1. ICD-10 is Coming Ready or Not Dr. Thomas Ayoub Norwalk Hospital

2. 3/4/2014 2 ICD - International Classification of Diseases –Issued by World Health Organization (WHO) –Used world-wide as tool to classify diseases and other health problems USA is the only country to use ICD codes for billing purposes

3. 3/4/2014 3 Change is long overdue USA is the last country to implement ICD-10 ICD-9 been in use in the USA since 1979 HHS proposed change to ICD-10 in 2008 Original start date 2011 – there will be no more delays

4. 3/4/2014 4 Effects include: Clinical documentation/EHR systems Encounter forms/Superbills Practice management systems Contracts Public health and quality reporting tools Much worse than Y2K IT Issues

5. How Can Physicians Prepare March 4, 2014

6. 3/4/2014 6 Most Common ICD-9 CMS recommends that offices start by: listing their most commonly used ICD-9 codes becoming familiar with corresponding ICD-10 codes

7. 3/4/2014 7 Start with highest volume codes The vast majority of practices use very few codes… 5% of codes account for about 70% of the volume Majority Rules

8. 3/4/2014 8 Principal DiagnosisICD-9 % SCREEN MAMMOGRAM NECV76.1230% ROUTINE GYN EXAMINATIONV72.3112% SCREEN MAMMOGRAM HI RISKV76.118% PREG STATE, INCIDENTALV22.24% ABN FINDING-BREAST NEC793.893% Top Norwalk Hospital OB/GYN Diagnoses in ICD-9 The top 5 codes account for 57% of the volume.

9. 3/4/2014 9 Use free internet sites like http://www.icd10data.com or download free apps Translate ICD-9 to ICD-10

10. 3/4/2014 10 Example: OB/GYN Most Common Codes ICD-9 DescriptionICD-9 Code ICD-10 Code ICD-10 Description SCREEN MAMMOGRAM NECV76.12Z12.31 Encounter for screening mammogram for malignant neoplasm of breast ROUTINE GYN EXAMINATIONV72.31Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings Z01.419 Encounter for gynecological examination (general) (routine) without abnormal findings SCREEN MAMMOGRAM HI RISKV76.11Z12.31 Encounter for screening mammogram for malignant neoplasm of breast PREG STATE, INCIDENTALV22.2Z33.1Pregnant state, incidental ABN FINDING-BREAST NEC793.89R92.8 Other abnormal and inconclusive findings on diagnostic imaging of breast 4 of top 5 codes have a direct, 1 to 1 Match 1:1 Match

11. 3/4/2014 11 Example: OB/GYN Most Common Codes ICD-9 DescriptionICD-9 Code ICD-10 Code ICD-10 Description SCREEN MAL NEOP- CERVIXV76.2Z12.4 Encounter for screening for malignant neoplasm of cervix SUPERVIS OTH NORMAL PREGV22.1Z34.80 Encounter for supervision of other normal pregnancy, unspecified trimester LUMP OR MASS IN BREAST611.72N63Unspecified lump in breast INCONCLUSIVE MAMMOGRAM793.82R92.2Inconclusive mammogram VAGINITIS NOS616.10N76.0Acute vaginitis N76.1Subacute and chronic vaginitis N76.2Acute vulvitis N76.3Subacute and chronic vulvitis

12. 3/4/2014 12 The good news Unspecified codes exist for many diagnoses The documentation may already include ICD-10 level specificity Most of the code volume relates to musculoskeletal anatomy I am available for on-site help but will need to start with your top volume codes via email susan.herson@norwalkhealth.org

13. 3/4/2014 13 Colorectal Surgery Crosswalk

14. 3/4/2014 14 Specialty Societies for guidance & billing forms Websites and apps www.cms.gov/icd10 www.roadto10.org precyse app stat ICD10 app On site physician training 3M handouts in 18 subspecialties 1-hour training sessions in April with HC-Pro Resources

15. 3/4/2014 15 www.roadtoicd10.org

16. 3/4/2014 16

17. 3/4/2014 17 ICD-10 – changes to Office Process How does the office process change as a result of ICD-10

18. 3/4/2014 18 Office Issues Staffing: ½ of billers are expected to retire or change jobs Productivity: may drop as much as 50% Dual systems: required from several months prior to several months after…maybe longer Delayed Payments: the industry is expecting significant delays Cash Flow: CMS & Insurers will not accept bills after Oct 1, 2014 in ICD-9 format

19. 3/4/2014 19 Even if your practice is fully prepared for ICD-10, be sure you prepare for cash flow disruption The chances that every major payer will be able to handle new codes is slight Make arrangement for potential cash flow disruptions starting in November 2014 which may last up to 6 months Practical course of action – Secure line of credit for working capital to be drawn down if and when cash flow needs arise Be prepared for disrupted cash flow

20. 3/4/2014 20 Remember only the ICD-9 diagnosis codes are changing not the CPT-4 procedure codes If your practice has a superbill with pre listed ICD-9 codes – The superbill will have to redesigned with ICD-10 codes If Superbill ICD-9 code field is free text – If you write a diagnosis narrative, how will your staff be able to convert the narrative to an ICD-10 code – Will your narrative contain enough specificity – If you write in a diagnosis ICD-9 code, how will you know what ICD-10 code to write in Practices based on paper superbill

21. Outpatient – script from the ordering physician is key (for example Lab, Rad or specialist referral ) Patient Physician Script / Referral ICD-9 / ICD-10 Physician Office Physician ICD-10 Implementation – Outpatient 21 3/4/2014 Norwalk Hospital Critical to both Physician Office and Hospital Hospital bills can confuse patients

22. 3/4/2014 22 Patient Code is not clear Physician OfficeNorwalk Hospital ICD-10 Scripts – the Patient Experience Physician Script / Referral If the code is not clear, will result in phone calls to physician Re-work for physician Extends waiting time for patient

23. 3/4/2014 23 ICD-10 requires new Specificity Work in partnership with Physician offices on Process Will result in best process by doing parallel Goal for all – document most accurate Code Best clarity – share same ICD-10 alpha- numeric Code ICD-10 Script Process

24. 3/4/2014 24 ICD-10 Summary Bottom Line – if we don’t do ICD-10 correctly, we cannot bill!! ICD-10 drives same results for Physician Office and Hospital:

25. 3/4/2014 25 Tables today were set up to talk about: Getting Started Office Staff Training Physician Training Vendor Information NHP&S: Compare Notes with another practice How can we help