Nursing Intervention Classifications

hello, and welcome to thiscme/ce-certified presentation, "icd 10: getting from here to there:navigating the road ahead". my name isdr. ricardo martinez and i'm a practicingphysician and, just like for you, patient careis my number-one priority. understanding and diagnosing thenature of my patient's condition is a normal part of my day. it's very exciting to seethe innovations happening

within our medical communityand that helps me provide a more precisediagnosis for my patients. covered entities in theunited states will begin using the international classificationof diseases version 10, which is an improvementover the outdated icd-9 codes that we use today. now, the goals of today'sprogram are twofold: describe the overallstages and milestones generally involvedin a transition to icd-10

in a small healthcarepractice and explain how the newericd-10 codes may differ from the icd-9 codescurrently in use. as a practicing physician, i see the limitationsof icd-9 every day and why inputfrom the medical community into the development of icd-10has been so valuable. icd-9 is outdated, even antiquated,by today's practice standards,

and it limits the speedand accuracy with which i can gatherinformation, gain insights, and, more important,care for my patients. today, icd-9 doesn't evenaddress laterality, for instance,which signifies a condition affectsthe left or the right limb. on a professional note,when recently faced with a complex patientwho had an acute stroke and historyof a previous stroke,

we had to searchthrough many old records to determine whether that oldstroke was left- or right-side, wasting valuable timethat could've been dedicatedto patient treatment. with a single code, icd-10will provide us with more detail and better datamakes better care possible. because ofphysician enhancements now reflected in icd-10,this coding classification will become the new baselinefor clinical data,

clinical documentation,claims processing, and public health reporting. we want to provide toolsand resources to help fast-track your preparationfor the icd-10 transition. to help smallprovider practices and other healthcareprofessionals with the transitionto icd-10, the centers for medicare& medicaid services, or cms, is actively workingwith physicians,

industry leaders,and others. cms provides a numberof free technical assistance and training sessions,like this one; and is developingother resources, such as the online"road to 10" tool, which i'll introduce laterin this presentation. during this presentation,i will: explain the origin of icd-10, describe how the new icd-10diagnosis codes differ

from the current icd-9 codes, identify the benefitsof the transition, and introduce you to "road to 10: the small physicianpractice's route to icd-10", which is an online icd-10planning and training resource that walks you through the stages oftransition and implementation. this presentation will focuson icd-10 diagnosis codes, since they arethe most relevant

in the small providerpractice setting. the icd-10 procedure codingsystem, or the icd-10-pcs, will not be addressed here,since they are related to hospitaland other settings. healthcare has been using the internationalclassification of diseases for over a centuryto identify and track diseases and help us improveour care for our patients. although most of the world

transitioned to icd-10years ago, the currently usedversion of the icd-9 is fundamentally unchanged since its implementationin the united states in 1979. one major limitationof icd-9 is that it predates many moderntechnological advances in clinical terminology, reflecting the useof ct scans, for example, which was also inventedin 1979;

therefore,an update was necessary, to account for theseinnovations in medicine. for years, practitionersnoted the need for increased specificitywithin clinical terminology, documentation, and coding,to accurately represent the care providedto their patients. under sponsorship of theworld health organization, a group of physicians developedthe basic structure for icd-10; then, each specialtyprovided input

on the subset of procedureor diagnosis codes needed. addressing boththe changes in medicine and the needfor increased specificity, icd-10 will capturegreater detail in the clinical encounterfor each patient. this is especially helpfulwith the increase of electronic sharingof health records and the need for cliniciansto communicate and collaborate about patient care.

let's explore the differencesbetween the older icd-9 codes and the newer,enhanced icd-10 codes. now, there are7 main differences between the current icd-9 codesand the new icd-10 codes. (1) is laterality: icd-10 increases the codesby specifying laterality, especially the areasof injury and neoplasm. in fact, simply specifyingright, left, or bilateral addresses more than 40%of the new icd-10 codes.

(2) while icd-9 codes haveno placeholder characteristics, icd-10 uses x placeholdersfor certain codes to allow forfuture expansion. (3) is the overall numberof available codes. currently, icd-9 hasabout 14,000 codes. with the ability to captureincreased specificity and align with currentclinical terminology, icd-10 has 69,000 codes,however, only a subset of these 69,000 codesis most relevant

to the patient care withinyour area of practice. (4) icd-9 has limitedseverity parameters. icd-10 expandsthe severity parameters. (5) icd-10 expandsthe combination codes to better capture complexityof our patients. (6) icd-9 has onlyone type of "excludes notes"; icd-10 has 2 typesof excludes notes. and (7) the numberof characters changes: while icd-9 codes are3 to 5 characters,

the icd-10 codesare 7 characters. character 1 is alpha,2 is numeric, and 3 to 7 areeither alpha or numeric and the decimal's placedafter the third character. the icd-10 characters supportflexibility and expandability. in addition to these7 differences, icd-10 incorporates a fewother important changes. injuries are now groupedby anatomic site instead of the typeof the injury;

the v and e codesare now incorporated into the main classification,rather than separated into supplementaryclassifications; and the new codes' definitionsare provided, where necessary, to reflectmodern medical practice. the classification of certaindiseases and disorders may be differentin a number of icd-10 chapters due to category restructuringand code reorganizations or as a reflectionof current medical knowledge.

although some conditionsrequire very minor changes in codes and documentation,others would be much more significantly affectedby the transition to icd-10. for example, orthopedics is one of the most heavilyaffected specialties. let's look at a sample scenarioand explore the differences between the oldericd-9 codes the scenario is:a male patient comes in for his first follow-up visitfor a left-femur fracture.

now, he sustaineda crush injury in an on-the-job accidentinvolving a forklift. so what arethe characteristics of documenting fracturesin icd-10? the circumstances of the injury,such as where and how it occurred,are important for claims processingand coordination of benefits; and when documentingfractures in icd-10, 9 characteristicsmust be determined:

the type of fracture -- in this case,it's an open fracture; the fracture pattern --in this scenario, the patient's fracture isa transverse pattern; the localization, or location --in this scenario, the location ofthe patient's fracture is the middle ofthe left femoral shaft; displacement -- in this example,the fracture is displaced; classification --

the fracture in this case isa gustilo class ii; and the encounter of care --well, although this is a follow-up visit,it is a subsequent encounter; healing status -- the fractureshows routine healing; and any complications,whether acute or delayed, are also documented --in this case, there are no complicationspresent in this scenario; and then, last,the etiology to document in the external causecode --

we do not have enough detail,in this particular case, to know what happenedwith the forklift or the patient's rolewith the forklift, whether they're a driver,a passenger, or a bystander, therefore,the etiology to document in the external cause codesis unknown. in icd-9, this would beas an open fracture of the shaft of the femur,or icd-9-cm 821.11. in icd-10, we're more specific:displaced transverse fracture

of the shaft of the left femur,subsequent encounter, for open fracture type 1 or 2with routine healing. that would beicd-10-cm s72.322e, much more specific,greater detail. so, as you can see,the icd-10 code definitely adds detailand specificity that will be helpful,not only in the current case, but also in the potentialfuture care of this patient. knowing what icd-10 is,how it evolved,

and the main differencesfrom icd-9 are a great start, however, realizing that thereare benefits to your practice can also put the transitioninto perspective, so, today, we're focusedon 4 key areas of your practice: clinical, operational,professional, and financial. clinically,icd-10 will allow for easier researchof patients' medical history, and increasedpublic health reporting and long-term trackingof illnesses,

enable patientsegmentation for care, improve protocols, and provide new insightsinto clinical care. ultimately,icd-10 will result in more accurate and completeclinical decisions from improved data collectionand evaluation. operationally,icd-10 supports practice transitionto risk-sharing models, with more precise datafor patients and populations,

and affords more targetedcapital investment to meet practice needs through better specificityof patient conditions. icd-10 also enhancesthe definition of patient conditions,providing improved matching of professional resourcesand care teams with the needsof the patients. professionally, icd-10provides clear, objective data for credentialing, privileging,and quality reporting.

icd-10 also improves reporting,aids in prevention and detection of healthcarefraud and abuse; provides more specific datato support physician advocacy of healthand public health policy. and icd-10also improves data for peer comparisonand utilization benchmarking and better documentation of patient complexityand level of care. and now that we understandthe key benefits

of implementing this transitionfor your practice, let's look at the processof preparing for the transition. i'd like to introducean industry-inspired tool, which is an online resource to help small providerpractices transition to icd-10. this tool,developed by cms in collaborationwith industry partners, allows smallclinical practices to createa customized action plan

for icd-10 readinessand preparation. this resource also includesmore information on the backgroundand benefits of icd-10. the customized action planon the "road to 10" website has 5 distinct stepsthat correlate to the stages of preparation:planning, training, updating, engaging the partners,and testing. i'm going to use a samplefamily practice action plan and explain each stepas we walk through it.

so let's plan our journey. how will icd-10 affectyour practice? early on,in the preparation of icd-10 transition,you need to determine where diagnosis codesare used in your practice, identify the team members whowill join you on the journey, and prepare a practicalbut thorough budget. we developed several toolsand resources to get small providerpractices started

on the pathto icd-10 implementation. the icd-10 transition will include team membersfrom your practice, such as clinicaland nursing professionals, office managers,medical assistants, and even billersand coders. the first tool: a set of common icd-9 diagnosiscodes for your specialty, mapped to the correspondingicd-10 codes.

based on claims data analysisfrom a variety of sources, these are some of the codesthat your practice type is more likelyto see most frequently and have the most potentialto positively or negatively impactclinical productivity, according to your levelof preparation and ability to submitcompliant icd-10 codes, based onthe dates of service. this list gives youa great jumpstart

to think about the codesthat matter in your practice. you'll wantto compare these codes to your ownpractice experience, to account for your specificpatient population. now, these codes are groupedin an expandable list by common conditionswithin each specialty. as you can see here,in this family practice example, 12 conditions are listed with the relevantcurrent icd-9-cm codes

and each is expandablewhen clicked. as shown here, abdominal painhas, now, 12 new icd-10 codes with much greater specificity,allowing you to choose a code that most closely matchesyour patient's condition. the second tool,train your team, is a set of clinical scenariosspecific to your specialty. these scenarios highlightsome of the key differences between clinical documentationunder icd-9, compared to icd-10, and the implicationsto your practice.

these examples illustratethe importance of including the appropriate level of detailto substantiate the more specific icd-10diagnosis code selection. as illustrated in thisfamily practice scenario, the patient isa 47-year-old with midabdominalepigastric pain. other detailsabout the patient's history, exam, and assessmentand plan are shown and, below these details,our sample scenario presents

a summary of impacts on clinicaldocumentation and coding, based on icd-10 changes,as well as any other effects. in this example,the impact is minimal. there's a primer aboutclinical documentation. this document featuresbest practices on documentation for common conditions associatedwith your area of practice. it emphasizes the increasedspecificity and laterality that can now be capturedby the icd-10 codes and providesa brief description

of the documentation nuancesthat a coder should look for. in this family practice primer,you can see how the color-coded changes relatedto definition changes, the terminology differences,and the increased specificity. each change can be clickedto view the explanation. for example,expanding "hypertension" shows that the definitionchanged from benign or malignant to primary and secondary,et cetera. this section also showswhat documentation

may be most importantto correct code selection and gives examplesof the new icd-10 codes. by expanding "asthma",however, you can see theterminology differences, based on the currentclassification system; and, by expanding"abdominal pain", you can see an exampleof increased specificity that can be captured in thenew icd-10 code examples. in addition to these 3 tools,we've highlighted

several training and educationresources in the industry that cover coreicd-10 competencies for clinical documentation,coding, and administrativeoverview. this resource list includeslinks to each resource. for example, coding trainingwill be specifically needed to address anatomyand physiology. the education and trainingresource list provides industry-recognizedorganizations

that do providethis type of training. step 3 isupdate your processes. key action stepsare outlined by function area that your practice needsto follow. the function areas include: improvingclinical documentation, revising paper formsand templates, and modifying policiesand procedures. like some other stepsin the action plan,

update your processeshas a checklist with multiple action itemsthat can be used to track yourpractice's progress. engage your partnersis step 4 of the action plan on the "road to 10"online resource. this sectionprovides information on coordinating icd-10implementation activities with your key trading partners,such as payers, clearinghouses, technology vendors,and third-party administrators.

the portal provides assessmentsthat you can send to your clearinghouse,your emr vendor, practice management systemvendor, billing service, and payers to gaugewhere they are in the icd-10implementation process. the assessmentshelp determine which applicationsare affected by icd-10, how those applications will beupdated to accommodate icd-10, how your vendorwill handle reporting,

and what isthe testing timeline. this step also includes a checklist of activitiesto be completed in regards to yourtechnology partners. you can track your progressby marking items complete. unlike with version 4010,where clearinghouses were able to translate claimsinto version 5010 format, the transition to icd-10starts with your practice. you're responsiblefor submitting claims

in version 5010 format,with the icd-10 codes, to your clearinghouseand/or payer. the last step, testyour systems and processes, introduces a plan for internaland external testing for your practiceand it covers 4 main topics: prepare or obtaintest cases, conduct internal testingof affected systems and workflow processes andremediate systems as needed, conduct external testingof relevant hipaa

and nonstandard transactionsand remediate systems as needed, and practice codingin icd-10. prior to beginning testing,you'll need to prepare or obtainreal-world test cases. in this step of the action plan,we've provided a checklist of action items with notesand some resource links to help youcomplete each task. internal testing should beginafter you've updated versions of systems affectedby the icd-10 transition

and completed the system setupand configurations necessary within your practice. this industry-developedchecklist explains how to use your test cases to test your systemsand document the results. external testing with yourtrading partners is necessary to ensure that you cansubmit, receive, and process claims datacontaining icd-10 codes and helps to identifyand address issues

prior tothe transition date. this testing should begin once your internal testingis complete. in addition to testingwith your mac, it's importantto engage in testing with your othertrading partners as well, and this he checklist providedin the action plan outlines steps withthe descriptions and notes. as you complete itemson the list,

your progress can be trackedright in your action plan. your practicecan increase proficiency by practicing coding in icd-10,which helps verify whether your clinical documentationcontains sufficient detail. the provided checklistwill help you apply a practice and validationstrategy and, as with all checklistson the "road to 10", you can track your progress. these 5 steps that are outlinedin the online tools

include a lot of informationand opportunities for action. by delegating specific elementsof these checklists, you can involve the appropriatemembers of your staff in the preparation ofa successful icd-10 transition. in summary, remember: icd-10 fits into thelarger picture of ehealth: improved clinical datacapture and sharing, improved qualityof patient care, and more detailedpublic health information.

but the clock is ticking. so take action today to prepareyour practice for tomorrow by using the tools, training,and resources discussed in this presentation to help youthrough the transition. this tool helps: build a transition plan, take actionable steps, and see the results. it providesa 5-step action plan:

plan your journey,train your team, update your systemsand processes, engage your partners, and then test your systemsand processes. i hope the informationcovered today helps to ease your concernsand gives you a better understandingof the transition to icd-10. the online tool "road to 10: the small physicianpractice's route to icd-10"

is now availableto all provider practices. use this online tooland you'll see that preparing for icd-10 implementationtruly is achievable. i'd like to thank youfor participating in this educationalactivity. to proceed to the onlinecme/ce test, click on the"earn cme/ce credit" link.