icd-10 in prognocis · emr tabular reports use to build a new custom icd-10 crosswalk superbill in...

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ICD-10 In PrognoCIS

Transitioning

to ICD-10

Webinar (Revised: Sept 23, 2015)

The Road to ICD-10 Current ICD Analysis

New Tabular Reports in EMR to analyze the most commonly used

ICD-9 in your practice with and without patient content

Develop an internal crosswalk or superbill based on these codes

Transition Tools applicable in both EMR & Billing

Manage your master files by mapping appropriate ICD-10/SNOMED

codes to your ICD’s (if you use auto-populate functionality)

Encounter-level tools provide real-time update “as you go”

ICD-10 becomes effective October 1, 2015

October 1, 2015

DOS will determine whether “ICD-9 Encounter/Claim” or “ICD-10”

New ICD-10 Search tools moving forward

ICD-9 to ICD-10 Crosswalk

EMR Tabular Reports Use to build a new custom ICD-10 Crosswalk Superbill in preparation for October 1

Sort by ICD-9 Code at a diagnosis count overall or in the context of patient count

Count of ICDs per Given Period List

EMR Report Tabular Count of ICDs for Given Period

Analyze ICD-9 codes you are currently assessing by overall count, with no patient data in context

Identifies the most frequently-used

ICD-9, which you may want to

crosswalk first.

Diagnosis-wise Patients in a Given Period

EMR Report Tabular Diagnosis-wise Patients in a Given Period

Analyze ICD-9 codes you are currently assessing at the patient level rather than overall count

Gives you the ability to update PMH in advance for patients

scheduled prior to start of ICD-10.

Custom Superbill/Crosswalk Many clients use a Superbill or Encounter Form that lists their frequently used ICD-9 codes.

Here is a general idea based on client feedback as to how they are transitioning.

Simple Example Expanded Example A 1-to-1 crosswalk of basic ICD-9 to basic

ICD-10

Each basic ICD can be expanded at various

levels/conditions and may or may not have

same ICD-10/SNOMED

SNOMED not necessarily

needed

Hyperlink Tool

Encounter Level from any screen that includes diagnosis search/assign (i.e.: , , or ) or

where the ICD auto-populates from a master file or auto-copy functionality

Past Medical History and Transition Of Care

Assessment

Lab/Radiology Order

PQRS

New Feature

Hyperlink Tool ICD-9 Code will display as an underlined label (usually blue) to match ICD-10 Codes

Claim Details Page ICD Table

Master File Level

ICD-10 Transition Tool (new feature)

Preferred ICD (Clinic/Specialty level) + Doctor Preferred ICD

Complaints Master

Vaccines Master

Note: HM Protocols & Education masters also support ICD-10 but not

via Hyperlink Tool.

Invokes 1 of 2 filtered searches specific to the linked ICD-9; Preferred and Standard

Note: This Hyperlink Tool lets you assign an ICD-10 SNOMED to your ICD-9.

Preferred Filtered IMO Search New Feature

• The Preferred tab defaults, auto-filtered to only the specific ICD-9 code selected if it has been defined as a Preferred ICD.

• Includes all 3 levels of Preferred Codes; i.e.: CP, DS, & MP as applicable for your practice

The same ICD can be defined as Preferred

multiple times

Standard Filtered IMO Search New Feature

An alert will prompt that the code is not on your Preferred lists & default

to Standard tab.

• The Standard tab defaults, auto-filtered to only the specific ICD-9 code selected when it is not defined under Preferred

• The Keyword Search allows you to further search based upon conditions or other specificity criteria

Master Files

ICD-10 Transition Tool A single screen utility to modify master file values from one screen*

EMR Settings ICD-10 Transition

*Important Note: Users require Update

permissions to the appropriate master files to use the auto-

update feature.

Displays only primary, pre-defined ICD-9 Codes from the applicable master files (i.e.: Preferred,

Complaints, Vaccines). Complaint Optional ICD Codes are not applicable under Transition Tool.

To associate codes for the first time, you must update each master file directly under Configuration.

New Feature

This utility applies now for transitioning but also remains available to managing ICD-10 values moving

forward.

Clinic Preferred ICDs Settings Configuration Clinic Pref ICD (both Clinic & Specialty level)

ICD-10 Transition Tool

Clinic-level Preferred ICD

master

Specialty picklist allows you to modify DS codes if applicable

Complaints Settings Configuration Workflow Complaints (Primary ICD only) ICD-10

Transition Tool

Workflow Complaints

master

Optional ICD n/a on Transition Tool

Vaccines ICD-10

Transition Tool

Vaccines master

Settings Configuration Codes/Drugs Vaccines

Transition Tool displays only Vaccines for which you have predefined an ICD-9 to default when administering it.

Doctor Preferred ICDs Doctor’s Home Page My Preferences Search List ICD

ICD-10 Transition Tool

Preferred ICD master

ICD-10 Transition Tool – No Administrative Rights Users who do not have the appropriate Update rights for their User Role will be prompted accordingly

Health Maintenance Protocols

Every ICD-10 still has an ICD-9 associated.

New ICD-10 Range trigger may be created as needed

Existing ICD-9 Range triggers will continue to apply at the patient & system levels

New protocol can be defined per ICD-10 while keeping the 9

Education Master New ICD-10 Range trigger may be created as needed

Existing ICD-9 Range triggers will continue to apply/be valid

New handout can be defined per ICD-10 while keeping the 9

Every ICD-10 still has an ICD-9 associated.

Encounter Level

Past Medical History Existing ICD-9 codes will display as a hyperlink when carried forward under PMH after October 1, 2015

Hyperlink color will be blue by default; however, for Medicare Advantage HMO patients which are

subject to HCC (Hierarchical Conditional Coding), it will be green (current) or red (needs re-assessed)

Unless you are using the auto-populate-from-PMH feature, it is at your local discretion if you want to update history ICD-9 at this level. Note: If you are auto-populating Assessment from

here, however, you will want to update accordingly.

Transition of Care Add New ICD When adding new codes through Transition of Care, the user can invoke the filtered IMO search

and map the appropriate ICD-10/SNOMED before reconciling (i.e.: adding to PMH above)

Update Complaint Primary ICD When the Assessment ICD defaults from HPI Complaint Primary ICD

Local process may vary whether ICD auto-populates

Assessment & if it was already updated.

The user will be prompted to also update the Complaints Master based on User Role Permissions.

Update Complaint Primary ICD (cont’d)

This prompt will not display for users without

configuration update rights

Note: A user may have clinical access to the encounter but not have administrative access at

the configuration level; e.g.: a Scribe who updates the encounter for the physician.

Update Complaint Optional ICDs (from button) When the Assessment ICD is chosen from HPI Complaint Optional ICD Codes, it must already be

mapped to an ICD-10. The user can modify it from the Assessment screen if applicable.

Update Complaint Optional ICDs (cont’d) When ICD-9 is chosen on Assessment from the Complaint button ( ) and you modify the ICD-10 for

that Assessment, you will be prompted if you also want to update that Optional ICDs in the master.

This prompt will not display for users without

configuration update rights

Update Vaccine Default ICDs When a vaccine is administered on the Face Sheet, and the ICD defaults from the Vaccine Master.

Update Vaccine Default ICDs The user will be prompted to also update the Vaccines Master based on User Role Permissions.

This prompt will not display for users without

configuration update rights

Update PMH from Assessment ICDs When ICD on the Assessment is set to auto-populate PMH based on system properties or user decision,

it will automatically update both screens (effective as of that encounter date)

This works well for HCC when it needs to

be reassessed.

CAUTION:

When MH check box is selected here, it updates PMH, but it reflects that Encounter Date as the

Assessment Date.

Lab/Radiology Order Assign ICD

Some vendors have already been requiring

both ICD-9 & ICD-10 (temp.lab.icd.bothcodes)

Lab/Radiology Orders may be required prior to knowing the actual diagnosis & may be ordered outside

of an encounter; hence the hyperlink is provided and may be auto-populated to Assessment if desired.

Prescription Assign ICD

Note: The Hyperlink tool is not available

at this level.

The diagnosis will already be known when ordering a Prescription – whether within an encounter or as

a Refill; hence the hyperlink is not available. Assessment or PMH diagnoses are filtered in the pop-up.

Doctor Form Only existing Forms where the ICD element is a check box option supports Hyperlink functionality.

In this case, Doctor Form does not have to be redesigned; it will automatically be updated.

Current IMO Master Search includes Hyperlink functionality (previous Master Search did not)

Other ICD element types (e.g.: Text, selection list, etc.) do not support Hyperlink functionality.

PQRS Assign ICD Hyperlink functionality applies in reverse (clicking the ICD-10 allows you to select the ICD-9)

PrognoCIS requires and stores both ICD-9 & ICD-10

PQRS Info Info table displays both ICD-10 and ICD-9 details

Validation Alerts

IMO Search – ICD-9 w/o associated ICD-10 When selecting an ICD-9 from the Preferred or Custom tabs that is not yet mapped to an appropriate

ICD-10/SNOMED, the system will prompt you and will not let you update the selection to the screen

you are on (i.e.: PMH, Assessment, CPOE, Claim)

Assessment – ICD-9 w/o associated ICD-10 When an ICD-9 defaults to the Assessment and you attempt to save additional data without updating the

ICD, the system will prompt accordingly and will not save the Assessment & Plan data until you map it.

Assessment – No Administrative Update Rights When the clinical user is able to update the Assessment at the encounter level but does not also have

administrative/configuration rights for the underlying master file, system will prompt accordingly.

Encounter Close – ICD-9 w/o associated ICD-10 If ICD-9 codes are not updated at the individual screens, an alert will display upon Encounter Close and

prevent you from closing the encounter & creating the claim

Duplicate Codes Selecting a code that already exists on the patient’s Assessment based on same ICD9, ICD10, and

SNOMED combination will error as a duplicate and not let you save it.

Note: Validation scenarios apply system-wide whenever a code is added or modified.

Trying to add a code via Transition of Care that already exists on the patient’s PMH based on same

ICD9, ICD10, and SNOMED combination will error as a duplicate and not let you save it.

Practice Management (Billing)

Claim Details Screen – ICD-9 Claim All claims with a DOS prior to October 1, 2015 will be an ICD-9 Claim & will contain ICD-9 codes

• ICD-9 codes may or may not display with matching ICD-10*

* ICD-10 matching has been available since v3b1 upgrade; hence some may already be present.

• Pointers will populate the ICD-9 to charge row even if ICD-10 present

Claim Details Screen – ICD-10 Claim All claims with a DOS October 1, 2015 or after will be an ICD-10 Claim & will require ICD-10 codes

• ICD-10 codes must be present to send or print an ICD-10 claim

• Pointers will populate the ICD-10 to all charge rows even though the ICD-9 is present

Hyperlink Tool Functionality ICD9-Code with no ICD-10 Code Attached

Associate the unmatched ICD-9 code to an appropriate ICD-10 code if not yet assigned.

ICD-9 Code with an ICD-10 Code Attached

Modify the ICD-10 code associated to the ICD-9 code so it is billed with a different one than

originally assessed (as per local workflow processes)

Note: Hyperlink updates made at the claim level are applicable to the claim only. They do not sync into EMR master files nor prior claims history.

The Hyperlink Tool is available in the ICD Table on the claim itself; however, it is not applicable on the

History or Assessment pop-ups

Hyperlink is n/a because you cannot

modify claims history nor EMR master files

from Billing side.

Update Claim Details ICD (from / button)

UB04 Inpatient Claims – U button Behavioral change from auto-complete text (ICD-9 only) field to Assign ICD pop-up with both ICD-9 and

ICD-10 codes that are already assigned to the claim ICD Table

Similar to the Prescription, the ADM DX must already be assessed to the patient

Encounter/PMH

Validation for Missing Codes – Claim Level

Validation for Duplicate Codes – Claim Level*

SNOMED codes are not figured in the equation of duplicates on Billing side

Duplicate ICD-10s in the ICD Table are not allowed even if the associated ICD-9 is unique for each one

ICD-10 Claim vs. ICD-9 Claim

ICD-9 or ICD-10 codes will apply based on New Visit DOS regardless of

DOS being copied

Rebilling as same Visit ID will keep codes in tact as

the one being copied

Date of Service will determine whether ICD-9 claim or ICD-10 claim.

Payer Not Ready for ICD-10 (Payer Master Flag)

Settings Configuration Vendors Insurance Extra Info button

Work Comp carriers are not mandated to accept ICD-10 Codes; otherwise, all paper & EDI Payers do

Locally, some payers may not be ready; hence you are able to manage via the Insurance Master

Payer Not Ready for ICD-10 (Validation Alert) Such claims will initially go with ICD-9 although they are considered an ICD-10 Claim

Claim can later be re-sent w/ICD-10 claims if applicable once Payer Master flag is updated*

Alert will display upon every Save or Ready to

Send. This is not an error; you can still send the

claim.

Rebilling Payer Not Ready for ICD-10

Remove the Not Ready for ICD-10 flag in the Payer Master

Select claims you want to rebill Click the Resend icon ( )

Select Claims Processed By Claims Set filter per the insurance (i.e.: ABC Insurance in this example)

Once the payer is ready to accept ICD-10, you can easily resubmit them based on local workflow and

processes

ICD-10 Management Enhancements

IMO Search Screen

*Settings Configuration Admin Properties icd.search.tabs.sequence

Search tabs can be customized per local

preference*

The Hyperlink Tool becomes disabled on the standard IMO search once the ICD-9 has been mapped to an ICD-10. The Preferred & Custom lists are

available at this level; hence the hyperlink is not required.

Locally, you can now decide which search tab is your default when executing the ICD Search ( )

If you use Custom codes, your local description will be retained even after you map it to an ICD-10.

Drill-Down Tab New Feature

https://www.e-imo.com/solutions-ehr-systems

A new tab available on standard ICD Search screen expands the logic of the Standard

tab by allowing you to identify specific code based on specificity requirements

Drill-Down Tab (cont’d) Type any ICD-9, ICD-10 code, or Description and click to execute the search

New Feature

All matching combinations for the value entered will display with applicable action buttons

Expand the code to display additional specificity criteria until you drill it down to highest code

Add the code to the Conditions tab, which will then populate the assessment/claim

Drill-Down Tab (cont’d)

Expanding a Code When clicking , additional tables appear with additional conditions or specificity criteria

As you select a value in a table on the left, the tables to the right will change accordingly

Notice for migraine, I must also select a Type, Status, & Intractability

The number of tables that display will vary based upon the root disease/code being drilled-down

Expanding a Code (cont’d) Once you have selected a value in each applicable table (based on the patient’s situation), the

expanded code will display below the tables

Click to add it to the Conditions tab, which will then populate the assessment/claim.

Each table to the right filters based on values

selected to the left

Adding Selected ICD-10s to Encounter All codes you are selected via the icon, they are added to the Conditions tab

Expanded view of the Conditions tab with selected

ICD-10 codes that will populate assessment/claim.

The OK button adds them to the Assessment/Claim (depending from where you executed Drill-down).

Populated ICD-10 from Drill-Down All codes that were added to the Conditions tab during the Drill-down now populate the screen from

which the IMO search was executed (e.g.: Assessment, Claim Details, etc.)

Billing Scrubber Checks All existing ICD-9 scrubber checks remain valid while new ICD-10 operands have been added

Billing Settings Claim Scrubber Checks

Bill Filters New Filters

Custom Report Layouts New Fields

Labels, Tags, and Other Indicators

Patient Band Indicators & Tooltip Orange ICD-10 bar displays for Encounter Dates October 1, 2015 and after

Red ICD-9 bar displays for Encounter Dates before October 1, 2015

ICD tooltip will also reflect which one applies to that PMH, encounter, or claim

Print Tags & Claim Labels CMS-1500 Printed Claim – cell 21

Track Status

I- button

Claim Labels & Tooltip

Once the payer is rebilled, this label will reflect ICD-10

accordingly on the rebill.

History Labels (EMR and Billing screens)

New columns added to display ICD-10 codes as well as ICD-9 codes

Appendix HL7 Interface Vendors

ICD-10 Certified Lab Vendors (Sept. 30, 2015)

Lab Vendors

LabCorp

Quest Diagnostics

Bio Reference (Gen Path)

PCLS

NorDx Lab

Med Labs Diagnostics

Pathology, Inc.

Empire City Labs

Millennium Labs

CLA-PAML

PathGroup

Theranos

Solstas

Ingalls

Atherotech

US Medical Scientific

(Vendition Partners)

Boston Heart Diagnostics

Vista Clinical Diagnostics

Note: This list includes those vendors who transact using HL7 Interfaces. Send inquiries to Interface Services Team at interfaces@bizmaticsinc.com

Accumen

ProGenity

Sentra Lab (4 Medica)

Sharp Labs

Ethos

AP Easy

Health Diagnostic Laboratory

Pathology Reference Lab

Drugscan (Atlas Medical)

ICD-10 Certified PMS Vendors (Sept. 30, 2015)

Note: This list includes those vendors who transact using HL7 Interfaces. Send inquiries to Interface Services Team at interfaces@bizmaticsinc.com

PMS

Benchmark

HealthPac

X-Link

MDSynergy

Medical Mastermind

SunRise

Athena Health PM

Avisena – Medusind

Orchard

Collaborate MD

MedFocus RCM

Medisys

Advanced MD

Web Practice (Health Nautica)

ClinicX PM

MedEvolve eCeno

Assertus/Proclaim

Doc-tor.com

ICD-10 Certified EDI Vendors (Sept. 30, 2015)

EDI Clearinghouses

Gateway

Office Ally

Navicure

Availity

Availity RCM (RealMed)

Emdeon

P2P Stone River

Inmediata

ZirMed

Emdeon One (Capario One)

Ability (MD Online)

Optum/ENS Health

Note: This list includes those vendors who transact using HL7 Interfaces. Send inquiries to Interface Services Team at interfaces@bizmaticsinc.com

All PrognoCIS Billing clients’ clearinghouses are certified for ICD-10

The End of the Curve Deployment

ASP/Cloud users do not have to wait for the upgrade.

Requires V3B2, Service Pack 163 or higher. (As of September 2015, all ASP Servers are current.)

Preparation

Analyze ICD-9 data from the ICD-specific Tabular Reports

Create ICD-10 crosswalk/superbill internally

Start using the new tools now

Or wait and do it “as you go” at the encounter -level

Note: You can verify your version under the Info icon in system tray in the upper right ( ).

If you are a Client Server user, please contact your local IT Administrator for details.

PrognoCIS Technical Support & Resources

How may I help you?

PrognoCIS Resource Center

Recorded version of this webinar

ICD-10 specific modular videos

Technical Support 24/7

New toll free number (800) 552-3301

Email: support@bizmaticsinc.com

Live Chat

Implementation Manager (if applicable)

CMS Resources https://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/icd10

https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10ResourcesFlyer20150817.pdf

CMS Resources (cont’d)

Questions & Answers

Review Time!