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Provider Education Cathy Munn MPH RHIA CPHQ Sr. Consultant Basic ICD-10 Overview.

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Presentation on theme: "Provider Education Cathy Munn MPH RHIA CPHQ Sr. Consultant Basic ICD-10 Overview."— Presentation transcript:

1 Provider Education Cathy Munn MPH RHIA CPHQ Sr. Consultant Basic ICD-10 Overview

2 Status of ICD-10 Transition – Who, What, Where, When & Why – Industry Update Impact of the Change – Providers – Payers – Translation Examples Arkansas DMS Remediation Update Next Steps & Resources Agenda

3 ICD-10-CM (diagnoses) will be used by all providers in every health care setting ICD-10-PCS (procedures) will be used only for hospital claims for inpatient hospital procedures No impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes CPT and HCPCS will continue to be used for physician and ambulatory services including physician inpatient hospital visits Who: The Healthcare Industry

4 ICD-9-CM: International Classification of Diseases, 9 th revision, Clinical Modification – US transitioned from ICD-8 to ICD-9 in 1979 – Annual updates ICD-10: Developed by the World Health Organization as the nomenclature for all countries – ICD-10-CM: International Classification of Diseases, 10 th revision, Clinical Modification – US only – ICD-10-PCS: International Classification of Diseases, 10 th revision, Procedure Classification System – US only What: ICD-10 CM/PCS

5 Final Rule Originally Published by HHS on January 16, 2009 requiring the adoption of ICD-10 on October 1, 2013 – Dates of Service (outpatient) After 10/1/2013 – Dates of Discharge (Inpatient) After 10/1/2013 House Bill 4302 passed on March 31, 2014 delays the implementation of ICD-10 until “no earlier than October 2015” This is a Federal Mandate When: October 1, 20XX

6 Systems will have to utilize both ICD-9-CM and ICD- 10-CM for overlap e.g. claims backlog, Arkansas Medicaid allows providers 365 days to submit a claim. Inpatient discharges occurring on or after XX will use ICD-10-CM and ICD-10-PCS codes regardless of date of admission. Outpatient dates of service occurring on or after XX will use ICD-10-CM codes There will be period of time when payers will be processing claims in both ICD-9 and ICD-10 Where: Inpatient vs Outpatient

7 Better data will be available 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 risk Why: Data Benefits of ICD-10

8 ICD-10: Key to the success of each initiative ACOs/ Patient Centered Medical Home EHR/ Meaningful Use Value Based Purchasing Reimbursement changes Public Reporting & Quality Measures Health Insurance Exchanges Other Competing Priorities

9 Alpha CharacterNarrative Description A and BCertain infectious and parasitic diseases. C00 to D48Neoplasms. D50 to D89 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism. E Endocrine, nutritional and metabolic diseases. FMental and behavioral disorders. GDiseases of the nervous system. H00 to H59Diseases of the eye and adnexa. H60 to H95Diseases of the ear and mastoid process. ICD-10 Chapter Headings

10 ICD-9 Diagnosis Codes – 13,000ICD-10 Diagnosis Codes – 69, Characters3-7 Characters First character is numeric or alpha (E or V) First character is alpha Use of decimal after 3 rd character Characters 2-7 are alpha or numeric – letter U is not used Use of dummy placeholder “X” for future code expansion ICD-9 vs. ICD-10 Diagnosis Codes ICD-9 - E codes reference External Causes of Injury & Poisoning ICD-10 - E references the Endocrine System ICD- 9 - V codes reference Health Status & Contact with Health Services ICD-10 - V – Y codes reference External Causes of Morbidity

11 DiagnosisICD-9 CodesICD-10 Codes Fractures74717,099 Obstetrics1,1042,155 Poisoning2444,662 Diabetes69239 Migraine Headache4044 Impact of ICD-10

12 ICD-9 Procedure Codes – 4,000ICD-10 Procedure Codes – 72, Digits7 Digits All digits are numericAlpha or numeric composition Numbers Letters O & I are omitted Example: Artery suture has 1 code in ICD-9 Example: Artery suture has 195 coding options in ICD-10 Example: Fractured femur has 16 codes in ICD-9 Example: Fractured femur has 1530 coding options in ICD-10 ICD-9 Procedure vs. ICD-10-PCS The increase in the number of procedure codes is driven by the increased specificity, granularity & laterality contained within the ICD-10 codes. There are also 7 th digit designations (A or D) which identify initial or subsequent encounter for care.

13 Asthma Code Translations ICD-9 CodeDescriptionICD-10 CodeDescription Extrinsic asthma, unspecifiedJ45.20 Mild intermittent asthma, uncomplicated Extrinsic asthma, unspecifiedJ45.30 Mild persistent asthma, uncomplicated Extrinsic asthma, unspecifiedJ45.40 Moderate persistent asthma, uncomplicated Extrinsic asthma, unspecifiedJ45.50 Severe persistent asthma, uncomplicated Extrinsic asthma with status asthmaticusJ45.22 Mild intermittent asthma with status asthmaticus Extrinsic asthma with status asthmaticusJ45.32 Mild persistent asthma with status asthmaticus Extrinsic asthma with status asthmaticusJ45.42 Moderate persistent asthma with status asthmaticus Extrinsic asthma with status asthmaticusJ45.52 Severe persistent asthma with status asthmaticus

14 Otitis Media Code Translations ICD-9 CodeDescriptionICD-10 CodeDescription Acute suppurative otitis media without spontaneous rupture of eardrumH Acute suppurative otitis media without spontaneous rupture of ear drum, right ear Acute suppurative otitis media without spontaneous rupture of eardrumH Acute suppurative otitis media without spontaneous rupture of ear drum, left ear Acute suppurative otitis media without spontaneous rupture of eardrumH Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral Acute suppurative otitis media without spontaneous rupture of eardrumH Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear Acute suppurative otitis media without spontaneous rupture of eardrumH Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear Acute suppurative otitis media without spontaneous rupture of eardrumH Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, bilateral Acute suppurative otitis media without spontaneous rupture of eardrumH Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, unspecified ear

15 Congestive Heart Failure Code Translations ICD-9 CodeDescriptionICD-10 CodeDescription Congestive heart failure, unspecifiedI50.20 Unspecified systolic (congestive) heart failure Congestive heart failure, unspecifiedI50.21 Acute systolic (congestive) heart failure Congestive heart failure, unspecifiedI50.22 Chronic systolic (congestive) heart failure Congestive heart failure, unspecifiedI50.23 Acute on chronic systolic (congestive) heart failure Congestive heart failure, unspecifiedI50.30 Unspecified diastolic (congestive) heart failure Congestive heart failure, unspecifiedI50.31 Acute diastolic (congestive) heart failure Congestive heart failure, unspecifiedI50.32 Chronic diastolic (congestive) heart failure Congestive heart failure, unspecifiedI50.33 Acute on chronic diastolic (congestive) heart failure

16 Systems EHR, Practice Management & Billing Systems System upgrades/testing/cost Vendor readiness/testing Operations Systems, workflows & operating metrics Encounter forms/Superbills Payer readiness/testing Documentation Coding audit for documentation of specificity Identify common codes within the practice Consider dual coding to gauge accuracy & productivity Impact on Provider Operations

17 AHIMA Online Education Physician Series – Clinical Documentation for ICD-10: Principles & Practice Short, self-paced training modules Case-based, real life examples – Provides more than 200 bite-sized, on-demand, specialty-specific training modules that can be accessed anytime or anywhere with a mobile device – computer, tablet or smartphone – Delivers 3-5 minutes modules that cover physician’s 10 – 20 most commonly billed diagnoses & conditions making learning targeted and relevant to their practice specialty. – Clinical Documentation Resources

18 There are a wide variety of training opportunities and materials available through a variety of resources: – Professional Coding Associations – AAPC, AHIMA – Online Courses – ICD10 Monitor, Contexo University, Precyse, Nuance – Webinars – ICD10 Monitor, HCPro – Onsite Training – Train-the-Trainer approach, Coding Boot Camp – Arkansas Hospital Association – monthly coding classes – Non-Traditional - Partner with the HIM Department at a nearby hospital Training Resources

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20 Arkansas Medicaid has been working on ICD-10 for over two years – Completed Operational assessment Remediation of Medical Policy, Edits and Audits complete Provider Manual Updates – HP coordinating revisions Data Requirements – HP/MMIS, Xerox/ACS, integrated & stand alone systems – Ongoing Remediation of Pharmacy Policy & Edits Remediation of DHS reports, forms, and brochures Provider Outreach o Meetings/Webcasts o Provider Bulletins o Newsletters o ICD-10 Website Internal & external testing to begin mid-year Akansas DHS Current Stated

21 Leadership & Strategic Direction Communication & Planning Systems VendorsTrainingDocumentation Testing The Starting Point

22 Create a checklist of all systems & work flow processes that currently use ICD-9 Create a list of vendor contact information Identify all staff who work with ICD-9 Identify all possible work flow changes that will need to switch to ICD-10 Identify the practice billing service (if applicable) Identify the practice clearinghouse Identify a contact for each of the practice’s payers AMA ICD-10 Checklist

23 Contact vendors to determine their ICD-10 implementation plans Contact the practice’s billing service, if applicable, to identify their ICD-10 implementation plans Contact payers to determine their ICD-10 implementation plans Identify any internal work flow processes that will need to be change for ICD-10 checklist.pdf AMA ICD-10 Checklist

24 /Downloads/ICD10SmallandMediumPractices508.pdf 10/Downloads/ICD10SmallandMediumPractices508.pdf Industry Website Resources

25 CMS Resources

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27 CMS Road to I-10

28 White Papers (including but not limited to) – ICD-10 A Primer – ICD-10 Clinical Documentation – ICD-10 Physician Impact – ICD-10 Advantages – ICD-10 Specified or Unspecified Checklists published by CMS for providers (small, medium and large) at: – 10ImplementationTimelines.html 10ImplementationTimelines.html – Additional ICD-10 Resources

29 Websites to Watch


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