Medicare Update or Planning for ICD-10 Maureen Brooks February 20, 2014
Partial Code Freeze October 1, 2013 a partial update to include new technology and new diseases published October 1, 2014 no update unless a catastrophic event occurs causing the need for a new code
Reimbursement & Quality Problems with ICD-9-CM Example fracture of wrist - Patient fractures left wrist A month later, fractures right wrist ICD-9 CM does not identify left versus right requires additional documentation - ICD-10-CM describes Left versus right Initial encounter, subsequent encounter Routine healing, delayed healing, nonunion, or malunion
Structural Differences ICD-10-CM Diagnoses ICD-10-CM has 3 7 digits Digit 1 is alpha (A Z, not case sensitive) Digit 2 is numeric Digit 3 is alpha (not case sensitive) or numeric Digits 4 7 are alpha (not case sensitive) or numeric A66 Yaws A69.20 Lyme disease, unspecified O9A.311 Physical abuse complicating pregnancy, first trimester S42.001A Fracture of unspecified part of right clavicle, initial encounter for closed fracture
Laterality Left Versus Right C50.1 Malignant neoplasm, of central portion of breast C50.111 Malignant neoplasm of central portion of right female breast C50.112 Malignant neoplasm of central portion of left female breast
A00 B99 Certain infectious and parasitic diseases L00 L99 Diseases of the skin and subcutaneous tissue C00 D49 Neoplasms M00 M99 Diseases of the msk system and connective tissue D50 D89 Diseases of blood and blood-forming organs, immune mech N00 N99 Diseases of the genitourinary system E00E 89 Endocine, nutritional & metabolic diseases O00 O9A Pregnancy, childbirth and the puerperium F01 F99 Mental, Behavioral and Neurodevelopmental disorders P00 P96 Certain conditions originating in the perinatal period G00 G99 Diseases of the nervous system Q00 Q99 Congenital malformations, deformations and chromo abnorm H00 H59 Diseases of the eye and adnexa R00 R99 Symptoms, abd lab findings, not elsewhere classified H60 H95 Diseases of the ear and mastoid process S00 T88 Injury, poisoning and other external causes I00 I99 Diseases of the circulatory system V00 Y99 External causes of morbidity J00 J99 Diseases of the respiratory system Z00 Z99 Factors influencing health status and contact with health services K00 K95 Diseases of the digestive system
ICD-9 Dx Code1 Dx Desc1 DX CODE 1 DX DESC 1 ICD-10 380.10 Otitis externa, infective NOS 380.4 Impacted cerumen 382.9 Otitis media NOS H60.00 Abscess of external ear, unspec H61.23 Impacted cerumen, bilateral H66.90 Otitis media, unspecified, unspecified ear H60.10, H60.319, H60.329, H60.399 401.1 Hypertension, benign essential I10 Essential (primary) hypertension 401.9 Hypertension, essential NOS I10 Essential (primary) hypertension 428.0 Failure, congestive heart NOS I50.9 Heart failure, unspecified 461.0 Sinusitis, acute maxillary 464.4 Croup J01.00 Acute maxillary sinusitis, unspecified J05.0 Acute obstructive laryngitis (croup) 465.9 Infct up rsprt mlt sites, acute NOS J06.9 Acute upper respiratory infection, unsp 466.0 Bronchitis, acute 477.0 Rhinitis, allergic, d/t pollen 486 Pneumonia, organism NOS J20.9 Acute bronchitis, unspecified J30.1 Allergic rhinitis due to pollen J18.9 Pneumonia
Rumor has it. Clinical Documentation Concepts that are new to ICD-10 are not new to physicians who are already documenting a patient s chart with more information than an ICD-9 can capture. (CMS)
CLINICAL DOCUMENTATION Elements of documentation of a patient chart: Initial encounter, subsequent encounter, sequelae Acute or chronic Right or left Normal healing, delayed healing, nonunion or malunion Take a look at documentation for the most often-used ICD-9 codes in your practice and work with coding staff to select the appropriate corresponding ICD-10 codes. Identifying these codes will help reinforce the information to highlight when documenting patient diagnoses for ICD-10.
CLINICAL REVIEW Review changes in documentation requirements and educate staff by looking at frequently used ICD-9 codes and new ICD-10 codes (ongoing) Review patient questionnaires, review of system forms to accommodate the need for additional information. Review EMR templates and documentation
IMPLEMENTATION TIMELINE PLANNING: Identify your resources front office, back office, billing, coding, clinical Create a project team take a team approach Assess affects how will ICD-10 affect your processes, identify all who see ICD-9 Create project plan timeline, communication, responsibility Secure budget
VENDORS AND PAYORS Ask your payers and vendors software/systems, clearinghouses, billing services about ICD-10 readiness (2 months) Review trading partner agreements Ask about systems changes, a timeline, costs, and testing plans Ask when they will start testing, how long they will need, and how you and other clients will be involved Select/retain vendor(s)
Transition and Testing Conduct high-level training on ICD-10 for clinicians and coders to prepare for testing (e.g., clinical documentation, software updates) (ongoing) Start testing ICD-10 codes and systems with your practice s coding, billing, and clinical staff (9 months) Use ICD-10 codes for diagnoses your practice sees most often
Review coder and clinician preparation; begin detailed ICD-10 coding training (6-9 months) Work with vendors to complete transition to production-ready ICD-10 systems ICD-10 Transition training software
Complete Transition/Full Compliance October 1, 2014 Complete ICD-10 transition for full compliance ICD-9 codes continue to be used for services provided before October 1, 2014 ICD-10 codes required for services provided on or after October 1, 2014 Monitor systems and correct errors if needed
A Methodical Approach If you have not started your timeline yet, don t rush into decisions, take your time to evaluate your practice specific needs Start right away reviewing the crosswalk of ICD-9 to ICD-10 for training purposes
A WORD ABOUT ICD-10 Workers Comp and other small payers who are exempt from transitioning to ICD-10; ICD-9 will not be updated or supported after 10/1/13. GEMS software available at cms.gov a simplified crosswalk tool
RESOURCES www.cms.gov www.aapc.com www.mgma.com Your specialty professional web site
QUESTIONS THANK YOU