HS-ICD10 Conversion

HS-ICD10 Conversion:

Health Square team of industry ICD-10 expert professionals are absolutely committed to consistently providing our clients with nothing less than the finest ICD-10 Implementation, coding support, and training available. We provide fully compliant coding with industry leading turnaround time and accuracy, while ensuring optimal reimbursement. We know your time is valuable. Let us help with your implementation planning and rollout.

We strive to seamlessly integrate with your staff, quickly familiarizing ourselves with your practice and team. We then identify trends and recommend services designed to accelerate the revenue cycle or improve compliance. The result of our commitment, knowledge and expertise is a history of creating long-term relationships with measurable results. Work with leaders in the industry—call the Health Square team today!

What Health Square Can Do

• Develop implementation guidance for your organization
• Develop work plans and timelines
• Review documentation to ensure ICD-10 compliance
• Work with your organization to assist with implementation planning and execution
• Work with providers on documentation improvement
• Provide education and training on ICD-10 inpatient and outpatient coding
• Assist the organization with post implementation challenges

Introduction to ICD-10

On October 1, 2015 a key element of the data foundation of the United States’ health care system will undergo a major transformation. We will transition from the decades-old Ninth Edition of the International Classification of Diseases (ICD-9) set of diagnosis and inpatient procedure codes to the far more contemporary, vastly larger, and much more detailed Tenth Edition of those code sets—or ICD-10—used by most developed countries throughout the world.

This transition will have a major impact on anyone who uses health care information that contains a diagnosis and/or inpatient procedure code, including:

• Hospitals
• Health care practitioners and institutions
• Health insurers and other third-party payers
• Electronic transaction clearinghouses
• Hardware and software manufacturers and vendors
• Billing and practice management service providers
• Health care administrative and oversight agencies
• Public and private health care research institutions

Currently, the United States uses the ICD code set, Ninth Edition (ICD-9), originally published in 1977, in the following forms:

• ICD-9-CM (Clinical Modification), used in all health care settings
• ICD-9-PCS (Procedure Coding System), used only in inpatient hospital settings

Limitations of ICD-9

ICD-9 has several limitations that prevent complete and precise coding and billing of health conditions and treatments, including:

• The 30-year-old code set contains outdated terminology and is inconsistent with current medical practice.
• The code length and alphanumeric structure limit the number of new codes that can be created, and many ICD-9 categories are already full.
• The codes themselves lack specificity and detail to support the following:
  * Accurate anatomical descriptions
  * Differentiation of risk and severity
  * Key parameters to differentiate disease manifestations
  * Optimal claim reimbursement
  * Value-based purchasing methodologies
• The lack of detail limits the ability of payers and others to analyze information such as health care utilization, costs and outcomes, resource use and allocation, and performance measurement.
• The codes do not provide the level of detail necessary to further streamline automated claim processing, which would result in fewer payer-physician inquiries and potential claim payment delays or denials.

Benefits of ICD-10

By contrast, ICD-10 provides more specific data than ICD-9 and better reflects current medical practice. The added detail embedded within ICD-10 codes informs health care providers and health plans of patient incidence and history, which improves the effectiveness of case management and care coordination functions. Accurate coding also reduces the volume of claims rejected due to ambiguity.

Here the new code sets will:

• Improve operational processes across the health care industry by classifying detail within codes to accurately process payments and reimbursements.
• Update the terminology and disease classifications to be consistent with current clinical practice and medical and technological advances.
• Increase flexibility for future updates as necessary.
• Enhance coding accuracy and specificity to classify anatomic site, etiology, and severity.
• Support refined reimbursement models to provide equitable payment for more complex conditions.
• Streamline payment operations by allowing for greater automation and fewer payer-physician inquiries, decreasing delays and inappropriate denials.
• Provide more detailed data to better analyze disease patterns and track and respond to public health outbreaks.
• Provide opportunities to develop and implement new pricing and reimbursement structures including fee schedules and hospital and ancillary pricing scenarios based on greater diagnostic specificity.
• Provide payers, program integrity contractors, and oversight agencies with opportunities for more effective detection and investigation of potential fraud or abuse and proof of intentional fraud.

Comparing ICD-9 and ICD-10

There are several structural differences between ICD-9-CM codes and ICD-10 codes1. Table 1 illustrates the difference between ICD-9-CM (Volumes 1 and 2) and ICD-10-CM. Table 2 illustrates the difference between ICD-9-CM (Volume 3) and ICD-10-PCS.

Table 1: Diagnosis Code Comparison

 

Characteristic	ICD-9-CM (VoLS. 1 & 2)	ICD-10-CM
Field length	3-5 characters	3-7 characters
Available codes	Approximately 14,000 codes	Approximately 69,000 codes
Code composition (numeric or alpha)	Digit 1 = alpha or numeric Digits 2-5 = numeric	Digit 1 = alpha Digit 2 = numeric Digits 3-7 = alpha or numeric
Available space for new codes	Limited	Flexible
overall detail embedded within codes	Ambiguous	Very specific (Allows description of comorbidities, manifestations, etiology/causation, complications, detailed anatomical location, sequelae, degree of functional impairment, biologic and chemical agents, phase/stage, lymph node involvement, lateralization and localization, procedure or implant related, age related, or joint involvement)
Laterality	Does not identify right versus left	Often identifies right versus left
Sample code2	813.15, Open fracture of head of radius	S52123C, Displaced fracture of head of unspecified radius, initial encounter for open fracture type IIIA, IIIB, or IIIC

Table 2: Inpatient Procedure Code Comparison

Characteristic	ICD-9-CM (VoL. 3)	ICD-10-PCS
Field length	3-4 characters	7 alpha-numeric characters; all are required
Available codes	Approximately 3,000	Approximately 72,081
Available space for new codes	Limited	Flexible
overall detail embedded within codes	Ambiguous	Precise definition regarding anatomic site, approach, device used, and qualifying information
Laterality	Code does not identify right versus left	Code identifies right versus left
Terminology for body parts	Generic description	Detailed description
Procedure description	Lacks description of procedure approach	Detailed description of procedure approach. Precise definition of anatomic site, approach, device used, and qualifying information
Character position within code	N/A	16 PCS sections identify procedures in a variety of classifications (e.g., medical surgical, mental health, etc.). Among these sections, there may be variations in the meaning of various character positions, though the meaning is consistent within each section. For example, in the Medical Surgical section, Character 1 = Name of Section* Character 2 = Body System* Character 3 = Root Operation* Character 4 = Body Part* Character 5 = Approach* Character 6 = Device* Character 7 = Qualifier* (*For the “Medical Surgical” codes)
Example code	3924, Aorta-renal Bypass	04104J3, Bypass Abdominal Aorta to Right Renal Artery with Synthetic Substitute, Percutaneous Endoscopic Approach

 Implementing ICD-10

This ICD-10 Implementation Guide for Payers groups the ICD-10 implementation milestones and tasks into six phases:

1. Planning
2. Communication and Awareness
3. Assessment
4. operational Implementation
5. Testing
6. Transition

 1.Planning

• Establish project management structure.
• Establish governance.
• Plan to communicate with external partners.
• Establish risk management.

2. Communication and Awareness

• Create a communication plan
• Assess training needs and develop a training plan
• Meet with staff to discuss effect of ICD-10 and identify responsibilities

3. Assessment

• Assess business and policy impacts
• Assess technological impacts
• Evaluate vendors

 4. Operational Implementation

• Identify system migration strategies
• Implement business and technical modifications
• Prepare and deliver training

5. Testing

• Complete Level I internal testing
• Complete Level II external testing

 6. Transition

• Prepare and establish the production and go-live environments
• Deliver ongoing support