kareo - icd-10: don't freak out! webinar

KAREO | CONFIDENTIAL @GoKareo; #KareoTip PAGE 1 KAREO | CONFIDENTIAL

ICD-10-CMDon’t Freak Out

Go Practice

KAREO | CONFIDENTIAL @GoKareo; #KareoTip

Your Hosts Today…

Rochelle GlassmanPresident, United Physician Services, LLC

www.upshealthcare.com .

Lea ChathamContent Marketing Manager, Kareo

http://www.upshealthcare.com/


How to Participate Today…

Follow us on Twitter @GoKareo We’ll be tweeting live using the hashtag #KareoTip

Join our other social media channels for constant updates!

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Our Schedule for Today…

1 Introduction & Welcome Rochelle

2 ICD-10: Don’t Freak Out

3 Discover Kareo’s Role

4 Answer Questions


Rochelle Glassman

• Nationally-recognized healthcare consultant

• Former executive-level consultant for Cigna

• Healthcare business entrepreneur

• 30 years of healthcare business experience

• President/CEO United Physician Services, LLC

• Physician Advocate

• Trauma-trained RN [email protected]

602.685.9500

mailto:[email protected]

http://www.upshealthcare.com/






4 Answer Questions


What We’ll Cover Today

1. Business practice solutions for ICD-10 2. Overview of ICD-10-CM3. Feedback for online ICD-10 coding test


Business Practice Solutions

How to prepare for loss of revenue and reduction in productivity when coding diagnoses in ICD-10.

What to ask your payers about processing your claims after ICD-10 is implemented?

Steps to help prevent insurance claim rejections.


Strategies to Manage Revenue Loss

Take steps to implement a line of credit as soon as possible.

Prepare a multi-year budget for the ICD-10 transition.

Ask insurance carriers if they guarantee timely payments once ICD-10 is in effect?

Develop a plan to transition into the updated coding system including optimizing from 5 - 7 ‘characters.’

Identify the impact ICD-10 will have with related business associates & IT systems.

Avoid loss of cash flow and the task of ‘fishing’ for those extra dollars.


What to Ask Your Payers

Don’t chase after these funds… What is the action plan of your top eight to ten payers

for processing claims with ICD-10 diagnosis codes? Can each one adhere to contract guidelines to pay on

time once the claim is received? If a claim is rejected due to ICD-10 diagnosis codes

what is the protocol for resubmitting to get it paid? After resubmission when can you expect payment? Do your payers offer external testing for “Sample

patients” and when?


Prepare for Drop in Coding Productivity

1. ICD-10 training for the entire practice!

i. Billers & Codersii. Extra training for

anatomy/physiology and medical terminology

2. Understand key differences from ICD-9 to ICD-10.

3. Address any temporary staffing needs now and in the future.

4. How many ICD-10 trainers exist in your state (AHIMA, AAPC, etc.)?

“In times of drastic change, it is the

learners who inherit the future.”

E. Hoffer


Preventing Insurance Claim Rejections

Payers are ‘threatening’ to reject claims with unspecified diagnosis codes.

Determine documentation guidelines needed to assign codes to the highest level of specificity. Such as details to assign a code for closed fracture of the right carpal (wrist): initial encounter.

Run a report of commonly used diagnoses and physician notes and practice coding them in ICD-10.

Again, review and understand ICD-10 coding guidelines!


Example

In ICD-9, physician notes may state ‘other or ill-defined fracture of lower limb, NOS’ assign code; 827.0.

This may be rejected in ICD-10! To assign this code in ICD-10, the documentation would

need notes to include items such as the specific bone of the lower limb, is it with or without fibula, and record of the current encounter as a first visit or follow-up.

Thus: Subsequent encounter for fracture of left tibia shaft without fibula and the fracture is healing normally.

S82.202D


ICD-10 Overview


A little entertainment before the next subject… Do you feel like you are hitting something head on… ??Link: For ICD-10 Struck by… http://www.youtube.com/results?search_query=ICD-10+Code+W61.92+&oq=ICD-10+Code+W61.92+&gs_l=youtube.12...1916.1916.0.3252.1.1.0.0.0.0.74.74.1.1.0...0.0...1ac.2.11.youtube.9scNnGiw9XM

http://www.youtube.com/results?search_query=ICD-10+Code+W61.92+&oq=ICD-10+Code+W61.92+&gs_l=youtube.12...1916.1916.0.3252.1.1.0.0.0.0.74.74.1.1.0...0.0...1ac.2.11.youtube.9scNnGiw9XM






http://youtu.be/uZrIZ9elYCo

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Overview of ICD-10

Be prepared! Are we behind other countries

implementing ICD-10? Why change? What’s the same? What is different? Discuss ‘Placeholders” What does GEMS mean? Excludes 1 & 2—what is that? Yes, there’s a code for that!

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We Are Lagging Behind

A number of other countries have already put ICD-10 in practice, including: United Kingdom (1995); France (1997); Australia (1998); Germany (2000); Canada (2001)

http://www.google.com/url?sa=i&source=images&cd=&cad=rja&docid=Iu3tKn36JcKW_M&tbnid=YwhnU9Ar51UyJM:&ved=0CAgQjRwwAA&url=http://www.zonu.com/fullsize-en/2009-11-06-10856/Countries-of-the-World.html&ei=4pBxUoqEJYrXygGXq4CwBQ&psig=AFQjCNEkvwXovlZ-l0AdH_fYERxYn7sQHw&ust=1383260770646752


Why the change?

With our increased medical knowledge we ran out of room with ICD-9 to add updated diagnosis codes.

With ICD-9 some diseases and conditions were combined with other body systems.

For example: the sense organs (eyes and ears) are included with the nervous system diseases but will have their own chapters in ICD-10 CM.

To reflect current medical knowledge, certain diseases have been reclassified to a more appropriate chapter in ICD-10 CM.

For example, gout has been reclassified from the endocrine chapter in ICD-9 CM to the musculoskeletal chapter in ICD-10.

• In ICD-9 V and E codes are expanded in ICD-10. Thus, Chapters starting with ‘V, W, X, and Y’ are categorized as “External Causes of Morbidity, while Z is “Factors Influencing Health Status’

• Example: V00.131 is fall from skateboard and Z00.110 is health exam for newborn under 8 days old


ICD-9-CM and ICD-10-CM Code Comparisons

ICD-9-CM Diagnosis Codes ICD-10-CM Diagnosis Codes

3-5 characters in length 3-7 characters in length

Approximately 13,000 codes More than 68,000 codes

First digit alpha (E or V) or numeric; Digits 2-5 numeric

•First digit is alpha; Digits 2-3 are numeric; Digits 4-7 are alpha or numeric [Example: digits 4-6 are numeric: H52.212 irregular astigmatism left eye]

Limited space for adding new codes Flexible for adding new codes

Lacks detail and laterality Very specific and has laterality

Example: Pregnant woman at 34 weeks, delivered

Example: O60.14X1, Pregnancy, woman, 34 weeks, 2 days gestation, delivered.


What is the same? What is different?

ICD-10-CM Code format

Comparison ICD-10 (7 characters) to ICD- 9 CM (5 digits)

ICD-9 Code format

X X X X X X X X X X X X

category

Categoryetiology, extension

anatomic site

Example: S91.321A : 2cm laceration of the

right foot with foreign body

severity etiology, anatomic site,manifestations

Example: 892.1 is the same diagnosis,

without laterality


Guidelines – Seventh Character Definitions Initial encounter: Indicated by an ‘A’ as the 7th character

The letter ‘A’ is used while the patient is receiving active treatment for the injury.

Example: T22.111A: Burn of first degree of right forearm, First or Initial encounter

Subsequent encounter: Indicated by the letter ‘D’ The letter ‘D’ is used for encounter after the patient has received active

treatment of the injury and is receiving routine care for the injury during the healing or recovery phase.

Example: T22.111D: Burn of first degree of right forearm, Subsequent encounter

Sequela: Indicated by the letter ‘S’ as the 7th character The letter ‘S’ is used for complication or condition called the sequela. It is

defined as a “late effect or the residual effect after the acute phase of an illness or injury has ended that arise as a direct result of an injury.” Such as scar formation after a burn. The scars are a sequela of the burn

Example; T22.111S : Burn of first degree of right forearm, Sequela


What Is GEMS?

The acronym GEMS means General Equivalence Mapping.

It was developed as a tool to assist with converting ICD-9 codes to ICD-10. or ICD-10 to ICD-9 codes.

These are designed as ‘code sets’ but never to be used to actually assign an ICD-10 diagnosis code and are not included in the Official Guidelines for Coding

The GEMS idea was developed by Center for Medicare and Medicaid Services (CMS ) and the Center for Disease Control (CDC).


Example of the specificity of ICD-10 codes

The ICD-10-CM Diagnosis Code of E11.341 is defined as “Type 2 Diabetes mellitus with severe non-proliferative diabetic retinopathy with macular edema.”

This one code in ICD-10 combines 3 ICD-9-CM codes needed to describe the same scenario:

Type 2 diabetes mellitus with severe non-proliferative (damage to blood vessels in the retina) diabetic retinopathy with macular edema:o 250.50 Diabetes with ophthalmic manifestations, type II or specified

type, not stated as uncontrolled;o 36206 Severe non-proliferative diabetic retinopathy;o 36207 Diabetic macular edema


Placeholders

ICD-10 CM utilizes a dummy placeholder, which is always the “x” and it has two uses.

When a code has less than six characters and a seventh character extension is required. The “x” is assigned for all characters less than six in order to meet the requirement of coding to the highest level of specificity.

W85.xxxA – Exposure to electric transmission lines, initial encounterS17.0xxA – Crushing injury of larynx and trachea, initial encounterS01.02xA – Laceration with foreign body of scalp, initial encounter


ICD-9 has “Includes and Exclude” NotesICD-10 has Two Types of Excludes Notes

Excludes 1 – Indicates that the code excluded should never be used with the code where the note is located (do not report both codes).Example:•Q03– Congenital hydrocephalus.Excludes 1: Acquired hydrocephalus (G91.-).

Excludes 2 – Indicates that the condition excluded is not part of the condition represented by the code but a patient may have both conditions at the same time, in which case both codes may be assigned together (both codes can be reported to capture both conditions).Example:L27.2 – Dermatitis due to ingested food.Excludes 2: Dermatitis due to food in contact with skin (L23.6, L24.6, L25.4)

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Additional changes for ICD-10

New concepts in ICD-10 There are 21 chapters in ICD-10 each one

beginning with a letter except for ‘U’ . Tabular Index is divided in chapters and

subdivided into blocks. The term “Sepsis” is being replaced with the

term “Septicemia” in Chapter 1 of ICD-10. In some cases multiple codes are still

needed. For example, a patient diagnosed with a malignant left ovarian tumor, major weight loss, and situational depression (C56.2, R63.4, F32.9).


Additional changes for ICD-10

Some diagnosis codes in ICD-10 are not difficult to find:

Examples: Acute cholecystitis is K81.0 and Acute appendicitis is K35.80. (As always, start with finding the main term in Index of Diseases and Injuries)

When coding for a diagnosis documented as bilateral two codes are assigned:o Idiopathic chronic gout, bilateral hips:

M1A051 (right hip) and M1A.052 (left hip)


ICD-10 Let’s do something fun!

Yes, there’s a code for that!

Hint: Anaphylactic shock due to fruits and veggies (T78.04XA)

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Thank you for attending this webinar!

If you have recently taken the online Entry level ICD-10 assessment please watch for an email response from the United Physician Services Team!

If you passed the test, congratulations and don’t freak out! You are on the path to be well prepared for ICD-10 implementation.

Next Step! accept the challenge of passing the Intermediate level test by visiting our online store:

www.upshealthcare.com/store

We are prepared to assist with your ICD-10 Coding needs! Contact us today to schedule a one on one session with an ICD-10 Trainer approved by AHIMA.

We can customize an ICD-10 specialty training course for your Best Business Practice. Contact us today for additional information!

Email us with any questions:[email protected] [email protected] or call 602.685.9500

http://www.upshealthcare.com/store








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