ICD-10 RSPMI Provider Education April 16, Cathy Munn MPH RHIA CPHQ Sr. Consultant

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1 ICD-10 RSPMI Provider Education April 16, 2014 Cathy Munn MPH RHIA CPHQ Sr. Consultant

2 Agenda Status of ICD-10 Transition Who, What, Where, When & Why Industry Update Impact of the Change Providers Payers Translation Examples Arkansas DMS Remediation Update Next Steps & Resources

3 Who: The Healthcare Industry ICD-10-CM (diagnoses) will be used by all providers in every health care setting ICD-10-PCS (procedures) will be used only for hospital claims for inpatient hospital procedures No impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes CPT and HCPCS will continue to be used for physician and ambulatory services including physician inpatient hospital visits

4 What: ICD-10 CM/PCS ICD-9-CM: International Classification of Diseases, 9 th revision, Clinical Modification US transitioned from ICD-8 to ICD-9 in 1979 Annual updates ICD-10: Developed by the World Health Organization as the nomenclature for all countries ICD-10-CM: International Classification of Diseases, 10 th revision, Clinical Modification US only ICD-10-PCS: International Classification of Diseases, 10 th revision, Procedure Classification System US only

5 When: October 1, 20XX Final Rule Originally Published by HHS on January 16, 2009 requiring the adoption of ICD-10 on October 1, 2013 Recent passage of HR 4302 Protecting Access to Medicare Act of 2014 states implementation of ICD-10 can be: No earlier than October 2015 Dates of Service (Outpatient) After 10/1/20XX Dates of Discharge (Inpatient) After 10/1/20XX Many unanswered questions the industry is waiting on CMS for guidance

6 Where: Inpatient vs Outpatient Systems will have to utilize both ICD-9-CM and ICD- 10-CM for overlap e.g. claims backlog, Arkansas Medicaid allows providers 365 days to submit a claim. Inpatient discharges occurring on or after XX will use ICD-10-CM and ICD-10-PCS codes regardless of date of admission. Outpatient dates of service occurring on or after XX will use ICD-10-CM codes There will be period of time when payers will be processing claims in both ICD-9 and ICD-10

7 Why: Data Benefits of ICD-10 Better data will be available for: Measuring the quality, safety and efficacy of care Designing payment systems and processing claims for reimbursement Conducting research, epidemiological studies and clinical trials Setting health policy Operational and strategic planning and designing healthcare delivery systems Monitoring resource utilization Improving clinical, financial and administrative performance Preventing and detecting healthcare fraud and abuse Tracking public health and risk

8 Other Competing Priorities ACOs/ Patient Centered Medical Home Health Insurance Exchanges ICD-10: Key to the success of each initiative EHR/ Meaningful Use Public Reporting & Quality Measures Value Based Purchasing Reimbursement changes

9 ICD-10 Chapter Headings Alpha Character A and B C00 to D48 D50 to D89 E F G H00 to H59 H60 to H95 Narrative Description Certain infectious and parasitic diseases. Neoplasms. Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism. Endocrine, nutritional and metabolic diseases. Mental and behavioral disorders. Diseases of the nervous system. Diseases of the eye and adnexa. Diseases of the ear and mastoid process.

10 ICD-9 vs. ICD-10 Diagnosis Codes ICD-9 Diagnosis Codes 13,000 ICD-10 Diagnosis Codes 69, Characters 3-7 Characters First character is numeric or alpha (E or V) Use of decimal after 3 rd character First character is alpha Use of decimal after 3 rd character Characters 2-7 are alpha or numeric letter U is not used Use of dummy placeholder X for future code expansion ICD-9 - E codes reference External Causes of Injury & Poisoning ICD-10 - E references the Endocrine System ICD- 9 - V codes reference Health Status & Contact with Health Services ICD-10 - V Y codes reference External Causes of Morbidity

11 Impact of ICD-10 Diagnosis ICD-9 Codes ICD-10 Codes Fractures ,099 Obstetrics 1,104 2,155 Poisoning 244 4,662 Diabetes Migraine Headache 40 44

12 ICD-9 Procedure vs. ICD-10-PCS ICD-9 Procedure Codes 4,000 ICD-10 Procedure Codes 72, Digits 7 Digits All digits are numeric Example: Artery suture has 1 code in ICD-9 Example: Fractured femur has 16 codes in ICD-9 Alpha or numeric composition Numbers 0-9 Letters O & I are omitted Example: Artery suture has 195 coding options in ICD-10 Example: Fractured femur has 1530 coding options in ICD-10 The increase in the number of procedure codes is driven by the increased specificity, granularity & laterality contained within the ICD-10 codes. There are also 7 th digit designations (A or D) which identify initial or subsequent encounter for care.

13 Code Translations Adjustment Disorder ICD-9 Code Description ICD-10 Code Description Adjustment disorder with depressed mood F Prolonged depressive reaction F Separation anxiety disorder F93.0 Emancipation disorder of adolescence and early adult life F94.8 Specific academic or work inhibition F94.8 Adjustment disorder with anxiety F43.22 Adjustment disorder with mixed anxiety and depressed mood F43.23 Other adjustment reactions with predominant disturbance of other emotions F43.29 Other adjustment reactions with predominant disturbance of other emotions F94.8 Adjustment disorder with depressed mood Adjustment disorder with depressed mood Separation anxiety disorder of childhood Other childhood disorders of social functioning Other childhood disorders of social functioning Adjustment disorder with anxiety Adjustment disorder with mixed anxiety and depressed mood Adjustment disorder with other symptoms Other childhood disorders of social functioning

14 Code Translations Schizophrenia ICD-9 Code Description ICD-10 Code Description Simple type schizophrenia, unspecified F20.89 Other schizophrenia Simple type schizophrenia, subchronic F20.89 Other schizophrenia Simple type schizophrenia, chronic F20.89 Other schizophrenia Simple type schizophrenia, subchronic with acute exacerbation F20.89 Other schizophrenia Simple type schizophrenia, chronic with acute exacerbation F20.89 Other schizophrenia Simple type schizophrenia, in remission F20.89 Other schizophrenia Disorganized type schizophrenia, unspecified F20.1 Disorganized schizophrenia Disorganized type schizophrenia, subchronic F20.1 Disorganized schizophrenia Disorganized type schizophrenia, chronic F20.1 Disorganized schizophrenia

15 Code Translations Mood Disorder ICD-9 Code Description ICD-10 Code Description Mood disorder in conditions classified elsewhere F06.30 Mood disorder in conditions classified elsewhere F06.31 Mood disorder in conditions classified elsewhere F06.32 Mood disorder in conditions classified elsewhere F06.33 Mood disorder in conditions classified elsewhere F06.34 Mood disorder due to known physiological condition, unspecified Mood disorder due to known physiological condition with depressive features Mood disorder due to known physiological condition with major depressive-like episode Mood disorder due to known physiological condition with manic features Mood disorder due to known physiological condition with mixed features

16 Impact on Provider Operations Systems EHR, Practice Management & Billing Systems System upgrades/testing/cost Vendor readiness/testing Operations Systems, workflows & operating metrics Encounter forms/superbills Payer readiness/testing Documentation Coding audit for documentation of specificity Identify common codes within the practice Consider dual coding to gauge accuracy & productivity

17 Staff Training Needs Assess the training needs of your staff Identify the staff in your office who code, or have a need to know the new codes Anticipate that everyone in your office will require some level of awareness training Consider training approaches for your staff including chart audits and documentation needs based on results Consider dual coding as a teaching opportunity

18 Clinical Documentation Resources AHIMA Online Education Physician Series Clinical Documentation for ICD-10: Principles & Practice Short, self-paced training modules Case-based, real life examples Provides more than 200 bite-sized, on-demand, specialty-specific training modules that can be accessed anytime or anywhere with a mobile device computer, tablet or smartphone Delivers 3-5 minutes modules that cover physician s most commonly billed diagnoses & conditions making learning targeted and relevant to their practice specialty.

19 Training Resources There are a wide variety of training opportunities and materials available through a variety of resources: Professional Coding Associations AAPC, AHIMA Online Courses ICD10 Monitor, Contexo University, Precyse, Nuance Webinars ICD10 Monitor, HCPro Onsite Training Train-the-Trainer approach, Coding Boot Camp Arkansas Hospital Association monthly coding classes Non-Traditional - Partner with the HIM Department at a nearby hospital

20 Websites & Resources

21 Akansas DHS Current State Arkansas Medicaid has been working on ICD-10 for over two years Completed Operational assessment Remediation of Medical Policy, Edits and Audits complete Provider Manual Updates HP coordinating revisions Data Requirements HP/MMIS, Xerox/ACS, integrated & stand alone systems Ongoing Remediation of Pharmacy Policy & Edits Remediation of DHS reports, forms, and brochures Provider Outreach o Meetings/Webcasts o Provider Bulletins o Newsletters o ICD-10 Website Internal & external testing to begin mid-year

22 The Starting Point Communication & Planning Testing Systems Leadership & Strategic Direction Documentation Vendors Training

23 AMA ICD-10 Checklist Create a checklist of all systems & work flow processes that currently use ICD-9 Create a list of vendor contact information Identify all staff who work with ICD-9 Identify all possible work flow changes that will need to switch to ICD-10 Identify the practice billing service (if applicable) Identify the practice clearinghouse Identify a contact for each of the practice s payers

24 AMA ICD-10 Checklist Contact vendors to determine their ICD-10 implementation plans Contact the practice s billing service, if applicable, to identify their ICD-10 implementation plans Contact payers to determine their ICD-10 implementation plans Identify any internal work flow processes that will need to be change for ICD-10 checklist.pdf

25 Industry Website Resources /Downloads/ICD10SmallandMediumPractices508.pdf

26 CMS Resources

27 CMS Resources

28 CMS Road to I-10

Additional ICD-10 Resources White Papers (including but not limited to) ICD-10 A Primer ICD-10 Clinical Documentation ICD-10 Physician Impact ICD-10 Advantages ICD-10 Specified or Unspecified

29 Additional ICD-10 Resources White Papers (including but not limited to) ICD-10 A Primer ICD-10 Clinical Documentation ICD-10 Physician Impact ICD-10 Advantages ICD-10 Specified or Unspecified Checklists published by CMS for providers (small, medium and large) at: 10ImplementationTimelines.html

30 Websites to Monitor

ICD-10 RSPMI Provider Education

ICD-10 RSPMI Provider Education Arkansas DHS ICD-10 Preparation & Implementation Cathy Munn, MPH RHIA CPHQ Sr. Consultant 1 Agenda Why ICD-10 & Why Now? Industry Update Key Points to Remember Impact of