o Procedures performed o Diagnoses Identified o Certain devices/equipment/supplies acquired for patient

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1 Image Surce: 6/30/2017 Curse Objectives A Practical Guide t Cding fr Audilgists in 2017 Megan Keirans, AuD University f Pittsburgh Physicians UPMC Department f Otlarynglgy Review types f cdes used in clinical audilgy Outline current updated ICD-10-CM diagnstic cdes relevant t clinical audilgists Practice apprpriate use f updated ICD-10-CM cdes Practice apprpriate use f dcumentatin required with new ICD-10-CM cdes Accuracy Cunts Cding Identifies: Prcedures perfrmed Diagnses Identified Certain devices/equipment/supplies acquired fr patient Cding accuracy affects: Hspital payments Prvider reimbursement Medical data cllectin Quality review Frmerly Physician Quality Reprting System (PQRS) Merit-Based Incentive Payment System (MIPS) in future Update: PQRS Physician Quality Reprting System (PQRS) Centers fr Medicare and Medicaid Services(CMS) designed t imprve quality f care t Medicare beneficiaries Tracking f practice patterns Retired December 31, 2016 N lnger need t reprt n 50 % f traditinal Medicare eligible patients t avid penalty Replacement : Merit-Based Incentive Payment System (MIPS) Merit-Based Incentive Payment System (MIPS) Perfrmance-based payment adjustment f up t 4% Des NOT currently include audilgists as qualifying prviders (expected January 2019) Fcus: mving payment system t reward high value, patient-centered care Eligible t participate if yu bill mre than $30,000 t Medicare and prvide care t mre than 100 Medicare patients per year MIPS Overview Guide: 1

2 Clinical Encunter Claim 6/30/2017 Wh Submits Cdes I Enter? Smaller practices and clinics May nt have dedicated cder Practice management sftware ften emplyed Can integrate all practice peratins: scheduling, reprting, cding, and billing Cding utsurced Hire independent medical cding prvider with certificatin American Academy f Prfessinal Cders ICD-10 prficiency testing Larger practices and hspitals Dedicated in-huse grup r department f cders respnsible fr submissins and claims May als utsurce cding t handle large vlume f patient recrds Can be prvided by netwrk r system affiliatin Diagnstic Cde Prcedural Cde And/Or Treatment/Management Cde Current Prcedural Terminlgy (CPT) Set maintained by American Medical Assciatin Physicians & Clinical Prviders Patients Cders Medical, Surgical, and Diagnstic Services Current Prcedural Terminlgy (CPT) Health Cmmn Prcedural Cding System (HCPCS) Internatinal Statistical Classificatin f Diseases and Related Health Prblems (ICD-10-CM) Accreditatin Organizatins Payers Prcedure cdes E.g fr cmprehensive audimetry N changes t HCPCS relevant t audilgists fr 2017 Health Cmmn Prcedure Cding System (HCPCS) Standardized system Established fr submitting claims t insurance cmpanies fr cverage f supplies and services Prducts, supplies, and services nt included in CPT cdes E.g. ambulance services, durable medical equipment such as prsthetics r rthtics V cdes fr hearing aids and ther devices E.g. V5270 fr televisin amplifier Internatinal Statistical Classificatin f Diseases and Related Health Prblems, 10 th Revisin, Clinical Mdificatin (ICD-10-CM) Cmmn language Diagnstic cdes fr diseases, signs and symptms, abnrmal findings, cmplaints, scial circumstances, & external causes f injury r diseases Used t dcument diagnsis resulting frm prcedures (CPT) billed E.g. H90.0 cnductive hearing lss, bilateral N changes t HCPCS relevant t audilgists fr 2017 Healthcare Prviders Researchers Health Infrmatin Managers Patient Organizatins Payers Cders Plicy Makers 2

3 ICD-10-CM ICD-10 used in Wrld Health Organizatin member states starting in 1994 Nt implemented in United States until 2015 Fee fr service medicine: Healthcare services are paid based n fee assciated with CPT r HCPCS cde submitted ICD-10-CM diagnsis cde supprts medical necessity fr service Illustrates why service was perfrmed Can be surce f denial Prviders d nt cde fr reimbursement! Patient histry What is measured What is visualized n examinatin ICD-10-CM Updated annually Current revisin implemented Octber 1, 2016 Updates affect dcumentatin, cding and billing, and E-recrds in all health care settings Benefits f ICD-10-CM Center fr Medicare and Medicaid Services Stated updated ICD-10-CM will prvide better data t: Reduce need fr attachments t explain patient cnditins Set health plicy Measure quality, safety, and efficacy f care Design health care systems Mnitr resurce utilizatin Imprve clinical, financial, and administrative perfrmance Cnduct research, epidemilgical studies, clinical trials Aid in designing payment systems and prcess claims fr reimbursement Track public health risks Updates: ICD-10-CM ICD-10-CM updates shuld be applied t: Superbill Dcumentatin Billing sftware Reprt frms Payer cntracts Patient cntracts/cmmunicatin Practice management systems Medicare Learning Netwrk, ICN August 2016 Imprtance f Dcumentatin Establishes medical necessity fr prcedures cmpleted Supprts services rdered Guidelines fr use f ICD-10-CM Specific diagnstic cdes shuld be reprted when supprted by available medical recrd dcumentatin & clinical knwledge f patient s health cnditin Each health care encunter shuld be cded t level f certainty knwn fr that encunter Supprts billing f diagnstic and interventin services Reprted patient histry, testing, and/r results supprt treatment r management recmmendatins It is nt apprpriate t use a specific cde nt supprted by dcumentatin in patient s medical recrd It is nt apprpriate t cnduct medically unnecessary diagnstic testing t determine a mre specific cde 3

4 Same HL Bth Ears Same type f hearing lss in bth ears: Use bilateral cdes Symmetry r asymmetry des nt matter H90.0 Cnductive hearing lss, bilateral H90.3 Sensrineural hearing lss, bilateral H90.6 Mixed cnductive and sensrineural hearing lss, bilateral Unrestricted Cde with unrestricted = Nrmal If patient has hearing lss in ne ear but nrmal hearing in ther ear, must use: H90.11 Cnductive hearing lss, unilateral, right ear, with unrestricted H90.12 Cnductive hearing lss, unilateral, left ear, with unrestricted H90.41 Sensrineural hearing lss, unilateral, right ear, with unrestricted H90.42 Sensrineural hearing lss, unilateral, left ear, with unrestricted H90.71 Mixed cnductive and sensrineural hearing lss, unilateral, right ear, with unrestricted H90.72 Mixed cnductive and sensrineural hearing lss, unilateral, left ear, with unrestricted Unspecified HL Indicates there is insufficient infrmatin in medical recrd r frm patient reprted histry t assign mre specific cde Limit use f unspecified types f cdes Only use in cases where type f hearing lss has nt yet been determined E.g. newbrn hearing screenings If ear with issue/ailment nt indicated in medical recrd, assign cde fr unspecified Unlike ICD-9 cdes, ICD-10-CM has unilateral cdes that have implied meaning fr the ther ear Still n cdes that list nly ne ear withut implied meaning fr ther ear Each cmplaint must have ne f the fllwing cdes: Ear specific If patient has a different type f hearing lss in each ear Must chse 2 cdes, ne fr each ear Bilateral Unspecified New 90.A series ear specific cdes Indicate different type f hearing lss in each ear by reprting 2 cdes Cde bth types f hearing lss (ne fr each ear) N lnger use unspecified hearing lss if patient has different types f HL in each ear This may lead t issues with reimbursement Sensrineural Hearing Lss in ne ear If ther ear has nrmal hearing: H90.41 Sensrineural hearing lss, unilateral, right ear, with unrestricted H90.42 Sensrineural hearing lss, unilateral, left ear, with unrestricted If ther ear has different type f hearing lss: H90.A21 Sensrineural hearing lss, unilateral, right ear, with restricted hearing n the cntralateral side H90.A22 Sensrineural hearing lss, unilateral, left ear, with restricted hearing n the cntralateral side 4

5 Cnductive Hearing Lss in ne ear If ther ear has nrmal hearing: H90.11 Cnductive hearing lss, unilateral, right ear, with unrestricted H90.12 Cnductive hearing lss, unilateral, left ear, with unrestricted If ther ear has different type f hearing lss: H90.A11 Cnductive hearing lss, unilateral, right ear, with restricted H90.A12 Cnductive hearing lss, unilateral, left ear, with restricted Mixed Hearing Lss in ne ear If ther ear has nrmal hearing: H90.71 Mixed cnductive and sensrineural hearing lss, unilateral, right ear, with unrestricted H90.72 Mixed cnductive and sensrineural hearing lss, unilateral, left ear, with unrestricted If ther ear has different type f hearing lss: H90.A31 Mixed cnductive and sensrineural hearing lss, unilateral, right ear, with restricted H90.A32 Mixed cnductive and sensrineural hearing lss, unilateral, left ear, with restricted Recurring r Lngstanding HL f Same Type Each unique ICD-10-CM diagnsis cde may be reprted nly nce fr an encunter. This applies t bilateral cnditins when there are n distinct cdes identifying laterality r tw different cnditins classified t the same ICD-10-CM diagnsis cde. (ICD-10-CM Official Guidelines fr Cding and Reprting, FY 2016) Recurring r Lngstanding HL f Same Type The fllwing are nly cvered fr initial evaluatin f hearing prblem: H90.3 Sensrineural hearing lss, bilateral H90.41 Sensrineural hearing lss, unilateral, right ear, with unrestricted hearing n the cntralateral side H90.42 Sensrineural hearing lss, unilateral, left ear, with unrestricted hearing n the cntralateral side H90.A21 Sensrineural hearing lss, unilateral, right ear, with restricted hearing n the cntralateral side H90.A22 Sensrineural hearing lss, unilateral, left ear, with restricted hearing n the cntralateral side H90.5 Sensrineural hearing lss, unspecified H90.6 Mixed cnductive and sensrineural hearing lss, bilateral H90.71 Mixed cnductive and sensrineural hearing lss, unilateral, right ear, with unrestricted hearing n the cntralateral side H90.72 Mixed cnductive and sensrineural hearing lss, unilateral, left ear, with unrestricted hearing n the cntralateral side H90.A31 Mixed hearing lss, unilateral, right ear, with restricted hearing n the cntralateral side H90.A32 Mixed hearing lss, unilateral, left ear, with restricted hearing n the cntralateral side H91.21 Sudden idipathic hearing lss, right ear H91.22 Sudden idipathic hearing lss, left ear H91.23 Sudden idipathic hearing lss, bilateral All subsequent evaluatins require clear dcumentatin in patient recrd that patient reprts a change in hearing Recurring r Lngstanding HL f Same Type Nrmal Hearing Patient reprts hearing lss but testing reveals hearing WNL 1. Can cde chief cmplaint r symptm that prmpted evaluatin MUST als reprt reasn fr test/prcedure and explain that results were nrmal in dcumentatin Cde cnditin t highest degree f certainty fr encunter Signs/symptms, abnrmal test results, ther reasn fr visit D nt cde diagnses dcumented as prbable, suspected, questinable, rule ut, r wrking diagnsis r ther similar terms indicating uncertainty. (ICD-10-CM Official Guidelines fr Cding and Reprting, FY 2016) 5

6 Nrmal Hearing Nrmal Hearing 2. H93.29Abnrmal auditry perceptin H Other abnrmal auditry perceptin, right ear H Other abnrmal auditry perceptin, left ear H Other abnrmal auditry perceptin, bilateral H Other abnrmal auditry perceptin, unspecified ear 3. H69.9 Eustachian Tube Dysfunctin If physician ntes eustachian tube dysfunctin when rdering audigram, but n hearing lss present, can use ETD as Dx H69.91 Unspecified eustachian tube disrder, right ear H69.92 Unspecified eustachian tube disrder, left ear H69.93 Unspecified eustachian tube disrder, bilateral Avid use f Z cdes: Z cdes represent reasns fr encunters Persn may r may nt be sick but enters health services fr specific purpse i.e. Z01 Encunter fr ther special examinatin withut cmplaint, suspected r reprted diagnsis Z01.10 Encunter fr ears and hearing withut abnrmal findings, Encunter fr ears and hearing NOS Shuld be verified with the payer r facility Exclude Cdes Cdes that indicate certain rules t abide by when cding: Excludes 1 Nt cded here These cdes shuld nt be used at the same time as the cde abve it in the listing Occurs when 2 cnditins cannt ccur simultaneusly E.g. cngenital frm f hearing lss c-ccurring with an acquired frm f hearing lss H90 Cnductive and sensrineural hearing lss Excludes 1: deaf nnspeaking NOS (H91.3), deafness NOS (H91.9-), nise-induced hearing lss (H83.3-), sudden (idipathic) hearing lss (H91.2-), ttxic hearing lss (H91.0-) Excludes 2 Nt included here Exclude Cdes The listed cnditin excluded is nt part f the cnditin that the cde represents Patient MAY have bth cnditins simultaneusly Can use bth cde and excluded cdes tgether when exclusin 2 cde appears under a cde E.g. H93.2 Other abnrmal auditry perceptins Excludes 2: auditry hallucinatins (R44.0) Central Auditry Prcessing Disrder ICD-10-CM has cde fr CAPD H93.25 Central Auditry Prcessing Disrder Central auditry prcessing disrder Cngenital auditry imperceptin Wrd deafness Excludes1: mixed receptive-expressive language disrder (F80.2) Vestibular Issues If cmpleting cmprehensive audigram (CPT 92557) n patient with type f dizziness nt yet diagnsed Can use: H81.91 Unspecified disrder f vestibular functin, right ear H81.92 Unspecified disrder f vestibular functin, left ear H81.93 Unspecified disrder f vestibular functin, bilateral 6

7 Vestibular Issues If the patient has been diagnsed with BPPV, when billing cmprehensive audimetry (CPT 92557) Can use: H81.11 Benign parxysmal vertig, right ear H81.12 Benign parxysmal vertig, left ear H81.13 Benign parxysmal vertig, bilateral Tinnitus New cdes indicating laterality available Tinnitus H93.11 Tinnitus, right ear H93.12 Tinnitus, left ear H93.13 Tinnitus, bilateral H93.19 Tinnitus, unspecified Pulsatile Tinnitus H93.A1 Pulsatile Tinnitus, right ear H93.A2 Pulsatile Tinnitus, left ear H93.A3 Pulsatile Tinnitus, bilateral H93.A9 Pulsatile Tinnitus, unspecified Additinal Diagnses Can have up t 12 ICD-10-CM cdes per claim Cdes Withut Cverage The fllwing are nt n list f diagnsis cdes which have cverage fr audimetric testing: Otalgia Aural Fullness Can and shuld list as chief cmplaint in encunter, but cannt be used as sle diagnstic cdes submitted with prcedural cdes Future f Internatinal Classificatin f Diseases Impending Update ICD-11 is currently in revisin prcess Mst recent cnference Octber 2016 t revise and finalize ICD-11 Nt yet cmplete Gal f cmmittee is t launch ICD-11 fr implementatin in release f ICD-10-CM replaces 2017 update Cdes t be used frm Octber 1, 2017 thrugh September 30, Nte: The 2018 General Equivalence Mappings (GEMs) will be psted in August The 2018 ICD-10-CM guidelines, and POA Exempt Cdes will be psted at a later date N significant changes t audilgy related cdes evident at this time 7

8 Resurces ASHA Cding Guidance Mst current cding requirements, audilgy-relevant cde lists Cding and Billing fr Audilgy and Speech-Language Pathlgy guide can be purchased Centers fr Medicare and Medicaid Services (CMS) Guidelines fr use f cdes Cde lk-up Updates t MIPS 10/03_ICD-10andVersin5010CmplianceTimelines.asp AAA Guidelines fr use f cdes FAQ s regarding cding Resurces D38A4D-A4B6-439E-B8CB-11BBB6B607E7 Need academy ID t access page Centers fr Disease Cntrl and Preventin (CDC) Wrld Health Organizatin (WHO) Questins? 8