ICD-11 Transition Report

There are two trends that I have learned about from UMA and TV. ICD-10 replacing IDC-9. ICD-10 will provide the medical billing/coder with more descriptions for describing encounters and hospital stay for patients. Where ICD-9 had 3,824 procedure codes and 14,025 diagnosis codes, ICD-10 on the other hand, has 71,924 procedure codes and 69,823 diagnosis codes that is a big difference. The affordable care act also made an impacted on billing/coding since more people are getting procedures done. These procedures will need to be coded and documented for doctors and hospitals to get paid.

The main and most obvious difference between ICD-9 and ICD-10 is that there is a significant increase in the amount of codes. ICD-9-CM has an approximate of 17,849 codes when combining all procedural and diagnosis codes, whereas ICD-10 has well over 68,000 Clinical Modification (CM) codes and over 71,000 Procedural Coding System (PCS) codes. There are also several structural differences between ICD-9-CM and ICD-10-CM/PCS. Some of them are:

- amount of diagnosis codes. ICD-10-CM has 69,823 codes compare to 14,025 codes in ICD-9-CM.

Are you and your staff anywhere near ready for ICD-10’s October 1st deadline? Maybe you’ve been overwhelmed just trying to implement all of the other changes happening in healthcare thanks to the Affordable Care Act, EMR mandates, increased Medicare audits, and value-based purchasing penalties; you’ve hardly had time to prepare for this latest coding switch.

RE: Unit 3 7/27/2015 5:05:08 PM I'm with you Jerica. ICD-9 seems like a cakewalk compared to ICD-10. I think the more work we do the better we will get. CPT coding has been the easiest by far.

As I type these words there are only 20 days until October 1st, AKA, ICD-10 transition day. Most people in the healthcare industry are wondering what that day will be like. What will happen? What will they have to do?

Physicians and other facilities are paid by insurance companies, including Medicare and Medicaid, based on the procedure (CPT) code they submit. These codes must be accompanied by the correct diagnosis or ICD-10 codes.There must be a valid reason for a medical encounter for the physician to be paid, such as pain, refills for medications, or a follow-up for such diseases as diabetes or any chronic condition. If you just submit the CPT or ICD-10 code separately then you will not be paid as both support each other. So it is vital that a medical biller and coder be aware of these rules and how to complete the claim forms properly.

In 1978, the World Health Organization published ICD-9. It was later modified by the US Public Health Service so that it could service the needs of American hospitals. This modification was named International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM). As of October 1, 2015, ICD-9-CM was replaced with ICD-10-CM. ICD-10-CM was considered an upgrade from ICD-9-CM because it was more specific and contained many more codes than its predecessor. Most of the categories contained in ICD-9-CM were completely full with no room for expansion. ICD-10-CM goes into a lot more detail than ICD-9-CM. ICD-10 has been upgraded to contain up to seven digits as opposed to the four to five that were associated with ICD-9.

The RRT intervenes before a crisis, which the Code 100 will be to activate the RRT, as a result lives are saved and adverse events are prevented. Data collection from the initiative has proven to be a beneficial tool; it has decreased code blue calls and has produced positive outcomes (Rankins, 2006). The IHI initiative included clinicians in collaboration with hospital and nurse leads to implement best practice protocols to prevent unnecessary deaths. The RRT deployed at first sign of patient decline does save lives (Richard, 2005).

This article discusses how the implementation of the new ICD10 codes are costing more than originally planned. All practices are required to use 2014-certified electronic health-record technology in order to receive funding from a federal electronic health record incentive program. The new estimates for the ICD10 implantation include the cost of such things as education, IT and documentation

There have been many studies documented in the literature regarding the reduction of CLABSIs. The majority of the studies have reported statistically significant decreases in CLABSI rates post-implementation of a quality improvement initiative (O‟Grady et al., 2011). Some studies used approaches in which multiple strategies have been implemented together to improve compliance with the use of evidence-based guidelines. A seminal study conducted by Pronovost et al. (2006), known as the Keystone ICU project, included a collaborative cohort of 108 ICUs within the state of Michigan. The strategies in this study included the use of five evidence-based bloodstream infection prevention practices for CVC insertions, use of a checklist to ensure adherence

A number of countries have already moved to ICD-10-CM, but here in the United States we are still behind, and have not evolved from ICD-9-CM to ICD-10-CM.

I think transitioning over to ICD-10-CM will make coding easier by being more specific with the descriptions. I think that the biggest challenge is going to be just learning the different sections of the ICD-10-CM. Some other challenges may include training in ICD-10-CM, the cost of the transition, and maintaining two coding systems because some private insurance like workman compensation insurance are not required to switch over to ICD-10-CM. I believe that we have had ICD-9 since 1979 with updates yearly, which makes the ICD-9 over twenty years and almost thirty years old. A lot has changed in the medical world since then and we are due for a change. Anything new will take some time to learn and I believe that the transition would be

Another interesting perspective comes from the Heritage Foundation in an article titled: The New Disease Classification (ICD-10): Doctors and Patients Will Pay. It was presented for review on May 18th, 2015, and was authored by: John Grimsley, and John S. O’Shea.

Imagine you are laying in a hospital bed connected to multiple machines, IV’s and monitors. The only thing keeping you alive is the heart and lung machine, the team of doctors, nurses and specialist. Even with the help of modern medicine you will only remain alive as long as you stay in that hospital bed; attached to those lifesaving machines. Even with the help of those machines your life is not guaranteed. Now imagine knowing that the only thing that can save your life is a heart transplant, and having to wait your turn on a very long list to get one.