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?

  • October, 1 2015

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?

  • Chronicity
  • Quality vs. Quantity
  • Laterality
  • Stages of healing
  • Episodes of Care
  • Comprehensive
  • Granularity

Who is affected by the change?

  • Hospitals
  • Physicians
  • Outpatient Facilities
  • Home Health Agencies
  • Home Medical Equipment
  • Reference labs
  • Health Plans & Payers
  • State Medicaid Departments
  • CDC
  • Medical Devices

How will HIM and CDI help you (physicians)

  • Queries
  • 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
  • Specificity
  • Clear, comprehensive diagnosis

Are CPT codes affected for outpatient procedures and physician services?

  • No