What is ICD-10?
- ICD-10-CM- U.S. Clinical Modification of the World Health Organizations (WHO) ICD-10 (Diagnostic Codes only)
- ICD-10-PCS- Developed under contract by CMS to replace ICD-9 procedure coding
Why now is the time!
- The World Health Organization (WHO) adopted ICD-10 in 1990. Since then, 136 countries have adopted ICD-10. The United States is still using ICD-9, 35 years later.
What is the compliance date?
Is it mandatory?
- The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA)
What are the benefits of ICD-10?
- Improved collection of data for quality reporting and value-based purchasing
- Provides better data to support performance measures, outcome analysis, cost analysis and monitoring of resource utilization
- Increased claims sensitivity for reimbursement methodologies, enhancing accurate payment for services rendered
- Enhanced ability to conduct public health surveillance and research
What changes will we see in ICD-10?
- Quality vs. Quantity
- Stages of healing
- Episodes of Care
Who is affected by the change?
- Outpatient Facilities
- Home Health Agencies
- Home Medical Equipment
- Reference labs
- Health Plans & Payers
- State Medicaid Departments
- Medical Devices
How will HIM and CDI help you (physicians)
- Education (e-learning available) and face-to-face with CDI specialists
- Tip Cards
- Section meeting presentations
What is the physicians’ role?
- Documentation is key!
- Query responses
- Clear, comprehensive diagnosis
Are CPT codes affected for outpatient procedures and physician services?