1. 2015 User Conference ICD-10 Practice Management April 23, 2015 & April 24, 2015 Presented by: Maria Germano and Melissa Holmes Senior Billing Training Manager Support Analyst PM Session

2. 2015 Office Practicum User Conference ICD-10

3. 2015 Office Practicum User Conference Is This Really Happening… or are you pulling our leg?

4. 2015 Office Practicum User Conference Yes, Actually… 163

5. 2015 Office Practicum User Conference What is it?

6. 2015 Office Practicum User Conference What is ICD-10? ■ICD-10 is the 10th revision of the International Statistical Classification of Diseases (ICD), and is a medical classification list, by the World Health Organization (WHO) 14,400 different codes (ICD-9) 68,000 different codes (ICD-10)

7. 2015 Office Practicum User Conference

8. ICD-10 CM was developed by the Centers for Disease Control and Prevention. Coding under ICD-10 CM uses 3 to 7 digits instead of ICD-9 CM which uses 3 to 5 however the format of the code sets is similar. The transition to ICD-10 CM does not affect CPT codes which will be continued to be used.

9. 2015 Office Practicum User Conference Why did they even come up with ICD-10? ICD-9 is 30 years old, has outdated terms and is inconsistent with current medical practice. ICD-9 limits the number of new codes that can be created and most of the ICD-9 categories are filled.

10. 2015 Office Practicum User Conference Why are we transitioning to ICD-10? ■Roughly 25 countries use ICD-10 for reimbursement and resource allocation in their health system. ■ICD-10 provides better reporting and statistics. 1998 1994 1998 1997 2000 2012 2005 2002

11. 2015 Office Practicum User Conference Important things to remember about ICD-10 ■Up to 12 diagnosis on a claim - 4 per CPT ■NOS codes will most likely be rejected ■More rejections at the payer level ■Do not use “similar” or integral codes ■5010 required for ICD-10

12. 2015 Office Practicum User Conference Main factor in ICD-10 ■ICD-10 requires providers to select diagnosis codes to ensure accurate coding ■Diagnosis codes are specific to severity of the exam and patient.

13. 2015 Office Practicum User Conference Alphabetic.vs. Tabular Index Alphabetic Index Tabular Index NEC “Not elsewhere classifiable” NEC “Not elsewhere classifiable” This abbreviation in the Alphabetic Index This abbreviation in the Tabular list represents “other specified”. When represents “other specified”. When a specific code is not available for a condition, a specific code is not available for a the Alphabetic Index directs the coder to condition the Tabular List includes the “other specified” code in the Tabular List. an NEC entry under a code to identify the code as the “other specified” code. NOS “Not otherwise specified” This abbreviation is the equivalent of unspecified.

14. 2015 Office Practicum User Conference Alphabetic.vs. Tabular Index Alphabetic Index Tabular Index Brackets are used in the Alphabetic Brackets are used in the Tabular Index to identify manifestation codes. List to enclose synonyms, alternative wording or explanatory phrases. Parentheses are used in both the Alphabetic Index and Tabular List to enclose supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number to which it is assigned. The terms within the parentheses are referred to as nonessential modifiers.

15. 2015 Office Practicum User Conference Other and Unspecified Codes “Other” codes Codes titled “other” or “other specified” are for use when the information in the medical record provides detail for which a specific code does not exist. Alphabetic Index entries with NEC in the line designate “other” codes in the Tabular List. These Alphabetic Index entries represent specific disease entities for which no specific code exists so the term is included within an “other” code. “Unspecified” codes Codes titled “unspecified” are for use when the information in the medical record is insufficient to assign a more specific code. For those categories for which an unspecified code is not provided, the “other specified” code may represent both other and unspecified.

16. 2015 Office Practicum User Conference How do we deal with this?

17. 2015 Office Practicum User Conference How do we deal with this?

18. 2015 Office Practicum User Conference Are you ready? ■ICD-10 is a huge change for not only you but also for the Insurance Payers ■Just like the transition of Vaccine Administration Codes, not all payers were ready for the new coding rules ■We have a contingency plan…...

19. 2015 Office Practicum User Conference ICD-10 is a Preference...

20. 2015 Office Practicum User Conference ICD-10 is a Preference...

21. 2015 Office Practicum User Conference Diagnosis Coding Rule 1.ICD-9 only. This is the current stage. All coding of encounters, claims, and problems is performed in ICD-9. 2.Hybrid. This will be the intermediate stage. All coding of encounters and claims will be performed in ICD-10, with automated downcoding to ICD-9 as needed. Encounters and claims will support up to 12 diagnosis (8 more than OP 11 allows). All coding of problems will be performed in SNOMED, as required by Meaningful Use Stage 2. 3.ICD-10 only. This will be the final stage. The same coding rules will apply as in hybrid mode, but automated downcoding to ICD-9 will be disabled. We expect to support it as of October 1, 2014, but in reality most practices will not switch to this mode until early 2015.

22. 2015 Office Practicum User Conference How will ICD-10 work with my payers?  Certain Payers will not accept ICD-10 in October 2015  Some Payers will not accept ICD-10 until 2016  Some Payers may accept ICD-10 prior to October 2015  OP allows you to set effective date at the Payer level.

23. 2015 Office Practicum User Conference Adding Diagnoses

24. 2015 Office Practicum User Conference Adding Diagnoses

25. 2015 Office Practicum User Conference Let’s Try It!

26. 2015 Office Practicum User Conference Let’s Play... Name that ICD-10 code!

27. 2015 Office Practicum User Conference Name that ICD-10 F41.0 Anxiety, unspecified

28. 2015 Office Practicum User Conference F41.0 Please note: “Anxiety” will now have 3 classification sets. ICD-10 CM Index (135) ICD-10 CM Codes (85) ICD-9 CM Codes (43) which equates to….. 263 possibilities!

29. 2015 Office Practicum User Conference Name that ICD-10 Acute Otitis Media (381.10 ( ICD-9) )

30. 2015 Office Practicum User Conference Helpful Link http://www.roadto10.org/action-plan/phase-2- train/common-codes-pediatrics/

31. 2015 Office Practicum User Conference Name that ICD-10 Preventive Visit (V20.2 or V70.0)

32. 2015 Office Practicum User Conference V20.2 - V70.0

33. 2015 Office Practicum User Conference Name that ICD-10

34. 2015 Office Practicum User Conference T33-T35 Frostbite (T33-T35) T33 Superficial frostbite T34 Frostbite with tissue necrosis T35 Frostbite involving multiple body regions and unspecified frostbite Chapter XIXInjury, poisoning and certain other consequences of external causes(S00-T98)

35. 2015 Office Practicum User Conference Frostbite continued

36. 2015 Office Practicum User Conference Name that ICD-10!

37. 2015 Office Practicum User Conference International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)-2015-WHO Version for ;2015 Chapter X Diseases of the respiratory system (J00-J99) Influenza and Pneumonia J09-J18

38. 2015 Office Practicum User Conference Flu

39. 2015 Office Practicum User Conference Flu, continued

40. 2015 Office Practicum User Conference Next Steps...What is your Action Plan? ●Develop an Implementation Strategy for your Practice ●Check with your Insurance Payers ●Work with Vendor Partners for readiness

41. 2015 Office Practicum User Conference Timeline for ICD-10 in OP OP’s recommendation is to spend the summer months preparing for ICD-10. June, July and August -- prep work for ICD-10 (templates, orders, surveys, etc) September -- hybrid mode testing with ICD-9 and ICD-10 October -- game time!

42. 2015 Office Practicum User Conference One piece of Good News!!! Look what just got easier... Vaccine DX codes for ICD-10 will all be the same... V23

43. 2015 Office Practicum User Conference Questions

44. 2015 Office Practicum User Conference References/Resources ■http://www.aapc.com/http://www.aapc.com/ ■http://www.ama-assn.org/http://www.ama-assn.org/ ■http://www.cdc.gov/nchs/data/icd/icd10cm_guidelines_2014.pdfhttp://www.cdc.gov/nchs/data/icd/icd10cm_guidelines_2014.pdf ■http://www.roadto10.org/http://www.roadto10.org/ ■CMS testing for ICD-10 claims Week of 07/21/2014

45. 2015 Office Practicum User Conference And Just Remember this…..

46. 2015 Office Practicum User Conference We want your feedback! Handout: ICD-10 Practice Management Handout