 27
It’s actually simple…it’s just
documentation.
There are only four new clinical
concepts that drive that entire
change:
1. laterality,
2. joint involvement,
3. encounter and
4. healing

3/28/2014 28
It’s actually simple…it’s just
documentation
If we don't start documenting these new concepts,
three things will happen:
(1) A claim will be coded lower than it should have
and will be reimbursed less than it should have;
(2) the claim can be submitted and billed but
eventually will be denied; or
(3) we don't end up billing it and query the
physicians, which is fine, but it slows down the
process significantly.

Provider presentation #1 icd 10

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (18)

Andere mochten auch

Andere mochten auch (18)

Ähnlich wie Provider presentation #1 icd 10

Ähnlich wie Provider presentation #1 icd 10 (20)

Provider presentation #1 icd 10