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Dial-In: (800) 933-2547 GE Healthcare Coding in ICD-10 Planning and Executing for Success
Dial-In: (800) 933-2547
GE Healthcare
Coding in ICD-10 Planning and Executing for Success
12/7/2011
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©2011 General Electric Company – All rights reserved.
This does not constitute a representation or warranty or documentation
regarding the product or service featured. All illustrations are provided as
fictional examples only. Your product features and configuration may be
different than those shown. Information contained herein is proprietary to GE.
No part of this publication may be reproduced for any purpose without written
permission of GE.
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General Electric Company.
General Electric Company, by and through its GE Healthcare division.
Portions of this presentation and content herein are the opinions and experiences, and represent the views, of the specific authors and presenters and are not statements of advice, opinion or information from GE Healthcare. These portions have not been prepared, screened, approved, reviewed or endorsed by GE Healthcare.
Agenda
Kickoff Lynn Wasielewski
Senior Field Marketing Manager - Services
GE Healthcare IT
GE’s Support of ICD-10 Readiness Barbara Bambic
Senior Director, Business Solutions Group
GE Healthcare IT
GE’s Training Services for IDC-10 Readiness Donna Akers Senior Director, Knowledge Services Org
GE Healthcare IT
AAPC Kim Reid, CPC, CPC-I, CEMC, CPMA
Director, ICD-10 Development and Training
AAPC
Wrap and Q&A Lynn Wasielewski
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Centricity Business Solutions Group
GE’s Support of ICD-10 Readiness
Barbara Bambic
Senior Director, Business Solutions Group
GE Healthcare IT
ICD-10: Are You on Track?
NCHICA and WEDI estimates: • 13 months to organize implementation • 36 months to identify process improvements • 14 months for internal system design • 12 months each for internal testing • 12 months for vendor code deployment • 10 months for external testing
CMS recommended timeline: • Assessment and Planning: Q1 2009 – Q2 2011
• Implementation Prep: Q1 2011 – Q2 2013 • Go-Live Preparation: Q1 2013 – Q3 2013 • Follow-Up: Q4 2013 – Q4 2013
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GEHC’s Commitment to You Compliant software delivered well in advance of the 10/1/2013 deadline
• Centricity Business version 5.0 General Release was released in Q3, 2011 – Over 100 customers are currently on our slot
schedule for the 5.0 release
• ICD-10 support release file for Centricity Business version 4.3 slated for Q1 2012 – Beta testing is complete
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GEHC’s Commitment to You
• Discovery Report and report Guided Review
• ICD-10 Customer Focus Groups
• Webinars and bulletins to keep you informed
• ICD-10 Site on GE Centricity Business Knowledge Center
• ICD-10 consulting and training from services team
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Centricity Business ICD-10 Services
ICD-10 impact assessment • Preparedness and impact report • Discovery report analysis and estimates
System upgrade and ICD-10 remediation • Dictionary cross mapping and updates • Test plan development, • CD-10 customization remediation
Organizational Training • Training plan and curriculum development • Train your trainers for success
Project management and functional consulting • Project planning and oversight • Resource estimates, risk mitigation and testing coordination
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Centricity Business Knowledge Services
Partnering With You to Prepare for the Change
Donna Akers
Senior Director, Knowledge Services Organization
GE Healthcare IT
• Knowledge Center
• ICD-10 Courses
• Application Training
• ICD-10 101 eLearning Course
• Courseware Development Resources
• Education Planning and Project Resources
• Trainers
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Centricity Business Knowledge Services ICD-10 Training Services
Knowledge Center
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ICD-10 System Setup Course
- 1 day course
- next offering: 1/10/2012 and 1/12/2012
ICD-10 Application Remediation Courses
- BAR/TES Remediation (1 day)
- next offering is 2/15/2012 and 2/16/2012
- Additional application remediation courses (1/2 day or 1 day)
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Centricity Business Knowledge Services ICD-10 Training Courses
Are you on our mailing list?
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Knowledge Service Organization ICD-10 Training Services
• How is our training different from AAPC?
• KSO will train your staff on how to enter the diagnosis codes into Centricity Business
• KSO does not train your staff on which code is the right one to use
• Coders are key to the ICD-10. How are you going to get them trained?
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AAPC Training Your Coders
Kim Reid, CPC, CPC-I, CEMC, CPMA
Director, ICD-10 Development and Training
AAPC
This presentation and the content herein are the opinions and experiences, and represent the views, of the specific authors and presenters and are not statements of advice, opinion or information of GE Healthcare. This presentation has not been prepared, screened, approved, reviewed or endorsed by GE Healthcare.
Presented by: Kim Reid, CPC, CPC-I, CEMC, CPMA
Director, ICD-10 Development and Training, AAPC
No part of this presentation may be reproduced or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or taping) without the expressed written permission of AAPC.
ICD-10 Final Rule Issues • Single implementation date for all users
– Date of service for ambulatory and physician reporting
– Date of discharge for inpatient settings
• ICD-9-CM codes will not be accepted for services
provided on or after October 1, 2013
• ICD-9-CM claims for services prior to implementation
date will continue to flow through systems for a period of
time
• 4010 electronic transaction standard to 5010 – January
1, 2012
• THERE WILL BE NO DELAY!!!
ICD-10 Changes
From 14,000 codes to approximately 69,000 ICD-10 codes
All codes have full descriptions for both ICD-10-CM and ICD-
10-PCS
ICD-9-CM
• 2010
• 14,000 codes ICD-10-CM
• 2013
• 69,000
Physician Practices: What Will Change?
Coding Transitions
Format and Structure
Categories
Alphanumeric
3 characters
Subcategories
4 or 5 characters
Codes
Up to 7 characters
ICD-10 CM Format
Extension Etiology, Anatomical site, Severity Category
Diabetes mellitus • Significant Change to Diabetes Mellitus
• There are six (6) Diabetes Mellitus categories in the ICD-10-CM. They are:
• E08 Diabetes Mellitus due to an underlying condition
• E09 Drug or chemical induced diabetes mellitus
• E10 Type I diabetes mellitus
• E11 Type 2 diabetes mellitus
• E13 Other specified diabetes mellitus
Diabetes Mellitus • Diabetes mellitus codes expanded to include the classification
of the diabetes and the manifestation.
• Category for diabetes mellitus has been updated to reflect the current clinical classification of diabetes
• No longer classified as controlled/uncontrolled: – E08.22, Diabetes mellitus due to an underlying condition with diabetic chronic
kidney disease
– E09.52, Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene
– E10.11, Type 1 diabetes mellitus with ketoacidosis with coma
– E11.41, Type 2 diabetes mellitus with diabetic mononeuropathy
Combination Codes
• ICD-10-CM consists of greater specificity.
• Examples
– I25.110, Arteriosclerotic heart disease of native coronary artery with unstable angina pectoris
– K50.013, Crohn’s disease of small intestine with fistula
– K71.51, Toxic liver disease with chronic active hepatitis with ascites
Complication Example
• ICD-10-CM provides 50 different codes for complications of foreign body accidently left in body following a procedure
• Only one code in ICD-9-CM.
Complication Example
• T81.535-Perforation due to foreign body accidently left in body following heart catheterization
• T81.530-Perforation due to foreign body accidently left in body following surgical operation
• T81.524-Obstruction due to foreign body accidently left in body following endoscopic examination
• T81.516-Adhesions due to foreign body accidently left in body following aspiration, puncture or other catheterization
Fractures • Fracture codes require seventh character to identify
if fracture is open or closed
• The fracture extensions are: – A Initial encounter for closed fracture
– B Initial encounter for open fracture
– D Subsequent encounter for fracture with routine healing
– G Subsequent encounter for fracture with delayed healing
– K Subsequent encounter for fracture with nonunion
– P Subsequent encounter for fracture with malunion
– S Sequelae
• S42.022-Displaced fracture of shaft of left clavicle initial encounter for closed fracture
– Requires 7th character A for initial encounter
– S42.022A
Fracture Coding
• A patient underwent surgery for an open burst fracture of the lumbar vertebra which became unstable.
• First listed diagnosis: S32.012B
– Seventh character “B” identifies the initial encounter for the open fracture.
Case Examples
• Fracture Clavicle
• 24 choices for fracture of clavicle (only 1 in ICD-9-CM)
• Documentation must include: – Laterality
– Displaced (anterior or posterior displacements)
– Nondisplaced
– Location; sternal end, shaft, lateral end, unspecified
– 7th digit extender; A, B, D, G, K, P, S
– Example: S42.011B Anterior displaced fracture of sternal end of right clavicle initial encounter open fracture
Case Examples
• Malignant Neoplasm Breast
• 54 choices for male/female breast
• Documentation must include:
– Laterality
– Location
– Use of an additional code to identify estrogen receptor status
– Example: C50.422 Malignant neoplasm of upper-outer quadrant of the left male breast
Neoplasm Case Example
• Large and small intestine
• 26 choices available
• Documentation must include:
– Specific site
• Appendix, caput coli, cecum, colon and rectum, ascending, caput, descending, distal, left, overlapping, pelvic, right, sigmoid, hepatic flexure, sigmoid flexure, duodenum, ileum, jejunum…
• Example: C18.5 Malignant neoplasm of splenic flexure
What Can Today’s Practices
Do To Prepare?
Updating skills
• Many coders will retire rather than go through the process of updating skills:
– Anatomy and Pathophysiology
– Medical terminology
– Going back to the basics
– Training in areas of deficiency
Documentation: Compliance and Quality
• In the clinical area, the largest impact to ICD-10-CM implementation is the documentation
– Since ICD-10-CM is more robust and has up to seven digits of specificity, will documentation currently be in the medical record to support ICD-10-CM on the “Go-live” date?
– By analyzing the documentation and conducting medical record documentation audits, the impact can be assessed
Documentation Impacts
Documentation of diagnoses and procedures
▫ Codes must be supported by medical documentation
▫ ICD-10-CM codes are more specific
▫ Revenue Impacts of specificity
▫ Denials
▫ Additional Documentation
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Performing an ICD-10-CM Readiness Evaluation
• Practitioners either have staff that conduct audits in your medical practice or routinely have a consultant audit for appropriate documentation and coding
– Important element of compliance and many practitioners have undergone this process from a comprehensive coding perspective
• But take a different approach – Review the patient chart note to make sure the physician
or non-physician practitioner is documenting a complete diagnosis to support an ICD-10-CM code.
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Performing an ICD-10-CM Readiness Evaluation
• ICD-10-CM readiness evaluation – different than the typical medical record
documentation and coding audit
– Auditor will assess the documentation and make a determination if:
1. does the documentation support the current diagnosis reported, and
2. will the documentation support an ICD-10-CM code(s)?
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AAPC Benchmark tracker
AAPC’s ICD-10 Plan for our Certified
Coders
• ICD-10-CM proficiency testing will begin October 1, 2012
and end September 30, 2014
– Every certified coder must take and pass a proficiency
examination on ICD-10-CM to maintain certification
– Open book 75 question test.
– Coder may use any resource available to complete examination
– May take the examination twice for a cost of $60.00
– Test is taken on line and is a timed
Resources
www.aapc.com/ICD-10/resources.aspx
Resources for all medical practices solo practitioners-large
medical groups
www.cms.hhs.gov/ICD10
Complete list of code sets for ICD-10-CM and ICD-10 PCS;
final rule and Official ICD-10-CM Guidelines
Questions?
Closing Remarks
Footer
Take Action Now!
1. Develop a plan and budget for your ICD-10 project
2. Join the GE Centricity Business ICD-10 Focus Group
3. Attend ICD-10 seminars at the 2012 Regional User Group meetings
4. Explore & monitor ICD-10 websites
5. Contact your account manager for assessment, consulting and training needs
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A copy of this presentation will be made available shortly on our external website:
http://www.gehealthcare.com/centricity-
business/resource-center.html#demos
