ICD-10 Ready or Not Gayle Graber, Debra Bennitt, Gayle Grabowski, Katie Fichtner.

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ICD-10 Ready or Not Gayle Graber, Debra Bennitt, Gayle Grabowski, Katie Fichtner

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ICD-10 Ready or NotGayle Graber, Debra Bennitt, Gayle Grabowski, Katie Fichtner

Brief OverviewOctober 1st 2015 deadlineNo grace periodAll providersPrior training participation

In case you might not have heardICD-10 goes into effect on October 1st of 2015 (just a week away!). There is no grace period for implementation of ICD-10. This change to ICD-10 affects all providers in every healthcare setting with no exceptions. BHS has offered training with the first one back in the spring of 2014 then again spring of 2015 for an introduction to ICD-10. Recorded trainings provided in July so communities can train/learn at their pace and the ability to replay training as needed. Weekly reminders for countdown to ICD-10. 2Where Should You BeAll residents should be dually codedUtilizing ICD-10 manualEnhancing knowledge of ICD-10 coding by practicing and codingBy this time all of your current residents should be dually coded with ICD-9 and ICD-10. Users should be using the ICD-10 manual efficiently and frequently to ensure appropriate code is chosen to the most specificity available per documentation. All staff members should be continuing to enhance their knowledge and comfort level with ICD-10 coding by either practicing and also coding for current residents. 3VERIFYACCURACYYou will want to verify that your ICD-10 codes are being completed and also accuracy of those codes. 4Verifying Reports in Matrix to check for ICD-10 codingICD-9 Diagnosis ReportICD-10 Diagnosis ReportGeneral Equivalence Mapping ReportRunning the ICD-10 and ICD-9 Diagnoses ReportThe ICD-10 and ICD-9 Diagnoses Reports provides you with detailed information on a resident's ICD-10 or ICD-9 diagnoses. The report lists the resident, medical record number, unit/room/bed, ICD-10-CM or ICD-9-CM diagnoses code with a description, diagnosis type, diagnoses category (for example: primary 1st Secondary, 2nd Secondary, and so on), and a date of diagnoses.The clinical diagnoses report displays the most current and active diagnoses, as sequenced, for the Active Residents To date.The payer (financial) report displays the most current and resolved diagnoses, as sequenced, for the resident over the billing period(s) selected from the Active Residents From date to the Active Residents To date. (Available for the ICD-9 Diagnoses Report only)

Running the General Equivalence Mapping ReportThe General Equivalence Mapping Report can help you recode residents with the new ICD-10 codes. For each resident, the report lists the residents current ICD-9 diagnoses, and the possible ICD-10 codes you could use for each one. This information is based on the General Equivalence Mapping files provided by CMS and is intended for use by a trained ICD-10 coder, as a guide only, with additional reference to the residents clinical record and ICD-10 coding materials as needed. We recommend that you carefully review all ICD-10 diagnosis coding for accuracy once it is completed.

5ICD-10 Resident Diagnoses Report


ICD-10 Resident Diagnoses Report A new ICD-10 Diagnosis Report is available, in addition to the existing ICD-9 Diagnoses Report (formerly called the Diagnoses Report): These reports are available from both the Reports menu (select Resident Reports) or the Facility menu (select Reports). A new ICD-10 Diagnosis Report security token is available in the Reports-Resident Info category for the new ICD-10 report. This security token is not automatically selected for any templates or users with this release. You must select this security token for any users that you want to be able to access the report. The new ICD-10 Diagnoses Report is similar to the existing report, with one key change: in the Sequencing field, you can only select Clinical, since A/R sequencing is not yet available for the ICD-10 codes. This will be available in a future release. In addition, you can now run both the ICD-9 Diagnoses Report (formerly the Diagnoses Report) and ICD-10 Diagnoses Report for 1500 payer types. 6Physician Orders Missing ICD-10 Diagnoses Report

This Physician Orders Missing ICD-10 Diagnoses Report lists resident orders with ICD-9 diagnoses that do not have corresponding ICD-10 diagnoses set up. As of 10/1/2014, orders carrying diagnosis codes will need to carry ICD-10 codes. As the transition date gets closer and you complete your ICD-10 coding, this report can help you identify any orders that have an ICD-9 code but have not yet been given an associated ICD-10 code.7AR and ICD-10

AR and ICD-10Before you create October Claims Compare the claims triple check report with the ICD-10 diagnosis reportGenerate a Claims Triple Check reportReports, A/R Analysis Reports, Claims Triple Check

Before you create any claims for October dates of service you should run a Claims Triple Check report out of Matrix. When the report is generated you want to ensure the ICD 10 codes have pulled correctly to the claim. If the ICD 10 codes have been sequenced by payer, they should match the codes on the triple check report. 9AR and ICD-10Generate an ICD-10 Diagnosis ReportReports tab, Resident reports, Resident Info, run an ICD-10 Diagnosis Report. Select Sequencing by payer, change the dates to October 1-31, select Both for the status, select the payer, or select all to review all payers, run the report.

Once you generate the ICD-10 diagnosis report by payer, compare the Prin/Adm and 1st secondary code to the (Adm) and (PRI) code on the triple check report. (For this example they will not match because I used a closed facility)10AR and ICD-10ICD-10 codes are pulled to the claim based on the dates of service

Bill TypeFacility Type/ServiceClaims Processing RequirementUse FROM or THROUGH Date21XSkilled Nursing (Inpatient Part A)If the SNF claims has a discharge and/or through dates on or after 10/1/2015, then the entire claims billed using ICD-10THROUGH22X

23XSkilled Nursing Facilities (Inpatient Part B)

Skilled Nursing Facilities (Outpatient)Split Claims Require providers split the claims so all ICD-9 codes remain on one claim with dates of service through 9/30/2015 and all ICD-10 codes placed on the other claim with DOS beginning 10/1/2015 and laterFROMIf you have a resident that discharges on October 1, 2015 your claim type will be a 214, the through date of the claim will be 10-1-2015. Even though you wont be paid for October 1st, this is the through date of the claim and therefore the ICD-10 codes should be on the claim. Prior to creating your claims, run a census for October, 2015 and determine if you have any residents that discharged on October 1st, if you do you should create those claims individually and use 10-1-2015 as the through date. 11AR and ICD-10The following question was taken from the CMS web-site;

Question 1: What should I do if my claim is rejected? Will I know whether it was rejected because it is not a valid code versus denied due to a lack of specificity required for a NCD or LCD or other claim edit?

Answer 1: Yes, submitters will know that it was rejected because it was not a valid code versus a denial for lack of specificity required for a NCD or LCD or other claim edit. Submitters should follow existing procedures for correcting and resubmitting rejected claims and issues related to denied claims.

Communities who submit claims and the Centralized Billing Office need to monitor the October claims to ensure they are received at the payer and are processing.

12Therapy and ICD-10Therapy will have to convert current patients in Oct from ICD9 to ICD10 diagnoses in the Smart Therapy softwareSmart Therapy Software also has the CMS GEM crosswalk available to assist with converting the codesTherapists have recently been instructed to review video training modules on selecting treatment codes using ICD10 coding and how to use the Smart conversion tables.13Therapy and ICD-10

This is a screen shot of the GEM conversion table in Smart the leads will be using to help convert to ICD10It lists the ICD9 code and the corresponding choices in ICD10.Therapists have several options for action on the table. Close code no longer being treated or relevant for example V57.xx therapy codes are no longer used. The replacement Z code is not used to explain why patient is receiving therapy. Direction is to code the medical reason therapy is required. Convert all 1:1 codes (those that only have one choice in ICD 10Select most appropriate code from a number of options listed when ICD10 is more specific than ICD915Matrix and Smart Diagnosis Codes Should MatchTherapists should use the ICD10 codes listed in matrix to select their medical reason for treatmentIf a diagnosis is not on the list, review medical record to see if diagnosis has been noted in past by a physicianNew diagnosis can be established with T.O or MD signature for a new diagnosis16Communication is the Key to Successful Coding and Sequencing

Our teams will need to communicate the new codes . 17Communicating the CodesICD Codes should be entered into matrix promptly after admission Clinical Team should discuss to verify accuracy of coding especially with moving to ICD10Obtain any unlisted diagnosis from MDClinical Team should prioritize codes for AR sequencing to lay out order of codes in billing

Prompt entry of codes in matrix prevents therapists from selecting a similar code but not the one coded in matrix on their documentation.

Use reimbursement meeting to discuss and sequence codes.

Therapy treatment census report lists medical and treatment codes used for therapy and can be used to help sequence codes18AR Sequencing for Therapy Only Bills (Part B, Insurance)Specific Therapy Encounter Codes (V57.XX in ICD9) are no longer used for principle code for therapyICD10 Codes identifying the medical reason that therapy is necessary will be required This may or may not be the same as the reason the resident requires ongoing residential careSome treatment will need specific ICD10 codes (Example ST tx for swallowing-will need a dysphagia diagnosisTriple CheckTriple Check requires Therapy, Nursing and Business Office to make sure ICD codes listed on UB04 are the same as those in matrix and on the MDSThis review helps verify processes are accurateIt also identifies if there is a problem and need to improve at coding and sequencing processesTHANK-YOUQUESTIONS?