ICD10 Are You Prepared? Presented by Cheri Welk, RHIT Manager, Physician Billing April 6, 2013

ICD10 A new Date!! CMS Announces ICD10 will be delayed 1 year – Implementation is now October 1, 2014

ICD10 Where do you start? Depends on your role Office/Practice Manager – IT Departments Work with your software vendors Work with your payers Educate your providers Coder Assess if you need additional training on Anatomy/Pathophysiology AAPC is requiring certified coders to take a proficiency assessment to maintain their CPC credential Providers Work with your coders to assure your documentation supports the level of specificity required for ICD10

ICD10 Software Venders and Payers End-to-End Testing Pilots Example; Qualedix QA and the North Carolina Healthcare Information and Communications Alliance (NCHICA) are piloting a trading partner certification program and an ICD-10 testing framework for end-to-end testing. Step 1: sharing of dual-coded clinical scenarios with two participating health plans, United Healthcare and Blue Cross Blue Shield of North Carolina Once the coding has been solidified, the transactions and associated file formats will be transferred to encoder products from 3M and Optum for internal testing to ensure that these products find the right codes, which already have been determined in the initial analysis based on the medical records The health plans will receive compliant 5010 transactions based on the exact clinical scenarios that were reviewed in order to ensure complete traceability to the original test cases. The health plans also will have the ability to test the transactions internally once their systems have been remediated, allowing them to produce accurate ICD-10-based adjudication and remittances. The reason this pilot sets the standard for key end-to-end testing methods is that it delivers the ability to show vendors, clearinghouses and health plans what actually will be sent and shared in a live environment – as opposed to basing an entire testing effort on internal payer mappings only. Providers will gain crucial insights into various mapping rules and the contracts they have with each health plan, based on the developed clinical scenarios.

ICD10 Coder Training As quoted by the Centers for Medicare & Medicaid Services (CMS), the Robert E. Nolan Company performed a study on challenges of ICD-10 implementation and estimated that each full time coder will need up to 40 hours of ICD-10 training. Physicians and other clinicians will need additional training, ranging between 12 and 80 hours eachquoted by the Centers for Medicare & Medicaid Servicesstudy Due to the clinical nature of ICD-10-CM a strong understanding of, or experience in anatomy and/or physiology will be required

ICD10 What does ICD10 look like? Guideline changes from ICD9---- assumptions made for causal relationships Hypertension and Chronic Kidney Disease Diabetes Laterality For bilateral site, the final character indicates laterality. Injury / Fracture Care Episodes of care 7 th Character Initial encounter Subsequent encounter Sequela

ICD10 What does ICD10 Look Like? (continued) Greater level of detail with its seven (7) alphanumeric characters instead of the 5-digit ICD-9 code set.. Going from roughly 17,000 codes to about 140,000 ICD10-CM consists of 21 chapters compared to 17 chapters in ICD9-CM Contrasts to ICD9 where injuries are classified by injury; in ICD10, they are grouped first by specific site (head, arm, leg, etc.) In ICD10, there are code extensions (seventh character) for obstetrics, injuries and external causes of injuries. Addition of a place holder (x).

ICD10 ICD-9-CM Code Format Category Etiology, Anatomic site, manifestation ICD-10-CM Code Format Category Etiology, site, Extension Manifestation

ICD10 Combination codes for conditions and common symptoms ICD-10-CM E10.21, Type I diabetes Mellitus with diabetic nephropathy I Atherosclerotic heart disease of native coronary artery with unstable angina pectoris Crohn’s Disease of large intestine with intestinal obstruction ICD-9-CM Diabetes w/ renal manifestations, type I Diabetic nephropathy, NOS Atherosclerotic heart disease of native coronary artery Angina Pectoris Regional Enteritis Large Intestine Other specified intestinal obstruction

ICD10 ICD-10-CM S06.0x1A Concussion with loss of consciousness of 30 minutes or less, initial encounter Rational Dummy placeholder which is always the letter ‘x’ and it has two uses: As the fifth character for certain six character codes. The ‘x’ provides for future expansion without disturbing the sixth character structure When a code has less than six characters and a seventh character extension is required. The ‘x’ is assigned for all characters less than six in order to meet the requirement of coding to the highest level of specificity. Seventh-character extension for episode of care A – Initial encounter D – Subsequent encounter S - Sequela

ICD10 General Equivalence Mappings (GEMS) Mappings between ICD-9-CM and ICD-10-CM classification systems have been developed to facilitate the transition from one code set to another. Public domain diagnosis code reference mapping files referred to as Diagnosis Code Set General Equivalence Mappings (GEMs) have been released by HCHS. There are to files available allowing for bidirectional mappings.

ICD10 GEM File

ICD10 Crosswalk in EncoderPro

ICD10

Questions?

ICD10 Resources THERE IS HELP OUT THERE!!! Surgical Management Professionals CMS Website AHIMA Website AAPC Website