Learn Connect Succeed. JCAHPO Regional Meetings 2015

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Terence Stokes
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1 Learn Connect Succeed JCAHPO Regional Meetings 2015

2 What Allied Staff Needs to Know to Prepare for ICD-10 Financial Interest JCAHPO Palm Beach June 26-27, 2015 Presented by: E. Ann Rose E. Ann Rose is President of Rose & Associates and acknowledges a financial interest in this subject matter ICD-10 ICD-10 is the diagnosis coding system developed by the World Health Organization (WHO) Created to replace ICD-9 as current diagnosis code set used in the U.S. ICD-10 now mandated by HIPAA ICD-10 does not affect CPT procedural code system October 1, 2015 ICD-10 Transition New go live date for ICD-10 conversion Start now to transition to new and improved documentation Understanding the ICD-10 differences and chart documentation changes are critical Will make your job much easier in Why the Change? Change is needed to move away from 30 year-old code set ICD-9 is outdated and obsolete Inaccurate data Outgrown level of specificity Technology and medicine has changed Many ICD-9 codes no longer accurately describe diagnoses they are assigned to represent Why the Change? ICD-10 far exceeds ICD-9 by number of diagnosis codes and concepts 14,000 codes in ICD-9 compared to 69,000 codes in ICD-10 Additional 6 th and 7 th digits created for greater specificity Will also allow for future expansion 5 6 Rose & Associates

3 Who s Affected? With few exceptions, all providers covered by HIPAA must convert Includes providers other than Medicare and Medicaid Exceptions Workers Compensation Auto Insurance Home owners insurance Business owner liability ICD-10 Differences Laterality plays a big part in ICD-10 Assessment must be specific to each eye: 1 Right eye 2 Left eye 3 Bilateral 9 Unspecified eye 7 8 ICD-10 Differences Specificity is more important than ever Impression must be as specific as it can be for a particular complaint or condition Particularly important for injuries Manifestation is critical where applicable Must list disease and manifestation Example: Diabetes with severe nonproliferative diabetic retinopathy with macular edema without macular edema ICD-9-CM ICD-10 Differences Differences 3-5 Characters 3-7 Characters All Characters are Numeric No laterality Supplemental chapters: Alpha and numeric characters ICD-10-CM Character 1 is alpha (A-Z, not case sensitive) Character 2 is numeric Characters 3-7 are alpha or numeric Laterality Now main chapters or integrated into ICD-10 code Total Traumatic Cataract H Total Traumatic Cataract, Right Eye H Total Traumatic Cataract, Left Eye H Total Traumatic Cataract, Bilateral Eye H Total Traumatic Cataract, Unspecified eye 9 10 ICD-10 Differences New ICD-10 Features Combination Codes (Describes two diagnoses, or diagnosis with associated manifestation, or diagnosis with associated complication) Added Laterality Episodes of Care Added Injuries, Poisonings, other external causes (Initial encounter, subsequent encounter) Expanded codes (diabetes, post-operative complications, injuries) Addition of Placeholder X allows for future expansion Expanded Ambulatory and Managed Care Encounter Details Timeframes Added External Cause Codes no longer supplementary classification Greater Specificity Enhanced Quality Reporting ICD-10 Differences Injuries grouped by anatomical site rather than type of injury Additional characters allow for identifying: Body system Root operation Body part Approach Device involved in a procedure Rose & Associates

4 Impact on ICD-10 requires more (and improved) chart documentation Has more unique, precise diagnosis codes Helps substantiate medical necessity ICD-10 will impact how you do your job How you deal with patients More questions specific to patient s complaint or condition How you interact with physicians and billers will require more specificity 14 General Basic medical record documentation requirements include: Severity or status of disease Acute or chronic for example Site Etiology Cause of the disease Any secondary disease process General Confirmation of diagnosis found from lab or diagnostic test Glaucoma, etc. Cause-and-effect relationship between medical treatment and eye disorder Cataract cause of decreased vision, etc. of complications that occurred intra-operatively or post-operatively intra-operative versus post-operative hemorrhage, etc General ICD-10 has greater specificity regarding type and cause of eye disorders Must be documented in the medical record Example: Cataract complicated With neovascularization With ocular disorder Requires thorough documentation in chart Still need to document upper or lower eyelid and laterality (right, left, bilateral, unspecified) General Also remember: Exam may be bilateral Test or surgery can be bilateral or unilateral It will be important to document each visit (procedure) accordingly so coder will know how to report diagnosis code for payment Technicians will need to pay closer attention to this as well Rose & Associates

5 must address: Story of what was performed and diagnosed accurately Must thoroughly reflect the condition of the patient What services were rendered What is the severity of the condition Key word for documentation is SPECIFICITY Make sure documentation reflects what happens at today s visit Permits coders to code principal diagnosis Only list conditions that coexist and affect patient care that day Do not document (or bring forward from EMR) conditions previously treated or that no longer exist Can document signs or symptoms Do not document probable, suspected, rule-out or questionable Current Chalazion OS Cataract CME Eyelid laceration Diabetic Myopia Differences Chalazion LLL New NS cataract, OS, floppy iris syndrome CME OS after cataract surgery Laceration, left eyelid, hit in eye with tree branch Type II diabetes using insulin Myopia OU; regular astigmatism OD Current Corneal Foreign body Ptosis BDR, OU Differences New FB in cornea, OD, initial encounter, subsequent encounter, or sequela (condition that is consequence of previous disease or injury) Mechanical ptosis OU Type II diabetes w/mild NPDR w/o macular edema; on insulin Current Elevated IOP Iritis OU Hyphema OS No Maculopathy Differences New Family history of glaucoma Chronic iritis OU Traumatic hyphema OS RA, taking plaquenil, no ocular disease Glaucoma Must assign as many codes as needed to identify type of glaucoma, the affected eye, and the glaucoma stage Expanded chart documentation will be required In some cases, even laterally will apply Mild glaucoma, OD Moderate glaucoma, OS If glaucoma different in each eye, coder will be required to bill two lines using each diagnosis Rose & Associates

6 Glaucoma Stages required as part of diagnosis in ICD Unspecified (rarely used) 1 - Mild 2 - Moderate 3 - Severe 4 - Indeterminate If not documented properly (and subsequently not coded), claim will deny Cataract Some descriptors have changed requiring different chart documentation Senile Cataract Now age-related cataract Cataracta brunescens/nuclear sclerosis cataract Now age-related nuclear cataract Cataract with neovascularization Now complicated cataract Infantile or Juvenile Cataract Now non-senile cataract Diabetes with manifestations Combination codes will be important Third character category shows type of diabetes Fourth character shows underlying conditions with specific complications Fifth character defines specific manifestation Sixth character defines combined manifestations Type I or Type II Diabetes Mellitus Mild, moderate, severe NPDR (or PDR) with macular edema without macular edema Type I Diabetes Mellitus With diabetic cataract With other diabetic ophthalmic complication Type II Diabetes Mellitus With diabetic cataract With proliferative diabetic retinopathy with macular edema without macular edema Blindness and low vision Some of the descriptors are different ICD-9 Profound impairment Moderate impairment Severe impairment Blindness In ICD-10 Just Blindness & Low Vision Specific codes will describe blindness in one eye and low vision in other eye» H54.11, Blindness, right eye, low vision left eye Rose & Associates

7 becomes more critical with trauma or injuries May need to ask more questions specific to the patient s complaint External cause Provide cause of injury How did injury happen? Was injury related to military, work, other? Place of Occurrence Where was patient when it happened? Home, work, car, boat, etc.? Activity What was patient doing at time of injury? Playing a sport, using a tool, cooking? s 73 year-old female presents for eye exam after noticing loss of sharpness in distance vision. States change in distance vision is mild Does not drive or watch TV But does knit and read without impairment Examination determines 20/40 OD and 20/50 OS Easily corrected to 20/15 with refraction Near vision excellent without astigmatism 34 Slit lamp shows normal optic nerve and macula OU and nuclear cataracts bilaterally Cataract OD is NS 2+ Cataract OS is slightly more opaque at NS 3+ Dispensed glasses to correct myopia Advised to wear sunglasses outdoors Follow-up in 3 months or, if changes, minimal, follow-up in 6 months Was also advised she could take multivitamin that contains Lutein, Zeaxanthin and Omega-3 FA Alphabetic Index: Cataract Senile nuclear (sclerosis) H25.1- Tabular List: H25.1 Age-related nuclear cataract Cataract brunescens Nuclear sclerosis cataract H25.13 Age-related nuclear cataract, bilateral Correct code sequence: H Rose & Associates

8 82 year-old female presents with caregiver for continued monitoring of eye disease Appears at ease and in control of her surroundings Previously treated for senile degenerative choroidal atrophy, and retinal neovascularization in both eyes Visual field defect shows significant central loss in both eyes but has fairly wide peripheral fields bilaterally Previously treated with Avastin injections for retinal neovascularization Fluorescein angiography shows dye leakage from retinal neovascularization but disease appears stable Told to return in 3 months for recheck Alphabetic Index: Atrophy choroid senile H Tabular List: 6 th H31.11 Age-related choroidal atrophy Correct code sequence: H Age-related choroidal atrophy, bilateral 6 th digit required H Retinal neovascularization, unspecified bilateral Use as secondary diagnosis not inherent part of the disease process for age-related choroidal atrophy No 7 th digits required 67 year-old male presents to office for ongoing care of glaucoma Diagnosed six months ago with angle-closure glaucoma bilaterally Eye pressure was initially difficult to control Left eye progressed fairly rapidly to moderate stage glaucoma Stage in right eye was difficult to determine, but both eyes appeared stable at exam 6 months ago Upon examination his visual field perception is unchanged in both eyes Only minimal visual loss in outer periphery of right eye but arcuate in left eye Visual acuity unchanged in right eye but slightly improved in left eye States doing fine with current glasses Testing confirms disease is stable at this time Patient anxious about surgery as long as medications are working and prefers no treatment at this time Told to return in 6 months, sooner if symptoms worsen Alphabetic Index: Glaucoma angle closure chronic H Tabular List: 7 th - H Chronic angle-closure glaucoma, right eye» 1 as 6 th character indicates right eye x7 th - H Chronic angle-closure glaucoma, right eye, indeterminate stage» 4 as 7 th character indicates indeterminate glaucoma stage Rose & Associates

9 7 th - H Chronic angle-closure glaucoma left eye» 2 as 6 th character indicates left eye x7 th - H Chronic angle-closure glaucoma, left eye, moderate stage» 2 as 7 th character indicates glaucoma stage Correct codes: H (Chronic angle-closure glaucoma, right eye, indeterminate stage), plus H (Chronic angle-closure glaucoma, left eye, moderate stage) A patient who had cataract surgery on the right eye two days ago now experiencing pain in right eye Following a slit lamp exam of affected eye, physician discovered lens fragments in right eye Returned patient to OR to remove fragments Alphabetic Index: Complications Postprocedural Following Cataract Surgery Cataract (lens) fragments H Tabular List: H Cataract (lens) fragments in eye following cataract surgery, right eye Correct code sequence: H H57.11 Ocular Pain Chapter 7 (Eye and Adnexa) includes instructional note to use external cause code following code for eye condition, if applicable, to identify cause of eye condition 66 year-old male jet skiing too fast at area lake Driving recklessly and fell off jet ski Hit in left eye with handle bar before entering water Admits to drinking too many beers before getting on jet ski Presented to office next day with complaint of eye swelling when he blows his nose Diagnosed with orbital floor fracture Alphabetic index: Fracture, traumatic orbit floor (blow out) S02.3 Tabular list: S02.3 Fracture of orbital floor [notice no laterality] Correct code sequence: x7 th - S02.3XXA Fracture of orbital floor No 5 th & 6 th digits available X place holder must fill empty spaces A is 7 th digit for initial encounter for closed fracture V93.33XA Fall on board jet ski Injury requires secondary code for external cause X is place holder no 6 th digit & diagnosis requires 7 digits A is for initial encounter [for injury] TRAINING 47 Rose & Associates

10 Training Training will be critical for ICD-10 Topics to study Clinical knowledge anatomy and medical terminology Clinical Administrator may appoint lead nurse/tech to help train Physician input may be key to proper documentation This will be your biggest challenge as a technician or nurse Training Suggest nurses/technicians get same training at same time as physicians That way everyone will be on board with same information Opportunities for Training On-line courses for ophthalmology Webinars specific to ophthalmology Training Professional Societies JCAHPO Webinars ASOA, AAO, and local Webinars On-site Consulting Training If practice goes that route Training Ask practice administrator to: Prepare list of most common diagnosis codes used in your practice cross-referenced to ICD- 10 codes Seeing new code descriptions may help you determine proper chart documentation Develop case scenarios or create sample charts to see if your documentation meets new requirements to select proper diagnosis Particularly level of specificity Training Test your documentation throughout the year Will allow time to fix and re-train before 10/1/15 Remember, documenting for ICD-10 will be new experience for physicians also Be patient! But, don t be afraid to bring issues to their attention They will appreciate it in the long run Resources Resources for ICD-10-CM Coding Manuals AAO Bookstore Has ICD-10 for Ophthalmology Has great crosswalk from ICD-9 to ICD-10 in front of book ASOA Bookstore AMA Bookstore Rose & Associates

11 Resources APPs you can download for free on smart phones or tablets ICD-10-CM Search (SuperCoder.com) Just do search in App store Searches ICD-10 codes Converts ICD-9 to ICD-10 Converts codes all the way to 7 th digit Has breakout arrows and notes when code needs to be expanded Find-A-Code Questions Rose & Associates results@roseandassociates.com Rose & Associates

Financial Interest. Why the Change? ICD 10 Overview: How The Change Will Impact Technicians and Nurses. Rose & Associates

Financial Interest. Why the Change? ICD 10 Overview: How The Change Will Impact Technicians and Nurses. Rose & Associates ICD 10 Overview: How The Change Will Impact Technicians and Nurses 2014 JCAHPO Technicians & Nurses Program ASCRS/ASOA Congress and Symposium Boston, Massachusetts April 26-28, 2014 Presented by: E. Ann