WELCOME to a PMI WEBINAR PRESENTATION

Size: px

Start display at page:

Download "WELCOME to a PMI WEBINAR PRESENTATION"

Estella Parks
5 years ago
Views:

1 WELCOME to a PMI WEBINAR PRESENTATION PMI presents: Nancy Maguire on the topic: Primary Care and ICD-10-CM Diagnosis Coding

2 Welcome to Practice Management Institute s Webinar and Audio Conference Training. We hope that the information contained herein will give you valuable tips that you can use to improve your skills and performance on the job. Each year, more than 40,000 physicians and office staff are trained by Practice Management Institute. For over 25 years, physicians have relied on PMI to provide up-to-date coding, reimbursement, compliance and office management training. Instructor-led classes are presented in 400 of the nation s leading hospitals, healthcare systems, colleges and medical societies. PMI provides a number of other training resources for your practice, including national and regional conferences for medical office professionals, self-paced certification preparatory courses, online training, educational audio downloads, and practice reference materials. For more information, visit PMI s web site at Please be advised that all information in this program is provided for informational purposes only. While PMI makes all reasonable efforts to verify the credentials of instructors and the information provided, it is not intended to serve as legal advice. The opinions expressed are those of the individual presenter and do not necessarily reflect the viewpoint of Practice Management Institute. The information provided is general in nature. Depending on the particular facts at issue, it may or may not apply to your situation. Participants requiring specific guidance should contact their legal counsel. CPT is a registered trademark of the American Medical Association. Practice Management Institute 9501 Console, Suite 100 San Antonio, Texas tel: fax: (210) info@pmimd.com

3 ICD-10 Diagnosis Coding Primary Care Nancy Maguire, ACS, PCS, HCS-D 1 It s Coming January 16, 2009 the final rule was published in the Federal Register The compliance date for this regulation is October 1, 2013 The compliance date refers to all claims received for encounters and discharges occurring on or after 10/01/13 2 1

4 Massive Change The impact of this transition is substantial The new code set include five times as many codes as the ICD-9 code set The different arrangement of codes will require more documentation, revised forms, retraining of staff and physicians, and changes to software and other information technology (5010) Changes in reimbursement patterns may also result from the increased specificity of the new code set 3 ICD-10 Diagnosis Codes ICD-10 codes must be used on all HIPAA transactions, including outpatient claims with dates of service, and inpatient claims with dates of discharge on and after October 1, 2013, Otherwise, your claims and other transactions may be rejected, and you will need to resubmit them with the ICD-10 codes This could result in delays and may impact your reimbursements, so it is important to start now to prepare for the changeover to ICD-10 codes This change does not affect CPT coding for outpatient procedures. 4 2

5 Diagnosis Codes 5010 The maximum number of diagnosis codes that can be reported on a claim was increased from eight to twelve in transaction update 5010 Although twelve diagnosis codes can be reported at the claim level, only four codes can be pointed to, or linked to, a specific service at the service line level So if a patient has twelve diagnoses and you perform a service that relates to five diagnoses, you can only point to four of them when billing for that service line 5 Today, ICD-9-CM Index Tabular 17 Chapters 13,500 codes Hypertension table Table of Drugs and Chemicals Neoplasm table Index to External Causes (E codes) Supplementary classification (V codes) 3-5 digits, numerical (except for V and E codes) 6 3

6 Tomorrow, ICD-10-CM Index, expanded Tabular 21 Chapters 68,000 codes Table of Drugs and Chemicals Neoplasm table Index to External Causes (V, W, X, Y codes) Supplementary classification (Z codes) 3-7 digits, alphanumerical First digit is alpha (U is not used) Sense organs eye and ear have their own chapter (7 and 8) Excludes 1 and Excludes 2 notes Pregnancy conditions trimester vs. episode of care (ICD-9) Underdosing taking less than a prescribed medication (new term) Laterality (the concept of unilateral/bilateral codes currently exists in ICD-9-CM, but the concept of identifying right side versus left side is new in ICD-10-CM). Placeholder x 7 Excludes Notes Excludes1 indicates not coded here The code being excluded is never used with the code The two conditions cannot occur together For example,s01.05xa Open bite of scalp, initial encounter : Excludes 1 superficial bite of scalp (S00.06, S00.07-) 8 4

7 Excludes 2 Note Excludes 2 indicates not included here The excluded condition is not part of the condition represented by the code It is acceptable to use both codes together if the patient has both conditions For example,t20.511a, Corrosion of first degree of right ear [any part except ear drum], initial encounter Excludes 2 corrosion of ear drum (T28.91-) 9 ICD-10-CM Combination codes: E Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema ICD-9 required three codes to describe the same narrative statement (250.50, , ) I25.11Atherosclerotic heart disease of native coronary artery with unstable angina pectoris Combination codes for poisonings and external causes T40.5x2APoisoning by cocaine, intentional self-harm, initial encounter T42.3x1DPoisoning by barbiturates, accidental (unintentional), subsequent encounter 10 5

8 Extensions Code extensions (seventh character) have been added for injuries and external causes to identify the encounter: initial, subsequent, or sequela. The extensions are: A Initial encounter D Subsequent encounter S Sequelae S90.519A- Abrasion, unspecified ankle; Initial encounter S96.919A-Strain of unspecified muscle and tendon at ankle and foot level, unspecified side, initial encounter; or S96.919DStrain of unspecified muscle and tendon at ankle and foot level, unspecified side, subsequent encounter 11 Documentation S52.131A- Displaced fracture of neck of right humerus, initial encounter for closed fracture. ICD-10-CM describes Right versus Left Initial encounter, subsequent encounter Routine healing, delayed healing, nonunion, or malunion ICD-10 requires much more documentation and preparation 12 6

9 Code also any associated. H Hypertensive retinopathy, bilateral Code also any associated hypertension (I10) I27.2 Other secondary pulmonary hypertension Code also associated underlying condition J09.01Influenza due to identified avian influenza virus with respiratory manifestations Code also any associated pneumonia (J12- J18) 13 Use additional code.. J35.- Chronic diseases of tonsils and adenoids Use Additional code to identify: exposure to environmental tobacco smoke (Z77.22) exposure to tobacco smoke in the perinatal period (P96.81) history of tobacco use (Z87.891) occupational exposure to environmental tobacco smoke (Z57.31) tobacco dependence (F17.-) tobacco use (Z72.0) 14 7

10 Category J35.- J35.- Chronic diseases of tonsils and adenoids J Chronic tonsillitis and adenoiditis J35.01 Chronic tonsillitis J35.02 Chronic adenoiditis J35.03 Chronic tonsillitis and adenoiditis J35.1 Hypertrophy of tonsils J35.2 Hypertrophy of adenoids J35.3 Hypertrophy of tonsilswith hypertrophy of adenoids J35.8 Other chronic diseases of tonsils and adenoids J35.9 Chronic disease of tonsils and adenoids, unspecified 15 Category J31.- Chronic rhinitis, nasopharyngitis and pharyngitis J31.0 Chronic rhinitis Excludes 1 allergic rhinitis (J30.1-J30.9) vasomotor rhinitis (J30.0) J31.1 Chronic nasopharyngitis Excludes 2 acute nasopharyngitis (J00) J31.2 Chronic pharyngitis Excludes 2 acute pharyngitis (J02.9) 16 8

11 Acute Bronchitis J20.- J20.- Acute bronchitis J20.0 Acute bronchitis due to Mycoplasma pneumoniae J20.1 Acute bronchitis due to Hemophilus influenzae J20.2 Acute bronchitis due to streptococcus J20.3 Acute bronchitis due to coxsackievirus J20.4 Acute bronchitis due to parainfluenza virus J20.5 Acute bronchitis due to respiratory syncytial virus J20.6 Acute bronchitis due to rhinovirus J20.7 Acute bronchitis due to echovirus J20.8 Acute bronchitis due to other specified organisms J20.9 Acute bronchitis, unspecified 17 Category H61.2- H61.2- Impacted cerumen H61.20 unspecified ear H61.21 right ear H61.22 left ear H61.23 bilateral 18 9

12 Essential (primary) hypertension I10 Includes high blood pressure hypertension (arterial) (benign) (essential) (malignant) (primary) (systemic) Excludes 1 hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11, O13-O16) Excludes 2 essential (primary) hypertension involving vessels of brain (I60-I69) essential (primary) hypertension involving vessels of eye (H35.0) 19 Placeholder x M80.08-requires a 7 th character M80.08-Age-related osteoporosis with current pathological fracture, vertebra(e) M80.08XA initial encounter for fracture M80.08XD subsequent encounter for fracture with routine healing M80.08XG subsequentencounter for fracture with delayed healing M80.08XK subsequent encounter for fracture with nonunion M80.08XP subsequent encounter for fracture with malunion M80.08XS sequela 20 10

13 Signs and Symptoms R05 Cough R07.1 Chest pain on breathing R09.81 Nasal congestion R Right upper quadrant abdominal tenderness R19.31 Right upper quadrant abdominal rigidity R11.2 Nausea with vomiting R26.0 Ataxic gait R31.0 Gross hematuria 21 S and T Category Codes Injuries: Initial, subsequent or sequela encounter (A, D, S), 7 th character Fractures: closed, open, routine healing, delayed healing, sequela, nonunion, malunion (7th character) New terms, example: subluxation vs. dislocation vs. displacement codes or burns vs. corrosion Chapter 19 injuries is very large with over 9,600 code selections and more with extenders

14 Encounter Forms Many full codes require information unique to each individual encounter, in this case the complete code could not be on a charge document because there could be 16 or more choices based on the circumstance Remove diagnosis codes from superbill if the code has infrequent use (ex, 25-30/year), you will need the room for I-10 codes! ICD-10 codes requiring additional digits would appear on a superbill as (.-), example abscess L02.- ICD-9 codes on a charge document may take up one page, ICD-10 diagnosis codes/specialty may be 10 pages long and that is onerous Electronic look-up is one solution 23 Crosswalk Crosswalk your common usage ICD-9-CM codes to their ICD-10 counterparts Identify code categories that require extenders This process would identify education focus for staff and physicians. This feedback will prepare physicians for providing coders the necessary information Practice coding patient encounters with ICD-10 codes The GEMS (General Equivalence Mappings) Mappings between I-9 and I-10 attempt to find corresponding diagnosis codes between the two code sets, insofar as this is possible 24 12

15 A New Generation of Diagnosis Codes ICD-10-CM has been updated to reflect the current clinical understanding and technological advancements of medicine, and the code descriptions are designed to provide a more consistent level of detail It contains a more extensive vocabulary of clinical concepts, body part specificity, patient encounter information, and other components from which codes are built 25 Differences Example, an I-9 code description containing the words complicated open wound does not have a simple one-to-one correspondent in I-10 The I-9 description identifies the clinical concept complicated, but according to the note at the beginning of the section, that one concept includes any of the following: delayed healing, delayed treatment, foreign body or infection I-10 does not classify open wound codes based on the general concept complicated ICD-10 categorizes open wounds by wound type laceration or puncture wound, for example and then further classifies each type of open wound according to whether a foreign body is present I-10 open wound codes do not mention delayed healing or delayed treatment, and instructional notes advise the coder to code any associated infection separately Therefore, depending on the documentation in the record, the correct correspondence between and I-9 and I-10 code could be one of several 26 13

16 Expectations Documentation 15% increase in time Increases in claim inquiries, reduction in cash flow 1% at a minimum Work Plan: Business process analysis multifaceted effort Start the budgeting process cost to involve a training budget Identify key staff to begin, clinical and administrative, assigntasks and responsibilities, accountability must be clearly understood Management Education, staff education, physician education, IT, billers, coders, computers--etc, etc.. Develop a plan for the education process to determine how this will impact your operations Develop a time frame to begin training and monitor progress Track progress of CMS efforts 27 Tips On Training ICD-10-CM Internal or external Knowledgeable about ICD-10 codes 6-month learning curve Start in early 2013 Practice coding patient scenarios Train to coders level of experience May have to refresh anatomy and medical terminology- take it up a notch for clinical terms Do not make sessions too long at one sitting Read the Guidelines and pertinent chapter code descriptions 28 14

17 Resources NCHS Basic ICD-10-CM information CMS ICD-10-information AHIMA - ICD-10 Education 10.html WEDI ICD-10 Implementation

Meet the Presenter. Welcome to PMI s Webinar Presentation. Understanding the ICD- 10-CM Guidelines. On the topic:

Meet the Presenter. Welcome to PMI s Webinar Presentation. Understanding the ICD- 10-CM Guidelines. On the topic: Welcome to PMI s Webinar Presentation Brought to you by: Practice Management Institute pmimd.com Meet the Presenter On the topic: Understanding the ICD- 10-CM Guidelines Libby Purser, CHI, CMC, CMIS, CMOM,