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

Brief Overview October 1 st 2015 deadline No grace period All providers Prior training participation

Where Should You Be All residents should be dually coded Utilizing ICD-10 manual Enhancing knowledge of ICD-10 coding by practicing and coding

Verifying Reports in Matrix to check for ICD-10 coding –ICD-9 Diagnosis Report –ICD-10 Diagnosis Report –General Equivalence Mapping Report

ICD-10 Resident Diagnoses Report 6

Physician Orders Missing ICD-10 Diagnoses Report

AR and ICD-10

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

AR and ICD-10 –Generate an ICD-10 Diagnosis Report Reports 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.

AR and ICD-10 ICD-10 codes are pulled to the claim based on the dates of service Bill TypeFacility Type/ServiceClaims Processing Requirement Use FROM or THROUGH Date 21XSkilled 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-10 THROUGH 22X 23X Skilled 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 later FROM

AR and ICD-10 The 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.

Therapy and ICD-10 Therapy will have to convert current patients in Oct from ICD9 to ICD10 diagnoses in the Smart Therapy software Smart Therapy Software also has the CMS GEM crosswalk available to assist with converting the codes

Therapy and ICD-10

Matrix and Smart Diagnosis Codes Should Match Therapists should use the ICD10 codes listed in matrix to select their medical reason for treatment If a diagnosis is not on the list, review medical record to see if diagnosis has been noted in past by a physician New diagnosis can be established with T.O or MD signature for a new diagnosis

Communication is the Key to Successful Coding and Sequencing

Communicating the Codes ICD Codes should be entered into matrix promptly after admission Clinical Team should discuss to verify accuracy of coding especially with moving to ICD10 Obtain any unlisted diagnosis from MD Clinical Team should prioritize codes for AR sequencing to lay out order of codes in billing

AR Sequencing for Therapy Only Bills (Part B, Insurance) Specific Therapy Encounter Codes (V57.XX in ICD9) are no longer used for principle code for therapy ICD10 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 care Some treatment will need specific ICD10 codes (Example ST tx for swallowing-will need a dysphagia diagnosis

Triple Check Triple 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 MDS This review helps verify processes are accurate It also identifies if there is a problem and need to improve at coding and sequencing processes