ICD 10 CM. Objectives: Session 2 Make the transition to ICD 10 CM as painless and seamless as possible. Questions from Session 1 9/4/2012

Transcription

1 ICD 10 CM SESSION 2: Planning Develop an ICD 10 transition plan for your office and practice. Objectives: Session 2 Make the transition to ICD 10 CM as painless and seamless as possible Timeline for implementation Readiness checklist Questions for your vendors, payers, partners vs. ICD 10 Questions from Session 1 1

2 Timeline for Implementation: Now Designate a champion in your office Download AHIMA s ICD 10 Preparation Checklist Work through the recommendations in the checklist Ask your vendors about ICD 10 readiness Create awareness for all clinicians and staff of upcoming changes and the implementation plans Timeline for Implementation: The rest of Assess skill levels of staff for training needs Assess clinical documentation for improvement needs (more specificity) Implement necessary skills development for staff and clinicians 2

3 Timeline for Implementation: 2013 Provide hands on training for staff using materials designed for physician practices Reconfigure practice specific ICD matrices Complete implementation i plans and prepare for go live on October 1, 2014 ICD 10 CM/PCS Vendor Checklist Category Deliverable Checklist Software Site specific project plan with timetable Major items to include: Completion of product solution Internal testing plan On site testing Update and testing of interfaces End to end testing plan Training Pilot go live Go live schedule Implementation of final products Post implementation review period Scope of Questions to ask: Can the organization's current version of the system be upgraded? Does the updated version support both and ICD 10? Organization specific system analysis Product Change What mapping or crosswalk strategy will be used between the old and new code sets? What modifications are expected in screen and reporting formats? What are the requirements to update applicable interfaces? Hardware Hardware requirements Items to consider: Hardware requirements for upgrade or replacement Hardware needed for testing Other equipment for upgrade or replacement of system Testing Questions to answer: Can the vendor run parallel systems to resolve issues before go live? Documented testing plan with timetable How will the vendor support testing of interfaces? and resources defined What on site resources will be available for testing? Does the vendor have a contingency plan if products are not ready for go live on October 1, 2013? Human Resources Budget Training plan with timetable and resources defined Implementation plan List of anticipated costs Items to consider: Vendor staff training plan for ICD 10 Formalized client training plan on new systems Formats for client training (e.g., webinar, on site, manuals, etc.) Go live resource commitments for on site and remote support Resource commitment for post implementation review and troubleshooting Items to include: Cost to upgrade system or replace it Cost of interface assessment and modifications Whether system training is included in costs Whether implementation and post implementation support is included Estimated hardware or equipment costs Whether there will be an increase in cost of ownership, such as maintenance, upgrades, and support fees The cost structure ICD 10 CM Training Resources FREE WHO Not so free AHIMA /ICD10.aspx?Tab=2 AAPC 10/training.aspx 3

4 ICD-10-CM Training Local resources Flathead Valley CC programs/certificate of applied science/medical coding cas.html MSU Great Falls MCA Questions for your practice management system vendor When will your product be upgraded to support ICD 10? When will we be able to run test claims using ICD 10? [If the date they provide you is later than June 1, 2014, push for an earlier date. This transition is going to be a huge one for all of us.] What preparation is needed on our end to test ICD 10? Questions for your PM and EHR system vendor Is the upgrade to ICD 10 included in my ongoing maintenance expense? Will our practice management (and/or electronic health record) software include a searchable ICD 10 database? Will your product support both and ICD 10 during a transition phase? Do you have projected dates for the transition phase? Will we be permitted to migrate to ICD 10 prior to October 1, 2013? 4

5 Questions for clearinghouses and payers When will you be ready to accept ICD 10 codes on claims? What changes must be made on our end to support ICD 10? Are additional registrations or notifications required? Will there be additional fees associated with ICD 10? What "claim scrubbing" edit changes will be made to your software to process ICD 10 claims? When will you be able to provide us with an explanation of how these new edits will impact operations? Questions for clearinghouses and payers When can we test ICD 10 submissions in total with our practice management software, our clearinghouse, and payers all testing the same data set(s) using ICD 10 codes in 5010 transactions? What are your plans to support both and ICD 10 concurrently? Will you be ready for migration to ICD 10 prior to October 1, 2013? Questions? 5

6 CM vs. ICD 10 CM CM (e.g ) 3 5 characters First character is numeric or alpha (i.e. E or V) Characters 2 5 are numeric Always at least 3 characters Use of decimal after 3 characters ICD 10 CM (S13.4xxA) 3 7 characters Character 1 is alpha All letters except U Characters 2 7 are alpha or numeric Always at least 3 characters Use of decimal after 3 characters ICD 10 CM vs. CM The Major Differences ICD 10 CM codes make greater use of letters. ICD 10 CM codes have up to seven characters, as opposed to five with CM. ICD 10 CM codes are much more specific in general and specify many details that cannot be represented in CM, includinglaterality laterality (which side ofthebody is affected) or ordinality of encounter (whether or not the care encounter is the patient s first for the condition). ICD 10 CM has fewer nonspecific (aka NOS ) codes than ICD 9 CM. ICD 10 CM in many cases categorizes diagnoses differently from CM. For instance, CM groups codes for injuries primarily by type of injury, while in ICD 10 CM they are grouped primarily by body area. 6

7 724.2 Low Back Pain Neck Pain Bronchitis, Acute Fatigue Sciatica Osteoarthritis Sprained ankle ICD 10 M54.9 Back Pain M54.2 Neck Pain J20._ Bronchitis, Acute R53.83 Fatigue M54.3_ Sciatica M19.90 Osteoarthritis Sprained ankle left ICD 10 Chapter XIII Diseases of the musculoskeletal system and connective tissue (M00 M99) Sample M54.2 Cervicalgia Excludes: cervicalgia due to intervertebral cervical disc disorder ( M50. ) M54.3 Sciatica Excludes: lesion of sciatic nerve ( G57.0 ) sciatica: due to intervertebral disc disorder ( M51.1 ) with lumbago ( M54.4 ) M54.4 Lumbago with sciatica Excludes: that due to intervertebral disc disorder ( M51.1 ) M Low back pain Loin pain Low back strain Lumbago NOS Excludes: lumbago: due to intervertebral disc displacement ( M51.2 ) with sciatica ( M54.4 ) M54.6 Pain in thoracic spine Excludes: pain due to intervertebral disc disorder ( M51. ) M54.8 Other dorsalgia M54.9 Dorsalgia, unspecified Backache NOS ICD 10 No 1 : 1 correspondence General Equivalence Mapping (GEM) 7

8 codes: ICD 10: Sciatica ICD 10 codes: lesion of sciatic nerve displacement of lumbar intervertebral disc without myelopathy sciatica thoracic or lumbosacral neuritis or radiculitis, unspecified backache, unspecified disorders of sacrum other symptoms referable to back other unspecified back disorders G55.1 nerve root and plexus compressions in intervertebral disc disorders G57.0 lesion of sciatic nerve M51.1lumbar andother intervertebral disc disorders with radiculopathy M54 dorsalgia M54.3 sciatica M54.4 lumbago with sciatica M54.5 low back pain M54.9 dorsalgia, unspecified M79.2 neuralgia and neuritis, unspecified codes: ICD 10: Lumbar Sprain ICD 10 codes: 724 other and unspecified disorders of back M54 dorsalgia lumbago M54.1 radiculopathy sciatica M54.3 sciatica thoracic or lumbosacral neuritis or radiculitis, unspecified M54.4 lumbago with sciatica backache, unspecified M54.5 low back pain disorders of sacrum M54.6 pain in thoracic spine other symptoms referable to back M54.8 other dorsalgia other unspecified back disorders M54.9 dorsalgia, unspecified displacement of thoracic or lumbar intervertebral disc without myelopathy M48 other spondylopathies displacement of lumbar intervertebral disc without myelopathy M48.3 traumatic spondylopathy displacement of intervertebral disc; site unspecified, without myelopathy M48.4 fatigue fracture of vertebra degeneration of lumbar or lumbosacral intervertebral disc M48.5 collapsed vertebra, not elsewhere classified intervertebral disc disorder with myelopathy, lumbar region M48.8 other specified spondylopathies postlaminectomy t syndrome M48.9 spondylopathy, dl unspecified postlaminectomy syndrome of unspecified region M53 other dorsopathies, not elsewhere classified postlaminectomy syndrome of cervical region M53.2 spinal instabilities postlaminectomy syndrome of thoracic region M53.3 sacrococcygeal disorders, not elsewhere classified postlaminectomy syndrome of lumbar region M53.8 other specified dorsopathies myalgia and myositis, unspecified M53.9 dorsopathy, unspecified 739 nonallopathic lesions, not elsewhere classified optional subclassification to indicate site of involvement for M48, M53, M nonallopathic lesions of head region, not elsewhere classified 0 multiple sites in spine nonallopathic lesions of cervical region, not elsewhere classified 5 thoracolumbar region nonallopathic lesions of thoracic region, not elsewhere classified 6 lumbar region nonallopathic lesions of lumbar region, not elsewhere classified 7 lumbosacral region nonallopathic lesions of sacral region, not elsewhere classified 8 sacral and sacrococcygeal region nonallopathic lesions of pelvic region, not elsewhere classified 9 site unspecified nonallopathic lesions of lower extremities, not elsewhere classified M51 other intervertebral disc disorders nonallopathic lesions of upper extremities, not elsewhere classified M51.0 lumbar and other intervertebral disc disorders with myelopathy nonallopathic lesions of rib cage, not elsewhere classified M51.1 lumbar and other intervertebral disc disorders with radiculopathy nonallopathic lesions of abdomen and other sites, not elsewhere classified M51.2 other specified intervertebral disc displacement 846 sprains and strains of sacroiliac region M51.3 other specified intervertebral disc degeneration lumbosacral (joint) (ligament) sprain M51.4 Schmorl's nodes sacroiliac (ligament) sprain M51.8 other specified intervertebral disc disorders sacrospinous (ligament) sprain M51.9 intervertebral disc disorder, unspecified sacrotuberous (ligament) sprain M60.9 myositis, unspecified other specified sites of sacroiliac region sprain M79.1 myalgia unspecified site of sacroiliac region sprain optional subclassification for site of involvement for M60, M lumbar sprain 0 multiple sites other psychalgia [used for psychogenic backache, but only if pain specifically attributable to psychological 5 pelvic region and thigh cause] 8 other 9 site unspecified M96.1 postlaminectomy syndrome, not elsewhere classified M96.3 postlaminectomy kyphosis S33 dislocation, sprain and strain of joints and ligaments of lumbar spine and pelvis S33.0 traumatic rupture of lumbar intervertebral disc S33.1 dislocation of lumbar vertebra Alaska Chiropractic Society S33.2 dislocation of sacroiliac and sacrococcygeal joint S33.3 dislocation of other and unspecified parts of lumbar spine and pelvis S33.5 sprain and strain of lumbar spine S33.6 sprain and strain of sacroiliac joint S33.7 sprain and strain of other and unspecified parts of lumbar spine and pelvis codes: ICD 10 Headache ICD 10 codes: headache tension headache (used for psychogenic or nonorganic headache) drug induced headache, not elsewhere classified complicated headache syndromes hemicrania continua new daily persistent headache primary thunderclap headache other complicated headache syndrome other specified headache syndromes hypnic headache headache associated with sexual activity primary cough headache primary exertional headache primary stabbing headache other specified headache syndromes R51 headache F07.2 postconcussional syndrome F45.4 persistent somatoform pain disorder G43 migraine G43.0 migraine without aura [common migraine] G43.1 migraine with aura [classical migraine] G43.2 status migrainosus i G43.3 complicated migraine G43.8 other migraine G43.9 migraine, unspecified G44 other headache syndromes, such as G44.1 vascular headache, not elsewhere classified G44.2 tension type headache G44.3 chronic post traumatic headache G44.4 drug induced headache, not elsewhere classified G44.8 other specified headache syndromes N95.1 menopausal and female climacteric states 8

9 codes: ICD 10: Fibromyalgia ICD 10 codes: myalgia and myositis, unspecified M79.7 fibromyalgia optional subclassification codes to indicate site of involvement 0 multiple sites 1 shoulder region 2 upper arm 3 forearm 4 hand 5 pelvic region and thigh 6 lower leg 7 ankle and foot 8 other 9 site unspecified codes: ICD 10 ACL Sprain ICD 10 codes: other internal derangement of knee old disruption of anterior cruciate ligament other internal derangement of knee [old disruption of ligaments of knee NOS] articular cartilage disorder, site unspecified sprain of cruciate ligament of knee M23 internal derangement of knee supplementary subclassification 1 anterior cruciate ligament may be used for the following codes M23.5 chronic instability of knee M23.6 other spontaneous disruption of ligament(s) of knee M23.8 other internal derangements of knee M23.9 internal derangement of knee, unspecified S83.5 sprain and strain involving (anterior)(posterior) cruciate ligament of knee codes: ICD 10: Wry neck ICD 10 codes: spasmodic torticollis musculoskeletal malfunction arising from mental factors [used for psychogenic torticollis] conversion disorder [used for hysterical torticollis] torticollis not otherwise specified M43.6 torticollis F45.8 other somatoform disorders [used for psychogenic torticollis] G24.3 spasmodic torticollis 9

10 Questions? What else is new for ICD 10 CM? Laterality Temporality Place holders Laterality For bilateral sites, the final character of the codes in the ICD 10 CM indicates laterality. An unspecified side code is also provided should the side not be identified in the medical record. If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side. 10

11 Laterality Left or right side for some MSK diagnoses Example: : ankle sprain, deltoid ligament ICD 10: S sprain of deltoid idligament right ih ankle Temporality Comprises the 7 th place in certain codes A initial encounter D subsequent encounter S sequella Temporality : Cervical sprain/strain ICD 10 S13.4xxA Sprain of ligaments of cervical spine, initial encounter S13.4xxD Sprain of ligaments of cervical spine, subsequent encounter S13.4xxS Sprain of ligaments of cervical spine, sequela 11

12 Place Holder Some codes require a 7 th place, e.g. laterality and temporality But the code is only specified to the 4 th place xx is used as a place holder for the 5 th and 6 th place E.g. S13.4xxA Sprain of ligaments of cervical spine, initial encounter Place holders The ICD 10 CM codes have space for updates due to technology changes Some codes that require a 7 th place (e.g. laterality and temporality) may have blank spaces To be filled with xx S13.4xxA Sprain of ligaments of cervical spine, initial encounter Questions? 12

13 Up next SESSION 3: Implementation Getting under the hood of ICD 10, how it is similar and how it is different from, how to use it. 13