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PREPARATION STEPS ICD-10 1

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PREPARATION STEPS

ICD-10

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VEI Consulting

PREPARATION STEPS ICD-10

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This information was current at the time of publication and/or presentation.

Medicare and commercial payer policies change frequently so source documents

have been provided within the presentation for your reference.

This presentation was prepared as a tool to assist providers and is not intended

to grant rights or impose obligations. Although every reasonable effort has been

made to assure the accuracy of the information within these pages, the ultimate

responsibility for the correct submission of claims and response to any remittance

advice lies with the provider of services. VEI Consulting, ICDExpert.net

employees, agents, and staff make no guarantee that this information is error-free

and bears no liability or responsibility for any results or consequences resulting

from the use of this information. Medical practitioners are responsible for the day

to day implementation and compliance with applicable state and federal laws and

regulations. Attendees should contact their own counsel or advisors for further

legal opinion.

Disclaimer

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Objectives

• Compliance Deadline

• Where we are today

• Structural Differences

• Planning Phase

• Steps to preparedness

• Resources

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WHERE WE ARE TODAY

• ICD-10 Mandatory Compliance Deadline: • October 1, 2014

• Industry Challenges

• It is not just about coding – It is about clinical

documentation of records to support accurate coding

• Better information leads to better care

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What is ICD-10?

International Classification of Diseases, Tenth Revision, Clinical

Modification (ICD-10-CM)

• The diagnosis code set that will replace ICD-9-CM Volumes 1 and 2

• Reports diagnosis in all clinical settings

International Classification of Diseases, Tenth Revision, Procedure

Coding System (ICD-10-PCS)

• The procedure code set that will replace ICD-9-PCS Volume 3

• Reports hospital inpatient procedures only

ICD-10-PCS will NOT replace CPT

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Why Convert to ICD-10-CM?

ICD-9-CM is outdated

• 30 years old – technology has changed

• Many of the categories are full

• Not descriptive enough

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Why Convert to ICD-10-CM?

Benefits of ICD-10

•Detailed health reporting and analytics

•Detailed information on condition, severity,

comorbidities, complications, and locations

•Expanded coding flexibility

•Improved operational processes 8

STAKEHOLDERS

• HIM

• Coding Processes

• CDI Processes

• IT

• System Compliance

• FINANCE

• Payer Contracts

• Account resolution

• PHYSICIANS/PRACTITIONERS

• Documentation specificity

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ASSESSMENTS

Organization

• Needs and Functions of all Departments

Coder/Biller/Staff

• Anatomy and Physiology

• Medical Terminology

• Official Coding Guidelines

Documentation Assessment

• Specificity and quality of clinical documentation

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Structural Differences

ICD-9-CM

3 to 5 digit codes

Letters V and E

14,315+ ICD-9-CM and 3,824 ICD-9-PCS

ICD-10-CM

3 to 7 alpha numeric characters

All letters except U

69,099 + ICD-10-CM

71,957+ ICD-10-PCS

Greater specificity 11

ORGANIZATIONAL & STUCTURAL CHANGES

ICD-9-CM

17 CHAPTERS

Letters V and E

Injuries classified by type

ICD-10-CM

21 CHAPTERS

Eye and Ear have their own chapter

All letters except U

Postoperative Complications moved to procedure specific body system chapter

Reclassifications

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CODE STRUCTURE

Code structure of ICD-10-CM versus ICD-9-CM

ICD-9-CM codes are three to five digits while ICD-10-CM codes can be from three to

seven characters, with the seventh character extensions representing visit encounter,

subsequent, or sequelae for injuries and external causes, etc.

ICD-9-CM Code Format ICD-10-CM Code Format

category etiology,

anatomic site,

manifestation

category etiology extension

anatomic site,

severity

3 3 2 8 S 4 2 3 1 1 K 7

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Tabular List – Structural Differences:

•Certain diseases have been reclassified to a more

appropriate chapter in ICD-10-CM to reflect current

medical knowledge

•Ex: Gout reclassified from the endocrine chapter

in ICD-9-CM to the musculoskeletal chapter in ICD-

10-CM

•Postoperative complications have been moved to

procedure-specific body system chapters

Structural Differences

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New for physicians and coders

• Laterality – need to know which side was affected

• Encounter – need to know if it was an initial encounter,

subsequent encounter or sequela

• Activity – need to know what the patient was doing when

the injury occurred

• Place of Occurrence – need to know where the patient was

when the injury occurred

Structural Differences

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Index – structured the same as ICD-9-CM

• Alphabetic Index of Diseases and Injuries

• Alphabetic Index of External Causes

• Table of Neoplasm

• Table of Drugs and Chemicals

Structural Differences

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Many conventions have same meaning

• Abbreviations

• Punctuations

• Symbols

• Notes such as “code first” and “use

additional code”

Structural Differences

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ICD-10-PCS allows identification of:

• Body system

• Root operation

• Body part

• Approach

• Device involved in the procedure

Structural Differences

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New for physicians and coders

•Added clinical concepts

•Ex: underdosing, blood type, coma scale, etc

•Obstetric codes identify trimester

•Changes in some code definitions

•Ex: acute myocardial infarction has changed from 8

weeks to 4 weeks

Structural Differences

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ICD-9 codes

• 14,315 CM diagnosis codes

• 3,824 PCS procedure codes

ICD-10 codes

• 69,099 CM diagnosis codes

• 71,957 PCS procedure codes

Change in character length requires system upgrades to

expand data fields for the longer codes

Structural Differences

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General Equivalence Mapping (GEM)

• Created by Centers for Medicare & Medicaid Services (CMS)

and Centers for Disease Control and Prevention (CDC) as a

general purpose translation tool

• Ensure that consistency in national data is maintained

• Updated annually

• NOT a substitute for learning how to use the ICD-10-CM and

ICD-10-PCS code books

• GEM and User Guides are found at CMS website

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Coding Snapshot - Fracture

ICD-9-CM Diagnostic Statement : Orbital fracture

• Assign ICD-9: 802.8 Other facial bones, closed

•Orbit

•NOS

•Part other than roof or floor

•Coder’s query to physician should include:

•Bone?

•Open or Closed?

•Physician updates diagnostic statement in medical record as

follows:

•802.6 orbital floor (blow out), closed

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Coding Snapshot- Fracture

ICD-10-CM Diagnostic Statement: Initial encounter

closed orbital floor fracture, batter hit by baseball in a

public park

•Assign ICD-10-CM:

•S02.3xxA fracture of orbital floor, initial encounter

for closed fracture

•W21.03xA struck by baseball, initial encounter

•Y92.320 baseball field as the place of occurrence of

the external cause

•Y92.830 public park as the place of occurrence of

the external cause

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Planning Phase

•Assign overall responsibility and decision-making

authority for managing the transition

•Ensure top leadership understands the breadth and

significance of the ICD-10 change

•Ensure involvement and commitment of all internal and

external stakeholders

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Planning Phase

• Impact/GAP Analysis

• Assessments

• Adhere to a well-defined timeline

• Plan a comprehensive and realistic budget

• What you don’t know today will hurt your organization

tomorrow!

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Steps to Preparation

#1: Identify Current Systems and Work Processes

Impact Assessment

• Where are you using ICD-9?

• Electronic or manual

• Clinical documentation

• Encounter Forms or Superbills

• Practice Management System

• Electronic Health Record (EHR/EMR) System

• Quality Reporting

• Public Health Reporting

• Contracts

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#2: Communicate with Practice Management System Vendor

• Review your contract to determine if regulatory updates are included in your maintenance

• Ask your vendor the following questions:

• Can my current system accommodate the data format changes for the ICD-10 codes?

• Will you be upgrading my current system to accommodate the ICD-10 codes?

• Will there be a charge for the upgrade?

• When will the upgrades be available for installation?

• When will the upgrades to my system be completed?

Steps to Preparation

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Steps to Preparation

#3: Communicate with Your Billing Service,

Clearinghouse and Payers

• Ask your billing service and clearinghouse the following

questions:

• Will you be upgrading your systems to accommodate the

ICD-10 codes?

• When will your upgrades be complete?

• When can I send claims and other transactions with ICD-10

codes to you so you can test that they will be accepted?

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Steps to Preparation

#4: Communicate with Your Payers About Your

Contracts

• Payers may modify the terms of their contracts for billing

• Medical policies and local coverage determinations may

require highest specificity be reported

• Payment schedules may be altered and reimbursed

differently for higher vs. less specific codes

• More detailed ICD-10 may impact payer medical review,

auditing, and coverage

• Negotiate extended timely filing limits and appeals time

limits

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Steps to Preparation

#5: Identify Changes to Practice Work Flow and

Business Processes

• Clinical documentation

• Encounter Forms or Superbills

• Quality Reporting

• Public Health Reporting

• The biggest disruption in workflow will occur

when the information needed for coding just isn’t

there!

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Steps to Preparation

#6: Identify Staff Training Needs

• Critical step is ensuring that staff are knowledgeable about the

ICD-10 code set

• Staff may require different training based on their involvement

with diagnosis codes

• Clinical staff will need to understand how their documentation

will impact the ability to code and bill

• Coding staff will need the most training to learn how to use the

new code set and capture the diagnosis using ICD-10

• Focus on learning the ICD-10 code set and work flow changes

• The most important thing to do TODAY is to ensure that

documentation is sufficient

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Steps to Preparation

#6: Identify Staff Training Needs

Ask the following questions:

• Which ICD-10 codes sets do we need to receive training: ICD-10-CM, ICD-10-PCS, or both?

• Who needs to be trained?

• How long will it take to train?

• What training format will work best?

• Where can we obtain training?

• What is the cost of training?

• What resources will be needed to support the staff after training?

• When should training be completed?

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Steps to Preparation

#7: Test – Test – Test!

Trading partners

• Organizations with which you exchange various transactions

Ask the following questions:

• Which transactions should I test with the ICD-10 codes?

• It’s not just about claims!

• Which trading partners should I test with?

• When should I begin testing?

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Steps to Preparation

#8: Budget for Implementation Costs

Include expenses for:

• System changes

• Practice business process changes

• Resource materials

• Training

• Continued education

• ICD-9 focused review of current documentation

• ICD-10 focused review of medical records

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Steps to Preparation

Transition Phase

How do you actually make the jump into transition

and what things do you need to look for while you are

making the transition?

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Steps to Preparation

Transition Phase – Where are you today?

Don’t be stuck between a rock and hard place

There is a code for that!

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References

• Centers for Medicare and Medicaid Services (CMS)

http://www.cms.gov/ICD10/

• American Medical Association www.ama-assn.org

• ICD-10 Final Rule Federal Register published January 16, 2009

http://edocket.access.gpo.gov

• ICD-10 Final Rule Federal Register published September 5, 2012

http://edocket.access.gpo.gov

• American Academy of Professional Coders www.aapc.com

• American Health Information Management Association www.ahima.org

• Assess Your Skills:

• Medical Terminology/Anatomy/Physiology:

http://www.dmu.edu/medterms/

• Human Anatomy and Physiology:

http://www.lrn.org/index.html?wwparam=1327609974

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Questions

Questions about this presentation can be emailed to

VEI Consulting Services

7330 Shadeland Station, Suite 200

Indianapolis, IN 45256-3985

www.veicorp.com/consulting

E-mail: [email protected]

Office: (317) 621-7197 Fax: (317) 355-8738

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