2015 User Conference

ICD 10 : It’s Coming! April 25, 2015

Presented by:

Maria Germano, CPC, CPEDCSenior Billing Support Analyst

General Session

2015 Office Practicum User Conference

2015 Office Practicum User Conference

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)

2015 Office Practicum User Conference

163

Is this real life?

2015 Office Practicum User Conference

Ready or not, here it comes!

2015 Office Practicum User Conference

■ Up to 12 diagnoses on a claim but only 4 for a specific code

■ Not otherwise specified codes will most likely be rejected as the codes are more specific

■ Payers are going to reject a lot more specifically however the clearinghouses will accept the claims

■ You cannot use two diagnosis codes that are “similar.” Integral diagnosis codes cannot be used with original diagnosis.

■ You have to be on 5010 for claim submission in order for ICD-10 to be supported

Important things to remember about ICD-10

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Do we have to?

2015 Office Practicum User Conference

Main factor in ICD-10

■ Understand that ICD-10 is different from ICD-9 due to the fact that the Physicians will have to take ownership in coding the diagnosis codes and there is no way for a biller or coder to know how severe the diagnoses are.

■ Diagnosis codes are specific to severity of the exam and patient.

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.

2015 Office Practicum User Conference

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.

2015 Office Practicum User Conference

■ 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…...

Are you ready?

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ICD is a Preference to Set….

ICD-9 only

Hybrid - Clinical Crossover

(10/1/2015)

ICD-10 only

Utilities -

System Admin -

System Preferences -

Billing -

“Diagnosis coding mode:”

2015 Office Practicum User Conference

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 diagnoses (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 will support it as of October 1, 2015.

Diagnosis Coding Rule

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Diagnosis coding mode

The three different modes are

ICD-9 onlyHybrid - clinical crossover

ICD-10 only

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ICD-9 only mode

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ICD-10 only mode

2015 Office Practicum User Conference

Hybrid mode

2015 Office Practicum User Conference

Payer level

❏ 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.

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-10October -- game time!

2015 Office Practicum User Conference

Will OP provide training on ICD10?

OP will provide the self instruction videos and documentation on how to use ICD-10 in OP.

We will be offering webinars and seminars on ICD-10 coding that will be available at an additional cost.

2015 Office Practicum User Conference

2015 Office Practicum User Conference

We at Office Practicum are here to make this transition as easy as

possible for you. We are going to be available every step of the way and

will hopefully make this a smooth and easy transition.

2015 Office Practicum User Conference

We want your feedback!