2015 User Conference

ICD-10 Practice ManagementApril 23, 2015 & April 24, 2015

Presented by:

Maria Germano and Melissa HolmesSenior Billing Training ManagerSupport Analyst

PM Session

2015 Office Practicum User Conference

ICD-10

2015 Office Practicum User Conference

Is This Really Happening… or are you pulling our leg?

2015 Office Practicum User Conference

Yes, Actually…

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What is it?

2015 Office Practicum User Conference

What is ICD-10?

■ ICD-10 is the 10th revision of the International Statistical Classification of Diseases (ICD), and is a medical classification list, by the World Health Organization (WHO)

14,400 different codes (ICD-9)68,000 different codes (ICD-10)

2015 Office Practicum User Conference

2015 Office Practicum User Conference

ICD-10 CM was developed by the Centers for Disease Control and

Prevention. Coding under ICD-10 CM uses 3 to 7 digits instead of ICD-9 CM

which uses 3 to 5 however the format of the code sets is similar.

The transition to ICD-10 CM does not

affect CPT codes which will be continued to be used.

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Why did they even come up with ICD-10?

ICD-9 is 30 years old, has outdated terms and is

inconsistent with current medical practice. ICD-9

limits the number of new codes that can be created

and most of the ICD-9 categories are filled.

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Why are we transitioning to ICD-10?

■ Roughly 25 countries use ICD-10 for reimbursement and resource allocation in their health system.

■ ICD-10 provides better reporting and statistics.

1998

1994

1998

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1997

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201

2

2005

2002

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Important things to remember about ICD-10

■ Up to 12 diagnosis on a claim - 4 per CPT

■ NOS codes will most likely be rejected

■ More rejections at the payer level

■ Do not use “similar” or integral codes

■ 5010 required for ICD-10

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Main factor in ICD-10

■ ICD-10 requires providers to select diagnosis codes to ensure accurate coding

■ Diagnosis codes are specific to severity of the exam and patient.

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Alphabetic .vs. Tabular Index

Alphabetic Index Tabular Index

NEC “Not elsewhere classifiable” NEC “Not elsewhere classifiable” This abbreviation in the Alphabetic Index This abbreviation in the Tabular list represents “other specified”. When represents “other specified”. When a specific code is not available for a condition, a specific code is not available for a the Alphabetic Index directs the coder to condition the Tabular List includes the “other specified” code in the Tabular List. an NEC entry under a code to identify the code as the “other specified” code.

NOS “Not otherwise specified” This abbreviation is the equivalent of unspecified.

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Alphabetic .vs. Tabular Index

Alphabetic Index Tabular Index

Brackets are used in the Alphabetic Brackets are used in the Tabular Index to identify manifestation codes. List to enclose synonyms, alternative wording or explanatory phrases.

Parentheses are used in both the Alphabetic Index and Tabular List to

enclose supplementary words that may be present or absent in the

statement of a disease or procedure without affecting the code number to

which it is assigned. The terms within the parentheses are referred to as

nonessential modifiers.

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Other and Unspecified Codes

“Other” codes Codes titled “other” or “other specified” are for use when the information in the medical record provides detail for which a specific code does not exist. Alphabetic Index entries with NEC in the line designate “other” codes in the Tabular List. These Alphabetic Index entries represent specific disease entities for which no specific code exists so the term is included within an “other” code.

“Unspecified” codes Codes titled “unspecified” are for use when the information in the medical record is insufficient to assign a more specific code. For those categories for which an unspecified code is not provided, the “other specified” code may represent both other and unspecified.

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How do we deal with this?

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How do we deal with this?

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Are you ready?

■ ICD-10 is a huge change for not only you but also for the Insurance Payers

■ Just like the transition of Vaccine Administration Codes, not all payers were ready for the new coding rules

■ We have a contingency plan…...

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ICD-10 is a Preference...

2015 Office Practicum User Conference

ICD-10 is a Preference...

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Diagnosis Coding Rule

1. ICD-9 only. This is the current stage. All coding of encounters, claims, and problems is performed in ICD-9.

2. Hybrid. This will be the intermediate stage. All coding of encounters and claims will be performed in ICD-10, with automated downcoding to ICD-9 as needed. Encounters and claims will support up to 12 diagnosis (8 more than OP 11 allows). All coding of problems will be performed in SNOMED, as required by Meaningful Use Stage 2.

3. ICD-10 only. This will be the final stage. The same coding rules will apply as in hybrid mode, but automated downcoding to ICD-9 will be disabled. We expect to support it as of October 1, 2014, but in reality most practices will not switch to this mode until early 2015.

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How will ICD-10 work with my payers?

Certain Payers will not accept ICD-10 in October 2015

Some Payers will not accept ICD-10 until 2016

Some Payers may accept ICD-10 prior to October 2015

OP allows you to set effective date at the Payer level.

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Adding Diagnoses

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Adding Diagnoses

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Let’s Try It!

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Let’s Play...

Name that ICD-10 code!

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Name that ICD-10

F41.0Anxiety,

unspecified

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F41.0

Please note: “Anxiety” will now have 3 classification sets.

ICD-10 CM Index (135)ICD-10 CM Codes (85)ICD-9 CM Codes (43)

which equates to…..263 possibilities!

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Name that ICD-10

Acute Otitis Media (381.10 (ICD-9) )

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Helpful Link

http://www.roadto10.org/action-plan/phase-2-train/common-codes-pediatrics/

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Name that ICD-10

Preventive Visit(V20.2 or V70.0)

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V20.2 - V70.0

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Name that ICD-10

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T33-T35

Frostbite (T33-T35)

T33 Superficial frostbiteT34 Frostbite with tissue necrosisT35 Frostbite involving multiple body regions and unspecified frostbite

Chapter XIXInjury, poisoning and certain other consequences of external causes(S00-T98)

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Frostbite continued

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Name that ICD-10!

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International Statistical Classification of Diseases and Related Health Problems 10th Revision

(ICD-10)-2015-WHO Version for ;2015

Chapter X

Diseases of the respiratory system

(J00-J99)

Influenza and Pneumonia J09-J18

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Flu

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Flu, continued

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Next Steps...What is your Action Plan?

● Develop an Implementation Strategy for your Practice

● Check with your Insurance Payers

● Work with Vendor Partners for readiness

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Timeline for ICD-10 in OP

OP’s recommendation is to spend the summer months preparing for ICD-10.

June, July and August -- prep work for ICD-10 (templates,

orders, surveys, etc)September -- hybrid mode testing with ICD-9 and

ICD-10October -- game time!

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One piece of Good News!!!

Look what just got easier...

Vaccine DX codes for ICD-10 will all be the same...

V23

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Questions

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References/Resources

■ http://www.aapc.com/■ http://www.ama-assn.org/■ http://www.cdc.gov/nchs/data/icd/icd10cm_guidelines_20

14.pdf■ http://www.roadto10.org/ ■ CMS testing for ICD-10 claims Week of 07/21/2014

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And Just Remember this…..

2015 Office Practicum User Conference

We want your feedback!

Handout:ICD-10 Practice Management Handout