Ppt 2014 icd 10 preparation-tmgma 04242014 edits

April 24, 2014
Prepared for Tennessee MGMA
Final Countdown to ICD-10…
Tennessee Medical Group Managers Association
April 24, 2014

April 24, 2014
• Understanding the new ICD-10
timeline
• Implementation steps for
practice managers to ensure
readiness for ICD-10
compliance
• Common vendor
recommendations and
available resources
• Brief ICD-10 overview
Agenda

April 24, 2014
Understanding the new
ICD-10 Timeline

April 24, 2014
ICD-10 Timeline for
Small-Medium Practices at a Glance
Source: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10SmallMediumTimelineChart.pdf

April 24, 2014
ICD-10 Timeline for
Large Practices at a Glance
Source: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10LargePracticesTimelineChart.pdf

April 24, 2014
Updated ICD-10 Timeline
Start Today
PYA
May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
Planning
Identify resources
Create project team
Assess effects
Create project plan
Secure budget
Communications
Inform staff
Contact vendors
Contact payers
Monitor vendor prep
Monitor payer prep
Testing
High-level training for
test team
Level 1: internal
Level 2: external1
Comprehensive Training
Documentation
Coding
2014 2015
Confirm ongoing practice schedule to correspond with
new "go live" date
1
Monitor external testing periods, especially updates regarding CMS limited testing currently scheduled for July 21 - 25, 2014 for selected volunteers.

April 24, 2014
Implementation Process
Processes Reports Work Flow
Information
Systems and
Software
All Forms of
Documentation
Analysis of all Departments

April 24, 2014
Priority List
Buy the ICD-10-CM Effective October 1, 2014 when released ~Sept 2013. (2014 Draft is
available)
Make sure all of your systems are up-to-date
Billing should have access to both code sets to properly handle new and old claims
Consider an encoder or mapping resource if EHR or PM does not have mapping
options
Update superbill with most used diagnosis codes

April 24, 2014
• Administrators: Confirm capabilities, provide
training, review processes
• IT staff: Confirm integration in system and
documentation
• Providers:
– Outpatient: Document in support of ICD-10 code
selected
– Inpatient: CM and PCS codes will have to be
supported
• Billers: Understand how to look up codes,
understand how to query physicians, pull new LCDs
• Coders: Understand ICD-10 guidelines and how to
properly select ICD-10 codes based on
documentation
Roles

April 24, 2014
How much emergency cash should providers keep in case of cash flow
disruption?
• Review what happened to your practice with HIPAA 5010--this would be a good
baseline; with the transition of ICD-10 there will be delays in reimbursement
• Vendors and Clearinghouses have been working hard, but we will not know the true
effects until the Compliance Date
• The amount of money that you will need to set aside will be impacted by the
preparation work you do for ICD-10
• It is recommended that you have up to several months' cash reserves or access to
cash through a loan or line of credit to avoid potential headaches
• Will need to cover at a minimum practice operation expenses for three to six months:
– Medical supplies
– Payroll
– Rent
Budget

April 24, 2014
Budget
• Cost of training/decreased staff productivity
• Cost of hardware/software upgrades
• Forms redesign
• Testing costs/Consulting services
• Vendor readiness – external testing
• Temporary maintenance of dual systems
• Cash reserves for denials increase, payment
delays, decreased productivity
Determine financial impact, budget, resources,
cash reserve needed for ICD-10 migration

April 24, 2014
ICD 10 & EHR
• Analyze EHR for functionality and compliance
• Review:
– Templates
– Interfaces
– Default documentation
– Level of detail
• Confirm EHR is updated with the ability to communicate to the billing system
in ICD-10 language
– Is your PM integrated with your EHR?
– Look for products to include drop down menus and selection edits
– Need appropriate “granularity” to accurately capture correct code

April 24, 2014
EHR Vendor Questions
• Can EHR translate ICD-9 to ICD-10 format?
• Can your EHR differentiate dates of service for
reporting ICD-9 or ICD-10?
• Will ICD-9 code from previous visit translate in
new encounter as ICD-10?
• Will system document ICD-10 on and after the
Compliance Date?
• Are diagnoses linked from diagnostic results?
• What are the capabilities of automated and
manual documentation entry?
• Do you anticipate any pricing changes due to the
switch to ICD-10?

April 24, 2014
Vendor Readiness
Our billing software vendor indicates they will be ready for
these transitions. What can I do in the meantime, besides train
for ICD-10 coding?
• Ask your billing software vendor for a detailed schedule of
deliverables and begin preparing to test implementation of the
modified software at your location.
• Be sure to verify the following:
– The vendor is addressing the ICD-10 upgrades
– The number and schedule of planned ICD-10 software releases
– Their ICD-10 conversion plan accommodates your clearinghouse
testing schedule
– Any related costs to your organization
– Customer support and training they will provide

April 24, 2014
Computer Assisted Coding (CAC)
• Is this the answer?
– Select the right codes
– Ensure that those codes are justified and
supported in the documentation
– Interface coded data correctly to billing
systems
– Educate billing teams about appropriate
codes
– Provide documentation and
feedback/education to physicians

April 24, 2014
Physician Work Flow
• Will the EMR allow the physician to enter a
descriptive diagnosis rather than a specific
diagnosis code?
• Is the physician prepared for the dramatic
increase in diagnosis codes now displayed on
the drop-down list?
• How will the physician’s workflow change when
more time is needed to assign the appropriate
diagnosis code?
• Can the EMR support a workflow that sends
patient encounters to coders for review and
assignment of the most specific diagnosis code
based on the physician’s documentation?

April 24, 2014
Superbill Changes –
Fact or Fiction
ICD-10-CM-based super bills will be too long or too complex to be of much use
Fiction (sort of)
• Practices may continue to create super bills that contain the most common
diagnosis codes used in their practice. ICD-10-CM-based super bills will not
necessarily be longer or more complex than ICD-9-CM-based super bills. Neither
currently-used super bills nor ICD-10-CM-based super bills provide all possible
code options for many conditions.
• The super bill conversion process includes:
– Conducting a review that includes removing rarely used codes.
– Cross walking common codes from ICD-9-CM to ICD-10-CM, which can be
accomplished by using the General Equivalence Mappings (GEM) and looking up
codes in the ICD-10-CM code book.
– Consider option of electronic super bill with posting scrubber that assist physicians in
the transition to ICD-10.
Source: http://www.whiteplume.com/learn-more/icd-10

April 24, 2014
Payer’s Role
• Communicate with your top payers to see
what, if any, ICD-10-CM changes will
take place prior to the deadline
– When will their testing begin?
– What will be required on your end?
o Additional staff resources
– Prior authorizations granted for services
to be performed after the Compliance
Date

April 24, 2014
Payer Response
Will the ICD-10 conversion have an
effect on provider reimbursement and
contracting?
• “Possibly. We are evaluating the impact of
ICD-10 on our contracting and clinical
operations. The ICD-10 conversion is not
intended to transform payment or
reimbursement. However, it may result in
reimbursement methodologies that more
accurately reflect patient status and care.”
Source: http://www.aetna.com/healthcare-professionals/policies-guidelines/icd_10_faq.html

April 24, 2014
What do I need to do to get the
claim out the door?
• Medicare will begin accepting a revised 1500 (version
02/12) on January 6, 2014
– Identify whether submitting ICD-9 or ICD-10 codes
– Use as many as 12 codes in the diagnosis field
• Current limit is four
– Qualifiers to identify the following providers role (Item 17)
• Ordering, Referring, Supervising
• Starting April 1, 2014, Medicare will accept only the
revised version of the form
– The revised form will give providers the ability to indicate
whether they are using ICD-9 or ICD-10 diagnosis codes
• http://www.cahabagba.com/news/medicare-accepting-revised-cms-
1500-claim-form-0212-starting-april-1/

April 24, 2014
What do I need to know to get the
claim out the door?
• Reporting ICD-10 diagnosis codes
• Claims Submission of diagnosis codes
– ICD-9 codes no longer accepted on claims with date of
service after the Compliance Date
– ICD-10 codes will not be recognized/accepted on claims
before the Compliance Date
– Claims cannot contain both ICD-9 and ICD10 codes--they
will be returned as “Unprocessable”
• Date span requirements
– Outpatient claims-split claim form and use from date
– Inpatient claims-use only through date/discharge date for
ICD-10 code submission

April 24, 2014
National Coverage Determinations
(NCDs)
• CMS is responsible for converting
approximately 330 NCDs
• Not all are appropriate for translation
– Edits based on HCPCS
– Older obsolete technology or
considered outdated
CMS has determined which NCD should be
translated and is in the process of
completing system changes for those NCDs
http://www.cms.gov/Medicare/Coverage/CoverageGenInfo/ICD10.html

April 24, 2014
Local Coverage Determinations
(LCDs)
• LCDs are developed by the
individual Medicare Auditing
Contractor (MAC – i.e., CAHABA)
• Contractors shall publish all ICD-10
LCDs and ICD-10 associated
articles on the Medicare Coverage
Database (MCD) no later than
April 10, 2014
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8348.pdf

April 24, 2014
Code Analysis
Review top 20-50 diagnosis codes
• Evaluate documentation currently in
the notes
• Crosswalk them to ICD-10
• Review new codes for additional
required codes, additional code
descriptions and “code also”
requirements
• Identify areas where additional
documentation will be required

April 24, 2014
Once I get this claim out the door,
am I going to get paid?
• The Department of Health
and Human Services (HHS)
anticipates that the percent
of returned claims following
the ICD-10 implementation
could be more than double
what we have seen in the
past with ICD-9 updates.

April 24, 2014
Training
Coding and Billing Staff
• Assess training needs and develop a plan
– Professional coding staff – ICD-10-CM
– Determine who will train staff and how
this will be accomplished
– Factor in time away from work, consider
post-testing and ongoing support
– Make ICD-10 proficiency part of your
coding staff’s performance goals
o ICD-9-CM to ICD-10-CM Dual Coding
• Assign staff members to be the
“ICD-10 Experts” looking at the impact
from the billing to the clinical side

April 24, 2014
Training
Clinicians
• Physicians – focus on codes germane to their practice
• Review clinical documentation improvement efforts and develop new strategies
• Incorporate documentation improvement as component to compliance training
• Ancillary staff – identify needs and level of training needed, nursing, financial
services, quality, utilization, ancillary departments…
Information Technology
• Training to ensure that codes are accurately cross-walked in organization’s IT
systems

April 24, 2014
What do certified coders need to do
to get ready for ICD-10?
What is the ICD-10 Proficiency Assessment and is it required?
(AAPC)
• The ICD-10 Proficiency Assessment is the only step of this roadmap
required for all certified AAPC members. You should prepare yourself as
you would for other exams or assessments. To ensure employers
continue to have confidence in a certified coder’s ability to accurately
code the current code sets, AAPC certified members will have two years
to pass an open-book, online, unproctored assessment.
– It will measure your understanding of ICD-10-CM format and structure,
groupings and categories of codes, ICD-10-CM official guidelines, and
coding concepts.
– Required for AAPC credentialed coders, (excluding CPPM®, CPCO™, and
CIRCC®), recommended for all others working with the new code set.
– Two years to take and pass the assessment, beginning October 1, 2013,
(one year before implementation of ICD-10) and ending December 31, 2015,
(current update)

April 24, 2014
AHIMA
In order to validate that an AHIMA Certified Professional has gained
knowledge of the ICD-10-CM/PCS coding system, CCHIIM has
determined that continuing education hours with ICD-10-CM/PCS
content will be required, as applicable and relevant to the specific AHIMA
credential(s) held by the individual.
• The total number of ICD-10-CM/PCS continuing education units
(CEUs) required, by AHIMA credential, is as follows:
*6 CEUs = 1 day of training
http://www.ahima.org/~/media/AHIMA/Files/Certification/ICD10_CEU_FAQs.ashx
– CHPS – 1 CEU
– CHDA – 6 CEUs
– RHIT – 6 CEUs
– RHIA – 6 CEUs
– CDIP – 12 CEUs
– CCS-P – 12 CEUs
– CCS – 18 CEUs
– CCA – 18 CEUs

April 24, 2014
Resources Available
• http://www.cms.gov/Medicare/Coding/ICD10/index.html
• http://www.ahima.org/icd10/
• http://www.aapc.com/icd-10/index.aspx
• http://www.cdc.gov/nchs/icd/icd10.htm
• http://www.who.int/classifications/icd/en/

April 24, 2014
Where can I Find the
ICD-10-CM Codes?

April 24, 2014
• Partial solution--these are tools to
convert ICD-9 to ICD-10 and vice
versa.
• To assist with the transition,
cross-walking between the code
sets will assist you with identifying
the differences between ICD-9
and ICD-10.
• Not a high percentage of accuracy
due to increased complexity of
ICD-10 versus ICD-9
Crosswalk

April 24, 2014
GEMs
GEMs are a comprehensive translation dictionary that can be used to accurately
and effectively translate any ICD-9-CM-based data, including data for:
– Tracking quality
– Recording morbidity/mortality
– Calculating reimbursement
– Converting any ICD-9-CM-based application to ICD-10-CM/PCS
The GEMs are not a substitute for learning how to use the ICD-10 codes.
More information about GEMs and their use can be found on the CMS website at:
• http://www.cms.gov/Medicare/Coding/ICD10/index.html
(select from the left side of the web page ICD-10-CM or ICD-10-PCS to find
the most recent GEMs)

April 24, 2014
Practical Mappings
GEM Examples – ICD-9 to ICD-10
ICD-9-CM: 902.41 Injury to renal
artery
ICD-10-CM GEM:
S35.403A Unspecified injury
of unspecified renal artery,
initial encounter

April 24, 2014
How Does the Mapping Work?
ICD-9-CM
• 493.92 Asthma,
Acute Exacerbation
ICD-10-CM
• J45.21 Mild, intermittent,
w/acute exacerbation
• J45.41 Moderate,
persistent, w/acute
exacerbation left
• J45.51 Severe,
persistent, w/acute
exacerbation

April 24, 2014
Percentages of Types of Matches
Mapping
Categories
ICD-10 to
ICD-9
ICD-9 to
ICD-10
No Match 1.2% 3.0%
1-to-1 Exact Match 5.0% 24.2%
1-to-1 Approximate Match with 1 Choice 82.6% 49.1%
1-to-1 Approximate Match with Multiple Choices 4.3% 18.7%
1-to-Many Matches with 1 Scenario 6.6% 2.1%
1-to-Many Matches with Multiple Scenarios 0.2% 2.9%
Source: http://www.ama-assn.org/ama1/pub/upload/mm/399/crosswalking-between-icd-9-and-icd-10.pdf

April 24, 2014
What does ICD-10-CM
look like?

April 24, 2014
ICD-10-CM Organization
Index to Diseases
and Injuries
Official Guidelines
Tabular List of
Diseases and
Injuries
The CM Manual divided into three main parts:
21 Chapters
Expanded injury
codes grouped
by site vs. type
of injury
Laterality (left
and right)
V and E codes
incorporated into
main
classification
Added a
placeholder X

April 24, 2014
Anatomy of an ICD-10-CM Code
3-7 Alphanumeric characters (digits)
X X X X X X X
.
1st character –
Alpha (A-Z)
2nd character -
Numeric
3rd - 7th
characters –
Alpha or
Numeric
Decimal
placed after
the first 3
characters
• All letters but U are used
• The letters I & O are used only in the 1st character position
• Each letter is associated with a particular chapter (Except C&D
Neoplasms )

April 24, 2014
X X X X
Category
.
Etiology, anatomic
site, severity
Added code
extensions (7th
character) for
obstetrics,
injuries, and
external causes
of injury
ICD-10-CM Characters and
Extensions
X X XAMS 0 2 6. 5 x A
Alpha
(Except U)
2 - 7 Numeric or
Alpha
Additional
Characters

April 24, 2014
• X Marks the Spot
– ICD-10-CM uses a placeholder character
“X” this will allow the code future expansion
– Where a placeholder, the X must be used in
order for the code to be valid (The X is not
case sensitive)
Placeholder Character

April 24, 2014
7th Character Extension
• Certain ICD-10-CM categories have a 7th character
feature; this “character” must always be in the 7th
character field
• These extensions are found predominantly in two
chapters
– Chapter 19 – Injury, Poisoning and Certain Other
Consequences of External Causes
– Chapter 15 – Pregnancy, Childbirth and the Puerperium

April 24, 2014
If a diagnosis code requires a
7th digit and the code is a
4-digit code, what do you do?

April 24, 2014
Place an x in the 5th and 6th digit
ICD-10-CM utilizes a placeholder: Character “x” used as a
5th character placeholder in certain 6 character codes
• To fill in other empty characters (e.g., character 5 and/or 6)
when a code that is less than 6 characters in length requires
a 7th character
Examples:
• T46.1x5A – Adverse effect of calcium-channel blockers, initial encounter
• S03.4xxA- Sprain of jaw, initial encounter
• T15.02xD – Foreign body in cornea, left eye, subsequent encounter

April 24, 2014
TMGMA Resource
Tennessee MGMA has partnered with PYA to
provide an ICD-10 user’s group for TMGMA
members.
• ICD-10 updates webinar: Friday, May 16,
noon to 1 pm CDT
• Ongoing user’s group list serve support for
ICD-10

April 24, 2014
Questions?

April 24, 2014
Thank you!
Linda ClenDening
Consulting Manager
Pershing Yoakley & Associates, P.C.
(865) 684-2735
lclendening@pyapc.com
www.pyapc.com
Valerie Rock
Consulting Manager
Pershing Yoakley & Associates, P.C.
(404) 266-9809
vrock@pyapc.com
www.pyapc.com

Ppt 2014 icd 10 preparation-tmgma 04242014 edits

Recommandé

Recommandé

Contenu connexe

Plus de PYA, P.C.

Plus de PYA, P.C. (20)

Dernier

Dernier (20)

Ppt 2014 icd 10 preparation-tmgma 04242014 edits

Notes de l'éditeur