ICD-10 SETUP PROCESS. Setup Steps to Perform Prior to ICD-10 Activation. Setup Steps to Perform Upon ICD-10 Activation

Transcription

1 CompuGroup Medical US 1 ICD-10 SETUP PROCESS Since the preparation for using ICD-10 Diagnosis codes started with the release of version in December 2013 and continues through the release of version 7.4.9, the following steps have been compiled as a quick reference that should be performed prior to using ICD-10 Diagnosis codes within CGM webpractice. Setup Steps to Perform Prior to ICD-10 Activation 1. Load the ICD-10 Diagnosis Codes (released in 7.4.4) 2. Practice posting claims with ICD-10 codes (released in 7.4.4) 3. Use the ICD-10 Preview Encounter Action to preview practice claims (released in 7.4.4) 4. Review the MLN Matters articles from CMS (first announced in 7.4.4) 5. Print the ICD-9 to ICD-10 Analyzer and Crosswalk Reports (after installing 7.4.9) 6. Update superbills to contain ICD-10 codes (released in 7.4.4) 7. Add a Sequence # using the Column Selectable Fields function to view ICD-10 codes in the Unposted Procedures function (released in 7.4.4) 8. Select the ICD Type field in the Search Integration for the Diagnosis Code Table so the ICD code version will display in Table searches (released in 7.4.4) 9. Update CGM webmobile Integration categories (if applicable) (after installing 7.4.9) 10. Update the ICD-10 Activation date for insurance carriers that will not be accepting ICD-10 codes as of (after installing 7.4.9) Setup Steps to Perform Upon ICD-10 Activation 11. Load the updated ICD-10 Diagnosis codes (after installing 7.4.9) 12. Update CPT/Dx Linking 13. Update the Diagnosis fields throughout CGM webpractice

2 2 CompuGroup Medical US Posting Encounters with the correct version of ICD codes Disclaimer Although numerous enhancements have been made to aid in the accurate posting of ICD codes during the ICD-10 transition period, you should be vigilant when entering and posting encounters to confirm you have entered the correct versions of the ICD codes - either ICD-9 or ICD-10 or both. The diagnosis codes that default on the ICD-9 and ICD-10 Diagnosis tabs in Procedure entry are controlled by default settings in CGM webpractice and can also be affected by Case selection while entering encounters. Although claims will split and generate correctly based on the ICD-10 Activation date for the insurance carrier and dates of service on the claims, you need to confirm the necessary ICD codes are posted for each claim to ensure proper reimbursement. To familiarize yourself with the enhancements provided for ICD-10 functionality, you should review the release notes in CGM webpractice Help (Release Notes, 7.4 Release Notes) from version through thoroughly for all ICD-10 related enhancements. Step 1: Load the ICD-10 Diagnosis Codes (Tables, Diagnosis Code Table, Load ICD-10-CM Codes) The ICD-10 code set was included in the release so you are not required to purchase it as you have had to do with prior code sets. You will need to load the ICD-10 codes into the Diagnosis Code Table using the Load ICD-10-CM Codes function prior to posting 'practice' claims in Procedure Entry and using the ICD-10 Preview Encounter Action in Encounter View to view the practice claims. Step 2: Practice posting claims with ICD-10 codes (Transactions, Procedure Entry Function) When you access the Procedure Entry Function, the ICD-10 tab will be located to the right of the ICD- 9 tab allowing you to toggle between the ICD-9 and ICD-10 codes. It is not required that you enter ICD-10 codes for each encounter since it is intended to be used when you want to 'practice' using ICD-10 codes. You have a couple of options available when completing the fields on the Procedure Entry Function screen. You can complete all of the fields on the screen first, including the ICD-9 codes and then toggle to the ICD-10 tab, or you can select the ICD-10 tab first and then complete all of the fields. Either way, the ICD codes are the only fields that are stored separately. You only need to complete the remaining fields one time and when you toggle between the two ICD tabs, those fields will remain populated. It was designed this way to eliminate the need for double-entry of data.

3 CompuGroup Medical US 3 You can type in either of the Diagnosis code boxes (ICD-9 or ICD-10) and the diagnosis results will auto-fill in a window beneath the Diagnosis code box. You can search by code, partial code, keyword, and multiple keywords can also be chained together (ex: cat bitten). You can use the arrow keys to move up and down within the results list or use the pointer to select a code in the list. After selecting the code you want, press Enter or Tab to add the code to the Procedure Entry Function screen. You can access the ICD-10 Coding Tool by clicking the magnifying glass for those situations that require a more detailed exploration of the ICD-10 codes. The ICD-10 Lookup functions in the same manner as the ICD-9 and ICD-10 Diagnosis fields on the Procedure Entry screen, where you can search by code, partial code, keyword, or chain together multiple keywords with the results auto-filled in a list. When you select a code from the results list, all of the detailed information for the code will be displayed. To add the diagnosis code to the Procedure Entry Function screen, click Select.

4 4 CompuGroup Medical US The ICD-10 Coding Tool also provides the General Equivalence Mappings (GEMs), as created by the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC). This is a crosswalk function for looking up the ICD-10 equivalent codes for ICD-9 codes and vice versa. You can either select a GEMs option and then type or select a code, or type or select a code and then select a GEMs option. After clicking Search, the equivalent ICD code will be displayed. Click Select in the top-right portion of the window to add the ICD-9 code (784.0) typed in the field at the top of the window or click Select below one of the ICD-10 codes to add it. Click Lookup to review detailed information about an ICD-10 code or if you want to perform a different search, click Reset. To return to the previous screen, click Back. Click Exit to close the ICD-10 Coding Tool. When you have added the diagnosis codes to the Procedure Entry Function screen and are done using the ICD-10 Coding Tool, click Exit to continue entering the procedure line items. The functionality for adding procedures has not changed, except that both the ICD-9 and ICD-10 diagnosis pointers must be managed separately, as they can and will vary.

5 CompuGroup Medical US 5 Step 3: Use the ICD-10 Preview Encounter Action to preview practice claims (Patient, Change Patient Data, History - Encounter View) After encounters have been saved, both the ICD-9 and ICD-10 codes will display when you review the patient's transaction history. You can use the ICD-10 Preview Encounter Action to preview the 'practice claim' in Encounter View. If the encounters do not contain any ICD-10 diagnosis codes this action will be inactive. After selecting the ICD-10 Preview Encounter Action, select the insurance carrier to create the preview claim and click Save. You can now view the practice claim using the ICD-10 Preview tab in the encounter.

6 6 CompuGroup Medical US The ICD-10 preview claim is strictly a practice claim and will not generate an actual insurance claim, will not be sent to the insurance carrier, and an entry will not be added to the Insurance Ledger. It is for preview and practice purposes only. Step 4: Review the MLN Matters articles from CMS Review the CMS MLN Matters SE1408 and CMS MLN Matters SE1325 articles that cover claims splitting with ICD-10 codes. Step 5: Print the ICD-9 to ICD-10 Analyzer and Crosswalk Reports (after installing 7.4.9) (Reports, Statistical Reports, Detailed Diagnosis Analysis) These reports provide a quick reference sheet for your top 50 posted ICD-9 diagnosis codes and a crosswalk to the matching ICD-10 codes. They can be run for a range of dates of service and by the following sorting options: Insurance Doctor Performing Doctor Location User

7 CompuGroup Medical US 7 All of the diagnosis codes entered for a procedure will be analyzed or you can select to only include the primary diagnosis code entered for a procedure. You can also select if you want to include the ICD-10 code Brief Description in the report. These reports can also be printed to Microsoft Excel via My Reports. Step 6: Update Superbills to contain ICD-10 codes (System, Form Wizards, Superbill Wizard or Reports, Data Management System, DMS Letter Processor, Maintain Letters) You should either create or modify your Superbill(s) to contain ICD-10 codes. Step 7: Add a Sequence # using the Column Selectable Fields function to view ICD-10 codes in the Unposted Procedures function (System, Database Maintenance Menu, Column Selectable Fields) To view any ICD-10 codes stored on unposted procedures, a Sequence # must be added for the ICD- 10 column using the Column Selectable Fields function. After accessing the function, click Unposted Procedures.

8 8 CompuGroup Medical US Type the Sequence # for the ICD-10 column and click Apply. The next time you access the Unposted Procedures function the ICD-10 / Other column will display. Step 8: Select the ICD Type field in the Search Integration so the ICD code version will display in Table searches (System, Database Maintenance Menu, Integrations, Search Integration) To view the ICD-10 codes when performing a Search on the Diagnosis Code Table, you need to select the ICD Type field using the Search Integration function. After accessing the function, select the Diagnosis Code Table.

9 CompuGroup Medical US 9 Select the ICD Type field from the Field list and click Save. Step 9: Update CGM webmobile Integration categories (if applicable) (after installing 7.4.9) (System, Database Maintenance Menu, Integrations, webtools Integrations, webmobile Integration) Create new Categories for the ICD-10 codes and then add the applicable ICD-10 diagnosis codes to the categories. Step 10: Update the ICD-10 Activation date for insurance carriers that will not be accepting ICD-10 codes as of (after installing 7.4.9) (Tables, Insurance Carrier Table, Maintain Insurance Carriers) Some insurance carriers will not be accepting ICD-10 codes as of 10/01/2015 and non-covered entity payers are not required to use ICD-10 codes. You will need to change the ICD-10 Activation date to a future date for those carriers so you can continue to submit claims with ICD-9 codes. Prior to submitting claims, verify whether or not a payer is a non-covered entity (auto-insurance, smaller workers compensation payer) and then update the necessary Insurance Carrier codes. A Payer ICD- 10 Readiness list is available at training.cgmus.com/emedix. This list is comprised of payers who have confirmed that they will be ICD- 10 ready and will therefore reject claims with ICD-9 codes and dates of service after October 1, Payers who have indicated that they will not be ready are also list.

10 10 CompuGroup Medical US Step 11: Load the updated ICD-10 Diagnosis codes (after installing 7.4.9) (Tables, Diagnosis Code Table, Load ICD-10-CM Codes) Load the updated ICD-10 code set, effective October 1, 2015-September 30, 2016, unless you already loaded the 2013/2014 codes (effective Date-October 1, 2013). In that case, you do not need to load the 2015 codes because there were no changes between the 2013/2014 codes and the 2015 codes. Step 12: Update CPT/Dx Linking (Tables, Procedure Code Table, CPT /DX Cross Linking Table, Maintain CPT /DX Linking) Any procedure codes currently stored in the CPT /DX Cross Linking Table should be updated to be linked to ICD-10 diagnosis codes. Step 13: Update the Diagnosis fields throughout CGM webpractice (Patient, Change Patient Data, Patient Name and Address) (Patient, Change Patient Data, Case Management) (Tables, Procedure Code Table, Maintain Procedure Codes) Update the following fields from ICD-9 to ICD-10 codes: Patient Name and Address Default Diagnosis Case Management Primary Diagnosis Maintain Procedure Codes Default Diagnosis