Maureen Brooks, CPC HMWC H.E.L.P September 6, 2012

Transcription

1 Maureen Brooks, CPC HMWC H.E.L.P September 6, 2012

2 The compliance date for upgrading to Version 5010 standards d for electronic health transactions was January 1, 2012; CMS enforcement discretion is in place until June 30, Most payors and clearinghouses have implemented V5010. Seamless Transition Medicare is retro-fitting 5010 for crossover claims

3 February 16, 2012 HHS Press Release: As part of President Obama s commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius today announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).

4 HHS issued a statement mandating the implementation date for ICD-10 is October 1, All covered entities must be compliant by October 1, 2014

5 Since HHS announced its intent to extend the compliance date, several articles in support of ICD-10 have been written. Some of the perks to the Revenue Cycle: Quicker turnaround Fewer denials More accurate claims Payors suggest improved data collection and analysis

6 Medicare is currently running silent audits of the level of service billed for some providers. Medicare is conducting post payment audits, requesting chart documentation and reporting back to providers their findings. Medicare is offering assistance with documentation and coding training. Medicare is not requesting a refund for discrepancies i found.

7 1. INFORM Give decision makers in the practice an overview and get buy-in 2. ASSIGN - Identify who will lead the implementation effort 3. ASSESS Determine what areas of the practice will be affected and what needs to change 4. REVIEW Identify your most common ICD-9 codes and review documentation

8 Create a team approach. Team assignments and reporting to the committee Obtain provider commitment Review/revise budget Communication is key: Staff Providers Patients

9 Review your use of ICD-9 in your practice Take an in-depth look at the current level of documentation Run a frequency report of the most used procedures and diagnosis codes.

10 Take an in-depth look at the current level of documentation in the medical record Review specificity, think about how to begin the process of improvement. Patient intake forms Health questionnaires Template chart notes

11 5. PLAN Plan the Implementation of ICD-10 for your practice. 6. PREPARE Prepare training materials, update internal policies, create flow charts 7. TRAIN Train staff and physicians 8. TEST Test the changes, run ICD-10 behind ICD-9 and review chart documentation 9. IMPLEMENT OCTOBER 1, 2014

12 EVALUATE Review payor results, correspondence, denials, assess work flows CQI CONTINUOUS QUALITY IMPROVEMENTS

13 Differences in ICD-10-CM Alphanumeric Structure Addition of 6 and 7 extensions to provide a higher h level l of specificity i Reorganizing and adding chapters Expanded to include health related conditions Creation of combination diagnosis/symptom codes to reduce the number of codes need to describe a condition

14 Code CHAPTER DESCRIPTION range CH 1 Infectious and Parasitic Diseases ICD 10 Certain infectious and parasitic diseases A00 B99 CH 2 Neoplasms ICD 10 Neoplasms C00 D49 CH 3 Endocrine, Nutritional and Metabolic Diseases and Immunity Disorders ICD 10 Diseases of the Blood and Blood forming Organs D50 D89 CH 4 Diseases of the Blood and Blood forming Organs ICD 10 Endocrine, Nutritional and Metabolic Diseases E00 E89 E89 CH 5 Mental Disorders ICD 10 Mental and Behavioral Disorders F01 F99 CH 6 Diseases of Nervous System and Sense Organs ICD 10 Diseases of the Nervous System G00 G99 CH 7 Diseases of the Circulatory System ICD 10 Diseases of the Eye and Adnexa (new) H00 H59 CH 8 Diseases of the Respiratory System ICD 10 Diseases of the Ear and Mastoid Process (new) H60 H95 CH 9 Diseases of the Digestive System ICD 10 Diseases of the Circulatory System I00 I99 I99

15 CH 10 Diseases of the Genitourinary System ICD 10 Diseases of the Respiratory System J00 J99 CH 11 Complications of Pregnancy, Childbirth and the Puerperium ICD 10 Diseases of the Digestive System K00 K94 CH 12 Diseases of the Skinand Subcutaneous Tissue ICD 10 Diseases of the Skin and Subcutaneous Tissue L00 L99 CH 13 Diseases of Musculoskeletal and Connective Tissue ICD 10 Diseases of the Musculoskeletal l lsystem and Connective Tissue M00 M99 M99 CH 14 Congenital Anomalies ICD 10 Diseases of the Genitourinary System N00 N99 CH 15 Newborn (Perinatal) Guidelines ICD 10 Pregnancy, Childbirth and the Puerperium O00 O9a CH 16 Signs, Symptoms and ILL Defined Conditions ICD 10 Certain Conditions Originating in the Perinatal Period P05 P96 CH 17 Injury and Poisoning ICD 10 Certain Conditions Originating in the Perinatal Period P05 P96 P96

16 CH 18 N/A ICD 10 Symptoms, Signs and Abnormal Clinical and Laboratory Findings CH 19 N/A ICD 10 Injury, Poisoning and Certain Other Consequences of External Causes CH 20 N/A ICD 10 External Causes of Morbidity (new) R00 R99 S00 T88 V00 Y99 CH 21 N/A Factors Influencing Health lthstatus t and Contact twith Health lthservices ICD 10 (new) Z00 Z99 SAME Index SAME Neoplasm Table SAME Table of Drugs and Chemicals SAME Index to External Causes Classification of Factors influencing Health Status and Contact with Health Service Supplemental Classification of External Causes of Injury and Poisoning V01 V89 E800 E999

17 C Cancer E - Endocrine H Hearing I - Infarct M Muscle N - Nephrology O OB P - Perinatal R Rule Out T Toxicity Y did it happen Vi is now Z

18 EXAMPLE FROM THE APPC WEBSITE ICD-10 Documentation Example The following case highlights the increased specificity required to code for ICD-10-CM: S: Mrs. Finley presents today after having a new cabinet fall on her last week, suffering a concussion, as well as some cervicalgia. She was cooking dinner at the home she shares with her husband. She did not seek treatment t t at that t time. She states t that t the people that t put in the cabinet in her kitchen missed the stud by about two inches. Her husband, who was home with her at the time told her she was out cold for about two minutes. The patient continues to have cephalgias since it happened, primarily occipital, extending up into the bilateral occipital and parietal regions. The headaches come on suddenly, last for long periods of time, and occur every day. They are not relieved by Advil. She denies any vision changes, any taste changes, any smell changes. The patient has a marked amount of tenderness across the superior trapezius.

19 O: Her weight is 188 which is up 5 pounds from last time, blood pressure 144/82, pulse rate 70, respirations are 18. She has full strength in her upper extremities. DTRs in the biceps and triceps are adequate. Grip strength th is adequate. Heart rate is regular and lungs are clear. A: 1. Status post concussion with acute persistent headaches 2. Cervicalgia 3. Cervical somatic dysfunction P: The plan at this time is to send her for physical therapy, three times a week for four weeks for cervical soft tissue muscle massage, as well as upper dorsal. We ll recheck her in one month, sooner if needed.

20 ICD-10-CM Coding: S06.0x1A Concussion with loss of consciousness of 30 minutes or less, initial encounter G Acute post traumatic headache, h intractable M54.2 Cervicalgia M99.01 W20.8xxA Y93.g3 Y Segmental and somatic dysfunction of cervical region Struck by falling object (accidentally), initial encounter Activity, cooking and baking Place of occurrence, house, single family, kitchen

21 Mrs. Finley presents today after having a new cabinet fall on her last week, suffering a concussion EXTERNAL CAUSE The falling cabinet is what caused the injuries. Description of the cause is required She was cooking dinner at the home she shares with her husband. She did not seek treatment at that time. She states that the people that ACTIVITY The activity of the patient needs to be documented. An activity code is only used once at the initial encounter

22 the cabinet in her kitchen missed 7 th CHARACTER Injury codes require the 7 th character. Documentation must be clear so that the correct extender can be applied Her husband, who was home with her at the time told her she was out cold for about two minutes. The patient continues to LOCATION The provider needs to include the location of the patient at the time of injury or other condition.

23 The headaches come on suddenly, last for long periods of time, and occur every day. They are not relieved by Advil. She denies any vision changes APPLIED SPECIFICITY For a concussion,,provider needs to specify if the patient had loss of consciousness. RELIEF OR NO RELIEF Intractable vs not intractable are an inherent part of ICD-10 for headaches. Documentation needs to be clear to assign the appropriate code.

24 with acute persistent ACUTE VS CHRONIC Documentation of the patients condition must include acute or chronic to assign the most appropriate ICD-10 code.

25 ICD-10-CM Coding: S06.0x1A Concussion with loss of consciousness of 30 minutes or less, initial encounter G Acute post traumatic headache, h intractable M54.2 Cervicalgia M99.01 W20.8xxA Y93.g3 Y Segmental and somatic dysfunction of cervical region Struck by falling object (accidentally), initial encounter Activity, cooking and baking Place of occurrence, house, single family, kitchen

26 General Equivalence Mappings (GEMS) Designed to aid in converting applications and systems from ICD-9 to ICD-10 Bi-directional mapping find and replace codes for lists of codes Affordable Care Act requires those using GEMS use the version posted on the CMS website updates to ICD-10CM, ICD-10 PCS, GEMS, and Reimbursement Mappings are now posted at

27 wse/2010/en

28 QUESTIONS..