Presentation on theme: "UNDERSTANDING ICD-10-CM"— Presentation transcript:
1UNDERSTANDING ICD-10-CM WHAT DOES IT MEAN TO YOUR PRACTICE?HOW SHOULD YOUR OFFICE PREPARE?
2WHAT IS ICD-10?- ICD-10 is a diagnostic coding system implemented by the World Health Organization (WHO) in 1993 to replace ICD-9. ICD-10 is in almost every country in the world, except for the United States.ICD-10 will be the most radical change to the healthcare industry in 20 years.Practices, billing services and vendors will have to maintain both the ICD-9 & ICD-10 code sets for some time in the future beyond the 10/2014 deadline.Maintained by the US National Center for Health StatisticsDesigned for greater clinical specificityAnatomicProceduralVisit specific informationTechnology (Compliance with 5010 is necessary)
3WHAT’S WRONG WITH ICD-9? Cannot describe 21st century care Many categories are fullNo detail on patient medical conditionsHas outdated and obsolete terminologyUsed outdated codesProduces inaccurate and limited dataInconsistent with current medical practice
5ICD-10 IS A COMPLETELY NEW SET OF CODES The format is completely different- Codes start with a letter- Up to 7 characters- Includes modifiers todescribe initial, subsequent orsequela visits and other information- Very specific codes- RT and LT- Upper and lower- Fewer NOS codes- More guidelines
6WHAT DOESSEQUELAMEAN ?Wikipedia: Sequela is a pathological condition resulting from a disease, injury, or other trauma. Typically, a sequela is a chronic condition that is a complication of an acute condition that begins during that acute condition. This is a contrast to a late effect.Examples and Uses: Chronic kidney disease, for example, is sometimes a sequela of diabetes, and neck pain is a common sequela of whiplash or other trauma to the cervical vertebrae.
7WHAT ICD-10 LOOKS LIKE ICD-9 Format ICD-10 Format X . X . -----/ / / / /-category etiology, category etiology, extensionanatomic site, anatomic site,manifestation severityICD-10 codes have the potential to reveal more about quality of care, so that the data can be used in a more meaningful way to better understand complications, better design clinically robust algorithms, and better tract the outcomes of care.ICD-10 incorporates greater specificity and clinical detail to provide information for clinical decision making and outcomes research.This means greater need for physician/practitioner involvement with coding.
8ICD-10 vs. ICD 9 DIAGNOSIS – FINGER LACERATION Is it simple or complicated?Is there tendon involvementSimple = 883.0ICD – 10What finger is it?Is it the right hand or left hand?What part of the finger is lacerated?Is it the initial encounter, subsequent encounter or sequela?Is the nail damaged?Are there fractures?Is there a Foreign Body?Are tendons injured?Laceration w/o FB right index finger w/o damage to nail, initial encounter= S61.210A
9FRACTURE CLASSIFICATION IN ICD-10-CM Fracture coding in ICD-10-CM requires documentation of site, laterality, type of fracture, whether it is displaced or non-displaced, and the stage of healing (encounter), which includes open fracture classification.
10TAKE THE FEAR OUT OF ICD-10-CM FRACTURE CODING A 35-year old man suffered open displaced tibia and fibula fractures of the right leg as the result of an automobile accident. In addition, he lost a lot of blood, also from the right legTo assign the correct ICD-10-CM code, coders will need to know:Which leg and which specific bone(s) the patient injured. (In this example, it’s the right tibia and fibula)Whether the fracture is open or closed (in this case, open)Whether the fracture is displaced (in this case, displaced)
11FRACTURE CODING CONT…… For open fractures, coders will also need to know what type of associated trauma the patient suffered to choose the appropriate character based on the Gustilo-Anderson Classification system.Gustilo-Anderson Classification System:ICD-10 categoriesS52 (fracture of forearm)S72 (fracture of femur)S82 (Fracture of lower leg, including ankle)All the above require additional seventh character extensions.
12SEVENTH CHARACTERS: CODING FOR A CLOSED FRACTURE. A - Initial encounter of for fractureD – Subsequent encounter for fracture with routine healingG – Subsequent encounter for fracture with delayed healingK – Subsequent encounter for fracture with nonunionP – Subsequent encounter for fracture with malunionS - Sequela
13SOME SILLY ICD-10 CODES V9733xD – “Sucked into jet engine, Subsequent encounter”…. They survived the first time!?Z631 – “Problems in relationship with in-laws”….really!?Where’s the subsequent encounter?X35.xxD – “Volcanic eruption, subsequent encounter”…. That’s some really bad luck!W61.49xA – “Other contact with turkey, initial encounter”….Every Thanksgiving!Z621 – “Parental overprotection”….aren’t all parents “guilty” of this every now and then.
14CONT….. ICD-10 DOCUMENTATION EXAMPLE: The following case highlights the increased specificity required to code for ICD-10.Mrs. Finley Presents today after having a new cabinet fall on her last week. (EXTERNAL CAUSE) suffering a concussion, as well as some cervicalgia.She was cooking dinner at the home she shares with her husband, (ACTIVITY)She did not seek treatment at the time (7th CHARACTER)She states that the people that put in the cabinet in her kitchen (LOCATION) missed the stud by about two inches.Her Husband, who was home with her at the time told her she was “out cold” for about two minutes. (APPLIED SPECIFICITY) CONCUSSIONThe headaches come on suddenly, last for long periods of time, and occur every day. They are not relieved by Advil. (RELIEF OR NO RELIEF).Patient suffers acute (ACUTE OR CHRONIC) persistent headaches post concussion.CONT…..
15CONT…. SEVEN CHARACTERS TO CONSIDER WHEN CODING ICD-10 1. EXTERNAL CAUSE: The falling of the cabinet is what caused the injuries. Description of the cause is required.2. ACTIVITY: In ICD-10 the activity of the patient needs to be documented. An activity code is only used once at the initial encounter.3. 7TH CHARACTER: Injury codes require a 7th character extender that identifies the encounter. Documentation must be clear so that the correct extender can be applied.4. LOCATION: Documentation needs to indicate the location of the patient at the time of injury. In ICD-10 the details include the actual room of the house the patient was in when the injury occurred.5. APPLIED SPECIFICITY: Concussion. For a concussion, documentation needs to include if the patient suffered loss of consciousness.6. RELIEF OR NO RELIEF: Intractable vs. not intractable are an inherent part of the ICD-10 code for headaches and documentation needs to be clear to assign the appropriate code.7. ACUTE VS. CHRONIC: Documentation of the patient’s condition must include acute or chronic to assign the most appropriate ICD-10 codeCONT….
16ICD-10 CODES THAT DESCRIBE PATIENTS VISIT ICD-10-CMDESCRIPTIONSPECIFICITYS06.0X1AConcussion with loss of consciousness of 30 minutes or lessInitial encounterG44.311Acute post traumatic headacheIntractableM54.2CervicalgiaM99.01Segmental and somatic dysfunction of cervical regionW208XXAStruck by falling object (accidentally)Y93.G3Activity, Cooking and bakingY92.010Place of occurrence, house, single family, kitchen
17HOW MUCH TIME DO I HAVE TO PREPARE? On October 1, 2014, the ICD-9 code sets to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets.For providers who have not yet started to transition to ICD-10, they should take action steps now.
18UNDERSTAND THE EFFECTS ON YOUR PRACTICE. * CMS and the commercial payors are anticipating two years of claims and payments disruptions are possible after October 2014.Part of your Implementation Plan should be to acquire a line of credit or loan now to cover expenses in the disruption of cash flow.
19PERSONNEL Physicians/Nurses Greater detail requires more work at the provider/EMR levelICD-10 coding educationICD-10 reference materialsPayer code combination changes with ICD-10Billing Office/Coding SpecialistGreater detail requires more research/understandingICD-10 coding education and reference materialsPayer code combination changes with ICD-10Front Desk/ManagementGreater detail required on Encounter/SuperbillICD-10 code understanding, reference materialsChanges to all printed materials
20WHO IS YOUR CODER? Who will train them? You When will you train them? When will YOU learn the new conventions?Are updates required?Where do you find help?YouStaffCertified ProfessionalOutsourcedSoftware assistedEHR
21Prepare your practice. Set timelines. SUMMARY……You must start NOW!Prepare your practice. Set timelines.ICD-10 Training and Education is a must for staff and providers.Consider outsourcing billing to professionalsSoftware Compliance for 5010 as the GatewayCode mapping applications to convert ICD-9 to ICD-10Charting Changes – EMR vs. Paper updates to accommodate ICD-10Detailed documentation from the providers is the key to successful coding and reimbursement.12 months until compliance and although its tempting to put this out past the 5010 deadline – DO NOT WAIT
22Resources for ICD-10 General Information/Education/Resource Materials * CMS –* HHS –* AHIMA –* ICD-10 Made Easy –* Workgroup for EDI –* ZirMed –* AMA –* AAOS –Mapping of ICD-9 to ICD-10* Practice Management System & EMR Vendors* ZirMed* Navicure* Ingenix*MedPro Services does not endorse these companies or their services, this is merely a reference to available resources in the industry.
23Rebecca Kieffner, President & CEO MedPro Services, Inc.300 West Second StreetBloomington, IN 47403Telephone: (812)Fax: (812)Toll Free: (866)