Where Are You on the ICD-10-CM Radar Screen? ICD-10 Handout.pdfAll CPT codes copyright of the AMA...

Where Are You on the ICD-10-CM Radar Screen?

Medical Management Resources

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All CPT codes copyright of the AMA (American Medical Association) MMR is not affiliated with the AMA

MMR is not affiliated with CMS MMR is not affiliated with the Indiana Medical Group Management Association

This workbook is not designed to replace a full draft of ICD-10-CM codes

©Medical Management Resources 1

Outline INMGMA Meeting

February 25, 2015 & March 18, 2015 ICD-10-CM

Where Are You on the ICD-10-CM Radar Screen? This session will:

• Present an ICD-10 overview, including the mandate, the delay, and the benefits of ICD-10. • Identify top 10 diagnoses for all providers and corresponding ICD-10 codes. • Review preparation steps for providers and vendor readiness.

I. Mandate A. Delay until October 1, 2015 B. Benefits of ICD-10-CM C. Rand Study results II. The Top 10 Diagnosis by Specialty A. FP/IM B. Pediatrics C. OB/GYN D. Orthopedics E. Cardiology F. Other Specialties III. Where Are You Now-Readiness Assessment A. Vendors B. Payers C. Training D. Coding/Documentation E. Other Forms


ICD-10 Final Rule On January 16, 2009, the U.S. Department of Health and Human Services (HHS) released the final rule mandating that everyone covered by the Health Insurance Portability and Accountability Act (HIPAA) implement ICD-10 for medical coding.

Deadline for ICD-10 Allows Health Care Industry Ample Time to Prepare For Change On July 31st, 2014, The U.S. Department of Health and Human Services (HHS) issued a rule finalizing October 1, 2015 as the new compliance date. The U.S. Department of Health and Human Services (HHS) has issued a rule finalizing Oct. 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10. This new deadline gives providers, insurance companies, and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015.

Benefits of ICD-10-CM • Up-to-date classification systems will provide much better data for: • Measuring the quality, safety, and efficacy of care • Designing payment systems and processing claims for reimbursement • Conducting research, epidemiological studies, and clinical trials • Setting health policy • Operational and strategic planning and designing healthcare delivery systems • Monitoring resource utilization • Improving clinical, financial, and administrative performance • Preventing and detecting healthcare fraud and abuse • Tracking public health and risks • Decreases fraud, waste, and abuse

Dispelling Myths “Too Many Codes”

• 34,250 (50%) of all ICD-10-CM codes are related to the musculoskeletal system • 17,045 (25%) of all ICD-10-CM codes are related to fractures • ~25,000(36%) of all ICD-10-CM codes to distinguish ‘right’ vs. ‘left’

Only a very small percentage of the codes will be used by most providers.

Testing

Special acknowledgement testing weeks give submitters access to real-time help desk support and allows CMS to analyze testing data.

•Registration is not required. Mark your calendar and watch your Part B bulletins for information:

March 2 through 6, 2015 June 1 through 5, 2015


By Disease ICD-9 Codes ICD-10 Codes

Fractures 747 17099

Poisoning and toxic effects 244 4662

Pregnancy related conditions 1104 2155

Brain Injury 292 574

Diabetes 69 239

Migraine 40 44

Bleeding disorders 26 29

Mood related disorders 78 71

Hypertensive Disease 33 14

End stage renal disease 11 5

Chronic respiratory failure 7 4


Specialty ICD-9 ICD-10 Family Practice/IM 401.9 I10 Family Practice/IM 272.4 E78.5 Family Practice/IM 250.00 E11.9 Family Practice/IM 401.1 I10 Family Practice/IM 244.9 E03.9 Family Practice/IM 780.79 R53.83 Family Practice/IM 530.81 K21.9 Family Practice/IM 300.00 F41.9 Family Practice/IM 311 F32.9 Family Practice/IM V70.0 Z00.01

Diabetes found at E08 thru E13

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 Additional diabetes codes are found in the OB Chapter 15 with; Pre-existing diabetes at O24.31- (Type 1 and Type 2) Gestational Diabetes O24.41-

Manifestations of diabetes:

E08.621 Diabetes mellitus due to underlying condition with foot ulcer E09.621 Drug or chemical induced diabetes mellitus with foot ulcer E10.621 Type 1 diabetes mellitus with foot ulcer E11.621 Type 2 diabetes mellitus with foot ulcer E13.621 Other specified diabetes mellitus with foot ulcer


Specialty ICD-9 ICD-10 Pediatric Medicine V20.2 Z00.1 __ __ Pediatric Medicine 465.9 J06.9 Pediatric Medicine 780.60 R50.9 Pediatric Medicine 382.9 H66.90 Pediatric Medicine 518.81 J96.00* Pediatric Medicine 692.9 L30.9 Pediatric Medicine 477.9 J30.9 Pediatric Medicine 314.01 F90.1 Pediatric Medicine V03.82 Z23** Pediatric Medicine 493.90 J45.909

*perinatal/newborn is P28.5 (first 28 days of life) **one vaccination diagnosis code for all of ICD-10-CM regardless of vaccine New terminology for asthma from worldallergy.org Asthma Severity Frequency of Daytime Symptoms

(Mild) intermittent asthma Mild persistent asthma Moderate persistent asthma Severe persistent asthma

• Symptoms less than twice weekly and the patient is otherwise asymptomatic. • Pulmonary function studies are normal except during periods of disease and exacerbations are brief and easily treated. • Symptoms more than twice a week but less than daily. • The symptoms are severe enough to interfere with daily activities and may interrupt sleep up to twice a month. • Pulmonary function studies are normal or show mild airflow obstruction which is reversible with the inhalation of a bronchodilator. • Symptoms occur daily, and the disease severity warrants regular use of

medications for control. • Patients are constantly aware of their disease, require medications on a daily basis, have their sleep interrupted at least weekly, and have to accommodate their life style to the disease. • Pulmonary function is moderately abnormal, with the FEV1 being 60-80% of the predicted value. Continuous symptoms despite the correct use of medications. • The severity of the disease limits physical activities and is associated with frequent exacerbations and sleep interruption. Treatment requires combinations of medications on a constant basis. • Pulmonary function tests are severely affected with the FEV1 being <60% of predicted.


J45. __ __ Asthma [ ] intermittent [ ] mild persistent [ ] moderate persistent [ ] severe persistent [ ] uncomplicated [ ] exacerbation [ ] status asthmaticus

[ ] exposure to environmental tobacco smoke (Z77.22) [ ] exposure to tobacco smoke in the perinatal period (P96.81) [ ] history of tobacco use (Z87.891) [ ] occupational exposure to environmental tobacco smoke (Z57.31) [ ] tobacco dependence (F17.-) [ ] tobacco use (Z72.0)


Specialty ICD-9 ICD-10 Obstetrics Gynecology V27.0 Z37.__ __*2 Obstetrics Gynecology V72.31 Z01.419 Obstetrics Gynecology 650 O8Ø Obstetrics Gynecology 664.01 O7Ø.Ø Obstetrics Gynecology 654.21 O34.21 Obstetrics Gynecology V22.1 Z34.Ø __** Obstetrics Gynecology 663.31 O69.8__XØ*** Obstetrics Gynecology 664.11 O7Ø.1 Obstetrics Gynecology 626.2 N92.Ø Obstetrics Gynecology 644.21 O60.1__ X__****

*Various combinations of 4th and some 5th character spaces. 2 Secondary code only ** 5th character space is for trimester ***Different choices in position character space 5 for with or without compression **** 5th character space for trimester and 7th character for affected fetus

These code categories all require the 7th character: O31, O32, O33, O35, O36, O4Ø, O41, O6Ø.1-, O60.2-, O64, O69 0 – not applicable or unspecified 1 – fetus 1 2 – fetus 2 3 - fetus 3 4 – fetus 4 5 – fetus 5 9 – other fetus O6Ø.1 __ x __ Preterm labor with preterm delivery [ ] trimester 1 2 3 circle [ ] 7th character fetus circle


Specialty ICD-9 ICD-10* Orthopedic Surgery 715.96 M17.9 Orthopedic Surgery 719.46 M25.569 Orthopedic Surgery 715.36 M17.9 Orthopedic Surgery 719.41 M25.519 Orthopedic Surgery 354.0 G56.00 Orthopedic Surgery 727.61 M75.120 Orthopedic Surgery 715.35 M16.9 Orthopedic Surgery 719.45 M25.559 Orthopedic Surgery 717.3 M23.239 Orthopedic Surgery 820.20 S72.10__ __6th & 7th character**

*The majority of these codes are not an exact match ** 6th character +left or right, 7th character see sample: The appropriate 7th character is to be added to all codes from category S72

A - Initial encounter for closed fracture B - Initial encounter for open fracture type I or II initial encounter for open fracture NOS C - Initial encounter for open fracture type IIIA, IIIB, or IIIC D - Subsequent encounter for closed fracture with routine healing E - Subsequent encounter for open fracture type I or II with routine healing F - Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing G - Subsequent encounter for closed fracture with delayed healing H - Subsequent encounter for open fracture type I or II with delayed healing J - Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing K - Subsequent encounter for closed fracture with nonunion M - Subsequent encounter for open fracture type I or II with nonunion N - Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion P - Subsequent encounter for closed fracture with malunion Q - Subsequent encounter for open fracture type I or II with malunion R - Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion S - Sequela

Traumatic Fracture codes will always have 3rd character space of “2” and always have a 7th character: S12, S22, S32, S42, S52, S62, S72, S82, S92 Some fracture codes will need “x” placeholders: S32.2xx __ Fracture of coccyx This code category is not tracking any information in the 5th or 6th position but does require a 7th character. Quick sheet: M25.5 __ __ Pain, joint______ location [ ]right [ ]left M24.4__ __ Effusion, joint,__ location [ ]right [ ]left


Specialty ICD-9 ICD-10 Cardiology 414.01 I25.10 Cardiology 401.1 I10 Cardiology 427.31 I48.91 Cardiology 786.50 R07.9 Cardiology 794.31 R94.31 Cardiology 413.9 I20.8 / I20.9 Cardiology 272.0 E78.0 Cardiology 272.4 E78.4 Cardiology 785.1 R00.2 Cardiology 411.1 I20.0

• Acute MI codes changed from 8 weeks to 4 weeks or less duration in category I21 • A code from category I22 subsequent MI must be used in conjunction with a code from category I21 MI

when the subsequent MI occurs within 28 days of the original MI. Combination codes for ASHD of native coronary artery, bypass grafts (autologous or nonautologous vein or artery) with unstable angina, angina pectoris, documented spasm To find NCD’s that may affect your practice with ICD-10-CM codes go to: http://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html Additional free resources:

Visit: www.roadto10.org


http://www.roadto10.org/

Technology Vendor Contact Information Company Name

Address City State Zip Code

Telephone

Account/Sales Representative Name Phone Title Email

Technology Representative Name Phone Title Email Customer Support Phone Email

Vendor Solutions Used by the Practice

Name(s)

Version (s)

Type (s)

Electronic Health Record (EHR) System Decision Support Tools

Practice Management (PM) System Reporting Applications

Coding Translation and Look-up Tools

Other:


Questions for Technology Vendor Question Vendor Response

Application 1. Which of your applications are impacted by

ICD-10?

2. Are your applications remediated and are the ICD-10 updates generally available? Yes No Comments:

3. Is there a separate fee for your ICD-10 updates? Yes No Comments: 4. Will your systems use date of service to

determine the codes to use (ICD-9 or ICD-10)? Yes No Comments:

5. Will your systems support dual coding of services rendered before the compliance date? Yes No Comments:

6. Are there 3rd party embedded products in your software which need to be updated for ICD-10? Yes No Comments:

7. Is additional infrastructure (hardware, servers, etc.) potentially needed to accommodate your ICD-10 updates and store ICD-10 codes?

Yes No Comments:

Code Set Updates 1. How frequently will ICD-10 diagnosis code

updates be applied to your applications?

2. How long do you plan to support ICD-9 diagnosis code reference files?

Interfaces 1. Have your HIPAA transaction sets been updated

to address ICD-10? Yes No Comments:

2. What other interface changes will be included with your ICD-10 software updates?

Reporting 1. Which of your reports are impacted by ICD-10? 2. How will reports which are dependent upon

diagnosis code categories be handled?

3. How will longitudinal and historical reporting be updated to accommodate ICD-10?

4. How will quality and public health reports be updated to accommodate ICD-10?

5. Do any of your solutions require crosswalks from ICD-9 to ICD-10? Yes No Comments:

6. Which crosswalks are you providing and can they be customized?


Questions for Technology Vendor Question Vendor Response

Configuration 1. Do your applications have templates or tools

which can help practices document with a greater degree of granularity and specificity?

Yes No Comments:

2. Are you updating impacted rules and edits (clinical decision support rules, claims edits, etc.) with ICD-10 diagnosis codes?

Yes No Comments:

3. List the specific rules, edits, forms, templates, interfaces, reports, and crosswalks the practice is responsible for setting up on their own.

Testing 1. Will there be a test environment with ICD-10

updates practices can use to perform testing? Yes No Comments:

2. Are there test cases or other testing materials you make available to practices? Yes No Comments:

3. In what type of testing do you engage practices? Which practice staff members are generally involved?

4. What type of ICD-10 testing do you recommend practices undertake on their own?

Training 1. What type of training do you make available as

it relates to your ICD-10 product updates? Is there a fee practices incur for this training?

2. Will there be a training environment with ICD-10 updates practices can use? Yes No Comments:


Clearinghouse Contact Information Company Name


Telephone Account/Sales Representative Name Phone Title Email Technology Representative Name Phone Title Email Customer Support Phone Email

Questions for Clearinghouse Question Vendor Response

ICD-10 Implementation Strategy 1. Are your solutions currently ICD-10 compliant?

If not, when will they be updated? Yes No Comments:

2. Do you have a contingency plan to handle transactions with payers who may not be ready to accept ICD-10 codes on the compliance date?

Yes No Comments:

3. Are there ICD-10 software updates from you that need to be installed at practices? What is the process for installing these updates? Are there specific set-up activities for which practices are responsible?

Yes No Comments:

4. Is there a separate fee for your updates? Yes No Comments: 5. Will your solutions use date of service to

determine whether to use ICD-9 or ICD-10 codes?

Yes No Comments:

6. When will you stop accepting ICD-9 codes? 7. Will your solutions support dual coding of

services rendered before the compliance date? Yes No Comments:

8. Will you accept ICD-9 and ICD-10 codes on the same bill? Yes No Comments:

9. Will you accept split bills? Yes No Comments: Physician Practice ICD-10 Testing 1. Do you perform ICD-10 testing with physician

practices? How are participants selected? Yes No Comments:

2. Which of the following data flows do you validate as part of your ICD-10 testing support:

Comments:


Questions for Clearinghouse Question Vendor Response

o Practice to Clearinghouse? o Clearinghouse to Payer? o Payer to Clearinghouse? o Clearinghouse to Practice?

Yes No Yes No Yes No Yes No

3. On which of the following transactions are you able to perform ICD-10 testing with practices: o 270/271 Eligibility Inquiry/ Response? o 278 Auth. Request & Response? o 837P Claims Submission? o 835 Claims Remittance? o Non-Standard Transactions?

Yes No Yes No Yes No Yes No Yes No

Comments:

4. What volume and type of claims will you test? 5. What is the process a practice should follow to

engage in ICD-10 testing with you? What is the lead time needed to begin testing?

Communication and Education 1. How/will you share ICD-10 transition progress

with payers, vendors, and practices? Yes No Comments:

2. Do you provide advice to practices on how they can map their superbills to ICD-10? Yes No Comments:

3. Do you offer ICD-10 education to practices? What type of ICD-10 education? Is there a fee? Yes No Comments:

4. Do you offer tools for practices to crosswalk between ICD-9 and ICD-10? Yes No Comments:

5. What reports can you provide to help practices with the transition to ICD-10: a. Claim rejections and denials by ICD-9

diagnosis code and by payer? b. Commonly used unspecified ICD-9 codes? c. Other?

Yes No

Yes No Yes No

Comments:

6. Have you been working with EHR/practice management vendors, payers, and/or medical billing companies as part of your ICD-10 implementation? Which ones have you tested with? What progress has been made?

Yes No Comments:


Payer Contact Information Company Name


Telephone Provider Representative Name Phone Title Email Customer Support Phone Email

Questions for Payer Question Payer Response

ICD-10 Implementation Strategy 1. Are your solutions currently ICD-10 compliant?

If not, when will they be updated? Yes No Comments:

2. Will your systems crosswalk codes back to ICD-9 or will they be programmed to process ICD-10 codes directly?

Yes No Comments:

3. Do you have a contingency plan if your systems will not be ready on the compliance date?

Yes No Comments:

4. Have your HIPAA transaction sets been updated to address ICD-10? Yes No Comments:

5. Will your systems use date of service to determine the codes to use (ICD-9 or ICD-10)? Yes No Comments:

6. When will you stop accepting ICD-9 codes? 7. Will your systems support dual coding for

services rendered prior to the compliance date?

Yes No Comments:

8. Will you accept ICD-9 and ICD-10 codes on the same bill? Yes No Comments:

9. Will you accept split bills? Yes No Comments: Physician Practice ICD-10 Testing 1. Do you perform ICD-10 testing with physician

practices? How are participants selected? Yes No Comments:



2. Which transaction types do you validate with practices as part of ICD-10 testing? a. 270/271 Eligibility Inquiry/ Response b. 278 Auth. Request & Response c. 837P Claims Submission d. 835 Claims Remittance e. Non-Standard Transactions

Yes No Yes No Yes No Yes No Yes No

Comments:

3. What volume and type of claims will you test? 4. What is the process a practice should follow to

engage in ICD-10 testing with you? What is the lead time needed to begin testing?

Policy and Reimbursement 1. Will your fee schedules, capitation rates, or

other payment models be changing as a result of ICD-10? Please describe.

Yes No Comments:

2. Will existing provider contracts be amended for ICD-10 or will they be updated upon renewal? Yes No Comments:

3. Will patient eligibility and/or benefits change as a result of ICD-10? Please describe. Yes No Comments:

4. Will the following business or processing rules change as a result of ICD-10? a. Authorizations? b. Utilization Review & Management? c. Case Management? d. Medical Policy? e. Audit Policy? f. Claim Editing and Scrubbing? g. Payment Processing? Please describe the impact to providers.

Yes No Yes No Yes No Yes No Yes No Yes No Yes No

Comments:

5. Will claim processing and payment timelines change because of the ICD-10 transition? Please describe.

Yes No Comments:

6. Are there specific process or documentation changes you recommend that practices adopt to reduce the risk of claim rejections, denials, and errors? Please describe.

Yes No Comments:

Communication and Education 1. Do you offer ICD-10 education to practices?

What type of ICD-10 education? Is there a fee? Yes No Comments:

2. How/will you share ICD-10 transition progress with physician practices? Yes No Comments:

3. Do you offer tools for practices to crosswalk between ICD-9 and ICD-10? Yes No Comments:



4. Have you been working with EHR/practice management vendors, clearinghouses, and/or medical billing companies as part of your ICD-10 implementation? Which ones have you tested with? What progress has been made?

Yes No Comments:


I 10 Diagnosis Code Impact Inventory Template

Functional Area Practice Lead Processes and Forms Where Diagnosis Codes are Used

Information Systems Where Diagnosis Codes are Used

Patient Registration and Scheduling

Clinical Documentation/Health Records

Referrals and Authorizations

Order Entry

Coding

Billing

Reporting and Analysis

Other diagnosis-related functions, depending on the nature of the practice


Where Are You on the ICD-10-CM Radar Screen? ICD-10 Handout.pdfAll CPT codes copyright of the AMA...

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