Author: Rachel Tornheim

What Your Patients’ Conditions Look Like in ICD-10: Introducing NYP’s Code Mapping Tool

Rachel Tornheim

NOTE: This article is being re-published to keep NYP staff appraised on the tools available to aid them in the ICD-10 transition.  The code mapping tools for Cornell and Columbia can be found on the Support Center Page under the ‘Other Resources & Materials’ or by clicking here for Cornell and here for Columbia.

As we approach the October 1st, 2015 cutover date for ICD-10, many departments have requested the ICD-10 equivalents of their most commonly used ICD-9 codes. In response, the ICD-10 Project Management Office has built a dynamic tool that allows users to drill down into the campus, registration area, clinic ID, or even individual physician, view the ICD-9 codes for hospital-based outpatient services based on frequency, and see the ICD-10 codes to which each ICD-9 code can map.

There are two code mapping tools: one for Cornell and one for Columbia. The tools can be downloaded from the ICD-10 AnTENna website, and are available as links under the section on the right side of the page labeled “ICD-9 / ICD-10 Code Mapping Tool.”

CodeMapTool

The tools, built in Excel, have two main tabs. The “filters” tab is where the user selects the campus, registration area, clinic ID, and/or physician for which they would like to view results. After the selections are made, the table below updates to show the relevant ICD-9 codes and descriptions, sorted by volume. For each ICD-9 code, the table also displays the number of ICD-10 codes that ICD-9 code can map to. The more ICD-10 codes a given ICD-9 code can map to, the more additional documentation details will be required in ICD-10, and the more focus is warranted as we prepare for the transition. A summary table in the top right shows some key statistics for the selection.

Filter

In the “9 to 10 map” tab, users can see the specific ICD-10 codes that their current ICD-9 codes can map to. This report makes it clear which ICD-9 codes map to a single ICD-10 code vs. multiple ICD-10 codes, helping to illuminate the areas where the need for documentation enhancement is greatest. From looking at the descriptions of the ICD-10 codes, users can tell what additional documentation details will be needed in order to ensure that the correct ICD-10 code can be selected.

Detail

These tools are part of a larger arsenal of education and communication designed to arm departments with the information they need to be fully prepared for ICD-10. Please reach out to the ICD-10 Project Management Office at ICD-10help@nyp.org if you have any questions.

ICD-10 Go-Live, October 1, 2015… NYP ICD-10 Go-Live, July 1, 2015 – What it all means.

Rachel Tornheim

On October 1st, 2015, the entire healthcare industry in the U.S. will transition to ICD-10 as mandated by CMS.  On July 1st, three months prior, NYP will have its internal go-live for ICD-10, implementing ICD-10 for several internal processes that do not rely on interactions with external entities.  The purpose of this early internal go-live is to give us a buffer period during which we can practice using ICD-10, monitor and collect feedback, and potentially make adjustments to our processes in advance of the national go-live.

The internal processes that will be using ICD-10 as of July 1st are:

  • Provider Documentation in the EMR.  All providers will be documenting with the additional specificity necessary to support accurate ICD-10 coding.  They will be supported by the ICDx widget, a tool that will be embedded in Allscripts SCM that helps lead the provider to select diagnoses that meet ICD-10 specificity requirements.
  • Documentation Improvement activities.  The Documentation Improvement department, which is part of Health Information Management, is tasked with reviewing patient charts and querying physicians if any of the documentation appears deficient or requires clarification.  As of July 1st, the Documentation Improvement nurses will be reviewing charts with ICD-10 documentation requirements in mind, and will query physicians for those additional requirements as appropriate.
  • Coding.  Dual coding, or the generation of both ICD-9 and ICD-10 codes during a single coding session, is critical for ICD-10 readiness because it allows our coders to practice coding in ICD-10 while also building an inventory of dual coded cases that can be used to analyze the impact of ICD-10 on outcomes such as reimbursement and quality metrics.  As of July 1st, all of our coders will be engaging in dual coding.
  • IT interfaces.  All of our IT systems that receive and send ICD-9 codes have had to be updated to be able to store ICD-10 codes, which are longer.  The interfaces through which these systems send ICD codes to one another are currently being tested.  On July 1st, interfaces that go into Eagle will begin sending both ICD-9 and ICD-10 codes.

Between July 1st and October 1st, we will monitor the above processes and make any necessary adjustments to ensure a smooth full transition to ICD-10 on October 1st.

ICD-10 Readiness Spotlight: ICDx – A widget to support ICD-10 documentation

Rachel Tornheim

Enabling physician support of ICD-10 documentation requirements is one of the most important milestones in NYP’s ICD-10 project.  In order for NYP to be compliant with ICD-10, our physicians need to incorporate additional details into the documentation that they enter into their patients’ charts.  For example, proper ICD-10 coding requires information about the cause of a patient’s condition, the severity of that condition, and how long the patient has experienced it – details that are not necessary for ICD-9 coding.

NYP is supporting physicians in providing this additional documentation through several avenues.  The Documentation Improvement team has been training physicians on the additional ICD-10 documentation requirements for their specialty.  Documentation Nurses are also beginning to incorporate ICD-10 documentation requirements into their chart reviews, sending queries to physicians whose documentation is missing details that are needed for ICD-10 coding.

Additionally, the ICD-10 Provider Education and Adoption workgroup has collaborated with the IT department to develop a tool that is embedded in the Allscripts Sunrise Clinical Manager (SCM)Electronic Medical Record that helps guide physicians to provide ICD-10 required documentation while they are in the patient’s chart.  Called ICDx, this tool will launch automatically when a provider opens certain types of notes.  The tool helps providers maintain an accurate ICD-10 problem list which drives documentation that can be readily coded in ICD-10.  By guiding physicians to include ICD-10-compliant documentation while they are in the patient’s chart, the tool should reduce the need for subsequent queries from Documentation Improvement nurses.

The ICDx tool is currently being piloted with twelve physicians, who have provided mainly positive feedback.  The team is incorporating some requested changes into the tool, and plans to launch the tool institution-wide for the ten most frequently used notes on each campus later in the spring.  The tool will be incorporated into additional notes over time in order to ensure that our physicians can easily provide the required documentation for ICD-10 coding.

ICD-10 Readiness Spotlight: Report Conversion

Rachel Tornheim

At NewYork-Presbyterian Hospital, employees across the organization use reports for a wide variety of purposes.  Whether we’re looking at operational metrics like length of stay and discharges, quality indicators like readmissions and infection rates, or financial measures related to billing and payment, it’s important that our reports be accurate and up to date so that we can make informed decisions.  Because many of the reports we rely on to run our departments, practices, and units contain ICD-9 codes, the upcoming transition to ICD-10 means that we need to update our reports to reflect the new code set.

The ICD-10 IT workgroup, headed by Ken Thibault, has been leading the effort to ensure that all necessary reports are converted to ICD-10.  The group has already created an inventory of about 150 reports that use ICD-9 codes, and has begun the process of determining which ones need to be updated, collecting the relevant ICD-9 codes, and converting those ICD-9 codes to ICD-10 codes.  Once the ICD-9 codes are mapped to ICD-10 codes, the mapping is sent to the report’s business owner for approval, at which point IT will make the necessary updates so that the report will populate properly once we transition to ICD-10.

If you are a business owner of reports, you should be hearing from the ICD-10 team in the next month or two so that we can work with you on converting your reports.  If there are reports that you use that you want to make sure are on the inventory, please reach out to the IT team that manages the system in questions.  We look forward to partnering with you to ensure that your reporting needs continue to be met post October 1st, 2015.

What is ICD and ICD-10?

Rachel Tornheim

What is ICD? 

ICD stands for International Classification of Diseases.  This classification, which is developed by the World Health Organization, consists of a set of diagnosis codes, which describe what is wrong with a given patient, and a set of procedure codes, which describe the various tests and treatments that we use to understand and treat their condition.

What is ICD used for?

The diagnosis and procedure codes that are part of ICD are used for billing purposes, both to help providers check whether certain procedures were needed given a patient’s ailment (medical necessity checking), and to determine how much a provider should be paid for treating a given patient.

What is ICD-10?

ICD-10 is the 10th iteration of the International Classification of Diseases.

Why does the International Classification of Diseases need to be updated?

With advances in science, the discovery of new diseases, the development of new tests and treatments, and changing needs for data to inform outcomes research, each iteration of the ICD codes becomes obsolete over time.  ICD-9 has been in place for over 30 years.