IMPORTANT ICD-10 NEWS

ICD-10 Provider Readiness Survey

In November 2012 the Iowa Medicaid Enterprise (IME) announced the results of its ICD-10 Provider Readiness Survey. The survey was to be the first, of several, to track the preparation and readiness of providers for the transition to the ICD-10 code set on October 1, 2014. A second survey was launched in February 2013, and over 780 provider responses were received. The results echo national survey results and give cause for concern around provider ICD-10 readiness.

Comparing the results of the first and second surveys reveals small gains reported by Iowa providers in the progression of planning and training to prepare for ICD-10. Just 22% of respondents indicated they were more than a quarter of the way through planning for resources dedicated to implementing ICD-10 (up slightly from 15% on the first), and only 20% responded they had developed an ICD-10 training plan. Nationally, the Workgroup for Electronic Data Interchange (WEDI), which promotes and tracks the use of IT in health care, reported that over two fifths of provider respondents indicated they did not know when they would complete their impact assessment. “Because of the magnitude of ICD-10, it is critical that organizations complete their remediation efforts as quickly as possible in order to allow adequate time for testing,” said WEDI Chairman, Jim Daley.

The IME’s own project to prepare for use of ICD-10 is well on track and will be ready for external testing with providers in October 2013, but we are concerned that many of our provider partners are falling behind. Individual providers that are not able to properly code claims after the deadline could face payment problems and/or raise program integrity alerts. If a significant number of providers are unprepared, it could result in a late shift in policy such as another implementation delay or a “dual use” period, both of which add complexity and cost to the overall transition.

In many cases, it is not until actual planning (when staff are exposed to details of the complex change), that the full business impact becomes clear. This appears to be reflected in our survey as well: as planning scores have crept up, the percentage of providers indicating they will be ready to test in October of 2013 (36%) and comply with the production deadline (79%) actually dropped slightly (each by about 5%). This may be the result of planners recognizing the true extent of the challenge they face.

The IME will conduct external end-to-end testing with providers between October 2013 and October 2014 and urges providers to continue to move forward with their preparation and to allow plenty of time for robust ICD-10 testing alongside production ICD-9 claims to ensure a surprise-free transition to ICD-10. To view the full result of the survey, please click HERE.

If you have any questions on ICD-10 please send an email to: ICD-10project@dhs.state.ia.us 

ICD-10 Compliance Date

Press Release on the ICD-10 Compliance Date Delay

HHS News, April 9, 2012. HHS Secretary Kathleen Sebelius Announces Delay of ICD-10 until October 1, 2014

http://www.ime.state.ia.us/docs/ICD10_HHSNews20120409DelayPressRelease.pdf

The Federal Register posted the final rules on September 5, 2012 indicating the ICD-10 deadline be extended to October 1, 2014.

Federal Register / Vol. 77, No. 74 / Wednesday, September 5, 2012 / Final Rules

ICD-10 BASICS & BENEFITS

BASICS

ICD-10-CM and PCS (International Classification of Diseases, 10th Edition, Clinical Modification and Procedure Coding System) is an update to the ICD-9 and provides an expanded set of diagnosis and procedure codes to keep pace with advances in medicine over the last three decades. Another primary reason driving the migration from ICD-9 to ICD-10 is that the ICD-9 code set is running out of codes and its limited structural design is preventing the addition of new codes. ICD-10 consists of:

• ICD-10-CM for diagnosis coding in all health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.
• ICD-10-PCS for procedure coding in inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used with ICD-9-CM procedure coding and is much more specific. The format of the code sets is substantially different.

BENEFITS

The ICD-10 code sets provide significant benefits in areas such as program management, care management, and analysis of program costs and effectiveness and:

• Incorporate much greater specificity and clinical information for: improved ability to measure health care services, increased sensitivity when refining grouping and reimbursement methodologies, enhanced ability to conduct public health surveillance, and decreased need to include supporting documentation with claims
• Include updated medical terminology and classification of diseases
• Provide codes to allow comparison of mortality and morbidity data

RESOURCES

Centers for Medicare &Medicaid Services (CMS)

CMS provides extensive information, tools, and resources for implementing ICD-10. We are providing select links to assist you with your ICD-10 efforts. For more information, visit the CMS website at cms.gov.

45 CFR Part 162, Final Rule: Governing legislation for implementing the ICD-10 code sets.

Medicaid.gov: A CMS website with Federal policy guidance, lists of pending and approved waivers, highlights of CMS Affordable Care Act implementation efforts, State-specific program information and data, and search capabilities.

CMS ICD-10 Website: Provides resources for providers, payers and vendors, including ICD-10 implementation timelines, Fact Sheets, GEMs (see below), trainings, and links to other resources to help with the transition to ICD-10 code sets.

CMS Informational Bulletins: CMS publishes Informational Bulletins about a variety of topics, including ICD-10. You can sign up to receive these bulletins when they are released.

CMS ICD-10 Code Conversion Software: An announcement that CMS selected the 3M ICD-10 Code Conversion Software to assist them with their ICD-10 implementation efforts.

2012 ICD-10-CM General Equivalence Mappings (GEMs): GEMs are mappings between ICD-10-CM and PCS and ICD-9-CM codes. They are designed to assist in converting applications and systems from ICD-9 to ICD-10 codes and are updated annually.

ICD-10 MS-DRG Conversion Project: The Medicare Severity-Diagnosis-Related Grouping (MS-DRG) conversion project used the General Equivalence Mappings (GEMs) to convert the draft MS-DRGs v29.0 to ICD-10-CM and ICD-10-PCS to understand the potential impacts of the change in code sets.

Medicare Learning Network (MLN): The Medicare Learning Network (a registered trademark of CMS), provides CMS educational products and information for Medicare Fee-For-Service (FFS) Providers.

American Medical Association (AMA)

The AMA is a professional organization for physicians and provides resources on professional and public health issues, including the conversion to ICD-10 code sets.

AMA ICD-10 Website. This link takes you to the AMA's ICD-10 web page, which contains links to many resources.

AMA Wire. A weekly electronic newsletter that is searchable by topic. You can subscribe to the weekly newsletter.

American Health Information Management Association (AHIMA)

AHIMA is a resource for health information management (HIM), education, accreditation, professional credentialing, standards-setting, policy-making, and issue advocacy.

AHIMA Website: Provides online training courses, ICD-10 news, and other features; however, some resources are only available to members.

IaHIMA Website: The Iowa Health Information Management Association is a state organization affiliated with the national organization AHIMA. IaHIMA develops, promotes, and advances the Health Information Management profession in Iowa.

American Academy of Professional Coders (AAPC)

AAPC provides education and professional certification to physician-based medical coders and provides student training, certification, ongoing education, and networking.

AAPC ICD-10 Website: Provides resources and ICD-10 coding training and certification.

WEDI (Workgroup for Electronic Data Interchange)

WEDI provides a broad-based interactive forum for healthcare executives, managers, and advisors to utilize in addressing the business issues and policy formulation for the industry. (Registration or membership is required to access some information and resources.)

WEDI Website: Among the organization's activities are ICD-10 White Papers and quarterly ICD-10 surveys.

WEDI ICD-10 White PaperImplementation: This white paper is intended to provide industry guidance on building an Implementation Plan for compliance with the Final Rule regarding ICD-10.

WEDI ICD-10 White PaperRedefining Policies, Rules, and Categories: This white paper focuses on the methods and issues related to redefining policies, rules and categories that use groups of diagnostic or inpatient hospital procedure codes in algorithms or categories of analysis.

WEDI March 2012 Town Hall Presentation: A March 2012 Town Hall meeting presentation that includes a section on ICD-10 progress.

Other Resources

The following are websites related to ICD-10.

WHO ICD Website. The World Health Organization (WHO) provides you with links and downloads to help you better understand ICD coding and the transition from ICD-9 to ICD-10.

CDC ICD-10-CM Website. The Center for Disease Control (CDC) provides information about ICD-10-CM on its website.