ICD 10: The Road Forward - Molina Healthcare

Puerto Rico

ICD 10: The Road Forward

Agenda

ICD-10 Overview ICD-10 Documentation Examples Implementation Putting into Practice Resources

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Overview

Final Rule Issued

On July 31st, 2014, The U.S. Department of Health and Human Services (HHS) issued a rule finalizing Oct. 1, 2015 as the new compliance date.

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Now is the Time to Prepare Compliance Date ? Oct. 1, 2015

ICD-10 Go Live October 1, 2015

Jul 1 ? Dec 31, 2014 Build and Maintain

Momentum

Jan 2015 End-to-End Testing

Apr 2015 End-to-End Testing

Jul 2015 End-to-End Testing

Training

Oct 1, 2015 ? Feb 29, 2016 Post-Implementation Activities

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan

Feb

2014

2015

2016

Jul 1, 2014 ? Sep 30, 2015 Acknowledgement Testing

with Stakeholders

Apr 1 ? Sep 30, 2015 Operational Readiness

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ICD10 Quick Facts

ICD-10 international version

? Adopted by WHO in 1990 ? Most countries other than the US currently use ICD-

10 ? ICD-10 (International version) ~ 12,500 diagnostic

codes ? ICD-10 used for mortality reporting in the US - 1999

ICD-10-CM (US version)

? ~ 69,000 diagnostic codes ? Final rule published ? 2009

ICD-10-PCS

? ~72,000 codes ? Not part of an international standard ? Inpatient procedures only

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The "Anatomy" of ICD-10 structure

Alpha (not U)

Numeric

1st character

2nd character

3rd character

4th character

5th character

6th character

7th character

Category

Etiology, Anatomical Site, Severity

Extension

? 3 character codes ONLY if not further subdivided ? Codes without all required characters are invalid ? Alpha characters are NOT case specific (e.g., s93.401A)

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ICD-10 codes have UP TO 7 characters

The following are examples of the many possible alpha and numeric characters that are used in the 7th character position:

A = Initial Encounter

7th character

D = Subsequent Encounter S = Sequelae

3 = Fetus #3 in multiple gestation, complication of

Often seen in: Obstetrics, Musculoskeletal conditions such as fractures, injuries, and many others

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