ICD-10 Webinar

ICD-10-CM: Are You Prepared?

Intuitive Solutions - “Your Single Service Provider”

Tayyab YunusCEO, Intuitive Solutions

Meet your Presenter:

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Copyright Intuitive Solutions - All rights reserved.

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Purpose of Today’s Presentation

Help you build a plan to prepare and transition to ICD-10


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About ICD-10-CM

ICD-10-CM is the U.S. clinical modification to the World Health organization’s (WHO) International Classification of Diseases, Tenth Revision (ICD-10.)

CPT codes will not be affected

ICD-10 will be required for hospital diagnosis and procedural(ICD-10-PCS) coding AND medical diagnosis and symptom coding for outpatient/office settings

Every health care organization will be impacted by ICD-10 and must make the necessary changes for the transition

ICD-10 code set a lot more specific with a lot more codes!


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Why the change?

U.S. is the only industrialized nation that has not implemented ICD-10, by doing this our data will be consistent when describing morbidity and mortality disease data with other countries

Department of Health and Human Services (HHS) announced the final rule that ICD-10 will be in affect October 1st, 2015. Thinking that there will be a delay will not help your practice

Anyone covered under HIPAA will be required to comply with ICD-10

Practices will need to focus on documentation and what the details of the ICD-10 codes specific to their practice are


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ICD-10 Overview

Department of Health and Human Services (HHS) announced the final rule that ICD-10 will be in affect October 1st, 2015. Thinking that there will be a delay will not help your practice

ICD-10 will have 141,000 codes—more than 8 times the 17,000 codes in ICD-9. The additional codes will enable practices to be more specific on claims forms in reporting the care provided to patients.

Anyone covered under HIPAA will be required to comply with ICD-10

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How Detailed is ICD-10?

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ICD-10 Code Structure

1st

DIGIT

3rd

DIGIT

2nd

DIGIT

4t

h

DIGIT

6t

h

DIGIT

5t

h

DIGIT

7t

h

DIGITEXTENSIONETIOLOGY, ANATOMICAL SITE, SEVERITYCATEGORY

ALPHA(NOT U)

NUMERIC CHARACTERS 3-7 CAN BE ANY COMBINATIONOF ALPHA OR NUMERIC

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World Wide Adoption of ICD-10

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What are some differences and benefits?

ICD-9 Code length and alphanumeric structure limits

the number of new codes that can be created.

Lacks laterality

Outdated terminology

The lack of detail or non specific codes limits payers & others to analyze information

Lacks specificity to process claims and reimbursement accurately i.e. complexity and severity

ICD-10 Use of current medical terminology

More codes, better data!

Codes with greater specificity of severity, complexity, comorbidities, complications

Improved healthcare measurement & descriptive reporting with lesser rejected claims

ICD-10


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Organizational Differences inICD-10-CM

Keep a ICD-10 book handy for you and your staff!

ICD-10-CM consists of 21 chapters compared to 17 chapters in ICD-9-CM

Main classification contains health status and external cause codes replacing the V codes and E codes in the supplemental classifications of ICD-9-CM- No more V and E codes!

Diseases of the eyes and ears have been separated from the nervous system diseases and sense organs and have their own chapters. Example:

Type 2, diabetic neuropathy is in Chapter 6- diseases of nervous system- E11.40

Non-ulcerative bilateral blepharitis of the upper eyelids is in Chapter 7- H01.001 and H01.004

Left acute serous otitis media is in Chapter 8- H65.02 and H72.821Copyright Intuitive Solutions - All rights reserved.

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ICD-10 Chapters

Ch. 1 = A&B, Infectious

Ch. 2 = C&D, Neoplasms

Ch. 3 = D, Blood

Ch. 4 = E, Endocrine +

Ch. 5 = F, Mental

Ch. 6 = G, Nervous

Ch. 7 = H, Eye

Ch. 8 = H, Ear

Ch. 9 = I, Circulatory

Ch. 10 = J, Respiratory

Ch. 11 = K, Digestive

Ch. 12 = L, Skin

Ch. 13 = M, Musculoskeletal

Ch. 14 = N, Genitourinary

Ch. 15 = O, Obstetrics

Ch. 16 = P, Perinatal

Ch. 17 = Q, Congenital

Ch. 18 = R, Symptoms/Signs

Ch. 19 = S&T, Injury, poisoning, other consequence

Ch. 20 = V, W, X & Y, External Causes

Ch. 21 = Z, Factors influencing Health Status & Contact with H.S.

Depending on your specialty, your ICD-10 codes will start with one of these letters above. Example:

• Right upper quadrant rebound abdominal tenderness- R10.82


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Fracture: ICD-9 vs. ICD-10

Coding: Diabetes Mellitus

ICD-9 In series 250, there are10 different subcategories that

further define the patient’s actual condition.

250.0, diabetes mellitus without mention of complication

250.1, diabetes with ketoacidosis

250.2, diabetes with hyperosmolarity

250.3, diabetes with other coma

250.4, diabetes with renal manifestations

250.5, diabetes with ophthalmic manifestations

250.6, diabetes with neurological manifestations

250.7, diabetes with peripheral circulatory disorders

250.8, diabetes with other specified manifestations

250.9, diabetes with unspecified complication These codes require a fifth digit to indicate whether the diabetes is controlled or uncontrolled

ICD-10 In ICD-10-CM, there are 5 different categories

that are also then subdivided. Those categories are:

E08, diabetes mellitus due to underlying condition

E09, drug or chemical induced diabetes mellitus

E10, type 1 diabetes mellitus

E11, type 2 diabetes mellitus

E13, other specified diabetes mellitus

E14, unspecified diabetes mellitus

**NOTE: If “other” or “unspecified” code is overly used, payment will not be made if a more detailed alternative code was available.

14Copyright Intuitive Solutions - All rights reserved.

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What are my Implications?

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ICD-10 Requires Organizational Change

Practice Managers

Clinical Staff

Documentation (Scribes)

Health Plans

Billing/Coding staff (or outside companies)

Clearinghouses

EHR and PM software


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Documentation is Critical

“If it was not documented then it was not performed” – CMS

Documentation will be key with ICD-10- Figure out what ICD-10 codes your specialty is using and make sure your provider’s documentation of diagnosis detail is sufficient

Customize your trainings depending on specialty type

Medical record tells the “story” of the patient- state all elements of the diagnosis, ex. Etiology, severity, complexity, site, encounter type, etc.


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Internal Office Processes That Will Need Attention to ICD-10

Readiness

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Forms- will need to be updated to reflect ICD-10

Scheduling- Have knowledge of ICD-10 and the code changes

Pre-Authorizations- Coverage may change for patient with ICD-10


Front Desk

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Clinical

Visit note reflects what ICD-10 codes are billed

Orders for lab/radiology- make sure correct ICD-10 codes documented on the orders to meet medical necessity

Referrals- Correct reflective ICD-10 codes listed

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Update Superbills/Encounter forms

Cross walk ICD-9 to ICD-10

Review LCD’s- new ICD-10 codes may mean a change in coverage

Education of all staff involved in claims submission on ICD-10

Conduct a audit of current documentation and billing practices and compare it to the ICD-10 requirements in order to test documentation readiness

Ensure that your IT systems, your billing software, and clearinghouses are ready to accept the ICD-10 changes

Coder review of ICD-10 codes before they go out the door to ensure correct codes selection

Physician engagement and education!Copyright Intuitive Solutions - All rights reserved.

Billing – Avoid Increase in Denials

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You Need a Game Plan

Appoint a ICD-10 Champion

Designate ICD-10 Team

Conduct a Gap Analysis and an assessment of the impact

Get training and resources

Communicate with physicians on their documentation and if it seems to be ICD-10 ready

Establish Communication plan within the office

Contact Vendors

Internal/External Testing

Consider hiring outside ICD-10 experts to help you manage your ICD-10 transition


Questions?

Thank you!

Information cited from: www.cms.gov- Road to 10 | www.hcrs-inc.com

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ICD-10 Webinar

Healthcare

Transcript of ICD-10 Webinar