1. January 29, 2014 ICD-10 ORIENTATION AND SHC “PLAN”

2. PRESENTED BY IN COODINATION WITH SHC Rhonda Anderson, RHIA, President Anderson Health Info. Systems, Inc. 940 W. 17 th Street, Suite B Santa Ana, CA 92706 Tel. 714-558-3887Fax 714-558-1302 Office@ahis.net 2

3. OBJECTIVES Participants will identify: –Dates for New ICD-10 –Administrative Support Needed –Documentation support –Some general coding guidelines –SHC Work plan – Key timelines 3

4. FINAL REGULATION Final Regulations were released in January 2009 Implementation Date is October 1, 2014 All billing using ICD-10 begins 10/1/2014 ICD-10 for billing purposes as far as ability to accept the code known as “5010” was required by October, 2012-SHC is in compliance 4

5. SHC ICD-10 PROJECT TEAM Steering Committee- Foothill Resource Team – ( Aisha, Belen, Russell, Kathy Simpson, Greg Sewell, Wesla, Karen Florez, Norma Martinez, Tonya Martinez, Ted Chigaros, Rhonda Anderson) VPO’s / VPPS Support Team Regional Resource Team Facility Level Team 5

6. ICD-10 “HAS TWO PARTS” ICD-10 CM – Clinical Modification – Skilled Nursing will use “CM” ICD-10 PCS – Procedural Code System (used for procedures, operations within the hospital inpatient setting) 6

7. WHAT DOES ICD-10 COMPLIANCE MEANS? ICD-10 compliance means that everyone covered by HIPAA is able to successfully conduct health care transactions using ICD-10 codes All Billing Claims will be denied if not ICD- 10 by OCTOBER 1, 2014. 7

8. WHO IS AFFECTED?? Freestanding providers Ancillary services – “that means all of us really” who provide services and bill for them under Medicare, Medicaid/Cal and private insurances Therapy Providers 8

9. WHO IS AFFECTED?? -2 Developed for the provider and the coder….(person who may review the documentation and determine if code is accurate) Consistent, complete documentation in the medical record is a major emphasis 9

10. STATE MEDICAID PROG. NEED TO TRANSITION TO ICD-10 Like everyone else covered by HIPAA, state Medicaid programs must comply with ICD-10 10

11. REVIEW YOUR ROLE No you will NOT code! – Leadership needs some information about the importance –To know resources – and resources needed –Identify SHC Project Team – initiated now –Obtain assurance from the computer system –To know that coding is correct – in future to have a system to assure accuracy of coding, billing, documentation 11

12. CODES CHANGE EVERY YEAR ICD-10 codes will be updated every year Not in 2014 unless new technologies and new diseases IN 2015 – regular updates (affects training and also purchase of manuals – computer alone is not enough. 12

13. ICD-10 DIFFERENCES Organization – Two volumes Structure – Alphanumeric categories rather than numeric categories.(has “includes and excludes notes: –Categories are three digits –Chapters – re-arranged –Titles have Changed – examples on following slides 13

14. ICD-10 DIFFERENCES -2 CHAPTER*ICD-9-CMICD-10-CM* 1Infectious and Parasitic Diseases Certain Infectious and Parasitic Diseases - A00-B99 2NeoplasmsMalignant Neoplasms 6Diseases of the Nervous System and Sense Organs Diseases of the Nervous System 7Disease of the Circulatory System Diseases of the Eye and Adnexa 14

15. ICD-10 DIFFERENCES -3 CHAPTER*ICD-9-CMICD-10-CM* 8Diseases of the Respiratory System Diseases of the Ear and Mastoid Process H60-H95 9Diseases of the Digestive System Diseases of the Circulatory System 10Diseases of the Genitourinary System Diseases of the Respiratory System 15

16. ICD-10 DIFFERENCES -4 CHAPTERICD-9-CMICD-10-CM 13Diseases of the Musculoskeletal System and Connective Tissue 14Congenital Anomalies Disease of the Genitourinary System 16

17. ICD-10 Code composition – increased specificity Level of detail May consist of up to 7 digits with the seventh digit extensions representing visit encounter or sequelae as stated above Includes full code titles and no reference back to common 4 th and 5 th digits) V and E codes are no longer supplemental 17

18. ICD-10-CM DIAGNOSIS CODES – FORMAT & STRUCTURE 3-7 characters in length Approximately 68,000 codes Digit 1 is alpha, digit 2 and 3 are numeric; digit 4-7 are alpha or numeric Decimal placed after the first 3 characters, All letters used except “U” Flexible for adding new codes Very specific Has laterality 18

19. FIVE-SIX CHARACTER SUBDIVISION Way too much detail…but it looks like this!! –J10.8 – Influenza due to other influenza virus with other manifestations –J10.81 – Influenza gastroenteritis –J10.89 – Influenza with other manifestations: Influenzal encephalopathy Influenzal myocarditis 19

20. FIVE-SIX CHARACTER SUBDIVISION -2 Way too much detail…but it looks like this!! –ANOTHER EXAMPLE – WITH SPECIFICITY AND LATERALITY: S55.011 Laceration of ulnar artery at forearm level, right arm 20

21. MAPPING TOOLS Mapping from ICD-9 to 10 tools are available, General Equivalence Mappings (GEMS) – translation dictionary for diagnoses Called “GEMS” – general equivalence mappings CM – GEMS available PCS – GEMS just available last of September (acute hospital mostly) 21

22. GEM FILES Do not despair…you vendor should prepare as much of a crosswalk as possible NOTE: will require some conversion for long term resident’s diagnoses by the effective date of ICD-10 TRAININGLater TRAINING and how to use them…Key to early review!!! 22

23. THE WORKPLAN TRANSITION TO ICD-10 23

24. Work Plan to Facilities Steering Committee – Coordinating Dates 1.February – Brief Orientation ( Webinar) Feb 6 and Feb 7 2.March – 2 hours Webinar – 2 Sessions March 18 and 20 3.April /May/June/July – “Live Trainings” 4.July /August– Each Facility will transition all Long Term residents to ICD-10. 5.September 1 - All facilities ready ….Dual Coding ICD 9 and ICD-10 24

25. ICD-10 PROJECT PLAN -3 Determine who and how many staff needs training: –Facility Level ICD- 10 Team/ Attendees: –Administrator –DON –Medical Records –Diagnosis Coder – Nursing Supervisor –Biller –MDS –Admissions –Medical Director/ UR Doctors 25

26. IMPROVE DOCUMENTATION NOW All of the information that is required to code according to ICD-10 is information that is necessary to an individual’s care and is already documented in the medical record What we will ask is “how does your documentation in your facility compare to what is needed to code accurately using ICD-10? 26

27. ICD-10 CODES REQUIRE Clear focus to better documentation Absolutely critical to the success of ICD-10 Good resident care –focused on documentation: –Affect so many facets of health care downstream –Quality measures to analytics, research, payment and surveillance –Must be as accurately documented, coded and billed 27

28. ICD-10 CODES REQUIRE -2 Good resident care (cont.) –Requires i.e., physician, nursing, therapy– efforts to provide good documentation –?? To Ask –What are you documenting today? –Evaluate documentation “best practices” to increase quality/quantity as needed 28

29. ICD-10 CODES REQUIRE -3 Recognition of: –Impact of ICD-10 (not new but = new focus – medical, financial, even regulatory ramifications 29

30. DEVELOP THE RELATIONSHIP BETWEEN CLINICIANS Clinicians Director of Nursing (DON) do not need to understand all of the intricacies of coding, and coders do not need to understand all of the medical – but the 2 must work together to ensure optimal accuracy Increase questions from coders as there is a need to understand basic anatomy and pathophysiology. 30

31. STRATEGIES FOR TRAINING Leadership are those individuals who are responsible for moving things through the organization: –Understand what the impact of ICD-10 will be –What challenges are anticipated 31

32. STRATEGIES FOR TRAINING -2 Training Medical Record, MDS/PPS, DON, Business Office, Inquiry Staff, Medical Director: –Have training –Parallel coding taking the same cases and coding them accurate to ICD-9 and ICD-10 –Parallel training and testing –Start in early 2014 32

33. STRATEGIES FOR TRAINING -3 Leadership should understand enough about the coding changes to understand the implications: –Documentation –Business practices –MDS / Medicare PPS –$$ impact for training, implementation and billing 33

34. RESOURCES HIM Consultant – ICD-10 Certified and Specialized Training SHC Team members who have been to training will be “ Trainer” resource DCR’s / Medical Records Consultant will assist in Training Facilities 34

35. WHY PREPARE NOW? Major understanding for providers, payers and vendors Will drive business and systems changes, hospital, SNF, Physicians, Outpatient, et’l, from large national health plans to small provider offices, laboratories, medical testing centers Staff time – start looking at who is affected now and what they need to know Financial resources Options for ICD-10 transition 35

36. ICD-10 PROJECT PLAN -4 Evaluate current documentation Identify most commonly used diagnoses by checking out: –Reports – past coding Medicare coverage issues “ADR” –Documentation to support those diagnoses –Medical staff / Medical Director support –Clinical documentation improvements 36

37. TOO MUCH INFORMATION JUST AN EXAMPLE OR TWO – MORE THAN YOU NEED TO KNOW!!! Impacts your staff from prior to admission to discharge and beyond – billing finals, et’l 37

38. SPECIFIC INFO. NEEDED TO ACCURATELY CODE Diabetes Mellitus –Type of diabetes –Body system affected –Complication or manifestation –If type 2 diabetes, long-term insulin use 38

39. SPECIFIC INFO. NEEDED TO ACCURATELY CODE -2 Fractures –Site –Laterality –Type –Location 39

40. REVIEW CHANGES IN DOC. REQUIREMENTS Injuries –External cause – cause of the injury, more applicable to op –Place of occurrence – home, at work, in the car, etc. More related to op we will have some references –Resident Activity level code –External code status – indicate if the injury was related to military, work, or other 40

41. TRANSITION & TESTING Jan/Feb, 2014 – September 15, 2014 –Conduct high level training on ICD-10 for clinicians –Codes to prepare for testing –Clinical documentation review –Determine dual coding dates and record reviews 41

42. COMPLETE TRANSITION / FULL COMPLIANCE October 1, 2014 Complete ICD-10 transition for full compliance –ICD-9 codes continue to be used for services provided before October 1, 2014 –ICD-10 diagnosis and inpatient procedure codes required for services provided on or after October 1, 2014 –Monitor systems correct errors if needed 42

43. THANKS FOR ATTENDING Rhonda Anderson, RHIA President Anderson Health Information Systems, Inc. 940 W. 17 th Street, Suite B Santa Ana, CA 92706 Mobile 714-299-0573Office 714-558-3887 rhonda@ahis.net 43