David J. Freedman, DPM, FASPS, CPC, CPMA,CSFAC

Transcription

1

2 David J. Freedman, DPM, FASPS, CPC, CPMA,CSFAC Certified Professional coder Certified Professional Medical Auditor Certified Surgical Foot & Ankle Coder APMA Coding Committee, member since 2005 ICD 10 Team Manager APMA Past President, Maryland Board of Podiatric Medical Examiners CAC member Maryland Maryland Podiatric Medical Association Coding Tips. 26 years of Coding and Billing Experience

3 POTENTIAL SPEAKER CONFLICTS: 1) Volunteer as CAC representative with Medicare and APMA 2) Own and authored 3) Provide consulting services to doctors and medical company s

4 Disclaimer: Don t blame the speaker, me for the coding suggestions, jokes, or information for this presentation as its represents only the opinion of the lecturer. So, no consequences or liability incurred using information contained in this presentation. CPT, ICD-9-CM, ICD-10-CM and HCPCS code descriptors and coding policies do not determine coverage and payment policies, and do not ensure payment for any service. Coding coverage and payment policies of governmental and commercial payers may vary, so questions regarding coding coverage and payment for a specific item or service should be directed to the particular payer involved.

5 ICD-10 CM Is Just Around the Corner Need to understand the concept of ICD-10 Implementation date is Oct, This applies to CMS and private insurance Companies but there is an EXCEPTION TO THE RULE Workers Compensation and Auto Insurance are NOT mandated to switch, what does this mean to you?

6

7 ICD-10 CM Is Just Around the Corner First The Bad News

8 ICD-10 CM Is Just Around the Corner-Potential negative impacts Decreased productivity Interrupted cash flow Increased amount of rejections Incompatible systems Increased volumes of work Incorrect mapping Increased risk of payer audits

9 Discussion Points 1. History of ICD and WHO? 2. Why are we changing? 3. What is ICD-10? 4. What is the difference between CM and PCS? 5. Examples 6. What s it going to cost? 7. What do I do to get ready?

10 CMS links 1. sion_project.asp Education/Medicare-Learning-Network- MLN/MLNMattersArticles/downloads/SE1239.pdf CDC links 1.

11 There s an app for that:

12

13 ICDTENHELP.com Resource made simple Instruction Page is 1 st tab Now lets proceed 2 nd tab ICD 9 to ICD 10 Tabular Only

14

15 ICDTENHELP.com 3 rd Tab is ICD 10 Tabular Coding Only

16

17 ICDTENHELP.com 4 th Tab is ICD9 to ICD10 Index & Tabular

18

19 ICDTENHELP.com Rules of ICD 10

20

21

22 CM Clinical Modifications The CM part of ICD-10 can vary from country to country The US version of ICD-10 is different from the Canadian and the Mexican versions

23 Direct Comparison ICD-9 (five digits) X X X. X X Category etiology anatomic site, manifestation ICD-10 (seven digits) X X X. X X X X Category etiology extension anatomic site, severity

24 3 Character Categories Characters st Character Alpha A-Z 2 nd Character Numeric rd Character Numeric 0-9 Describes system or disease process

25 ICD-10 Terms Chapters 22 Chapters identifying categories Blocks Subchapters Etiology, anatomical site, severity Rubrics Identify closely related conditions Extensions

26 ICD-10 Chapters Chapter 1 A00-B99 Infectious and Parasitic diseases Chapter 2 C00-D49 Neoplasms Chapter 3 D50-D89 Hematological and Immune Systems Chapter 4 E00-E90 Endocrine, Nutritional and Metabolic Diseases Chapter 5 F01-F99 Mental and Behavioral Disorders Chapter 6 G00-G99 Diseases of the Nervous System Chapter 7 H00-H59 Diseases of the Eye and Adnexa

27 ICD-10 Chapters Chapter 8 H-60-H95 Diseases of the Ear and Mastoid Process Chapter 9 I01-I99 Diseases of the Circulatory System Chapter 10 J00-J99 Diseases of the Repiratory System Chapter 11 K00-K94 Diseases of the Digestive System Chapter 12 L00-L99 Diseases of the Skin and Subcutaneous Tissue Chapter 13 M00-M99 Disease of the Musculoskeletal System and Connective Tissue Chapter 14 N00-N99 Diseases of the Genitourinary System

28 ICD-10 Chapters Chapter 15 O00-O99 Pregnancy, Childbirth and Puerperium Chapter 16 P00-P96 Certain Conditions Originating in the Perinatal Period Chapter 17 Q00-Q99 Congenital Malformations, Deformations and Chromosomal Abnormalities Chapter 18 R00-R99 Symptoms, Signs and Abnormal Clinical and Laboratory findings, not classified elsewhere Chapter 19 S00-T88 Injury, Poisoning and Certain other Consequences of External Causes

29 ICD-10 Chapters Chapter 20 V00-Y98 External Causes of Disease or Morbidity Chapter 21 Z00-Z99 Factors Influencing Health Status and Contact with Health Services Chapter 22 Special Purposes

30 ICD-10 Example Index There is a period after the 3 rd character and often a dash Example Pain M79. Define the site, etiology, manifestation or state of the disease or condition Numeric Example Pain M79. -

31 ICD-10 Example 4th Character Define the site, etiology, manifestation or state of the disease or condition Numeric Example Pain M79. - M79.6 pain in limb, hand, foot, fingers, toes

32 ICD-10 Example 5 th Character 5 th character identifies a level of specificity Letter or Number (0-9) Example M79. Pain M79.6 pain in limb, hand, foot, fingers, toes M79.60 Pain in limb

33 ICD-10 Example 6 th character is even more specific Numeric (0-9) Describes specific location or cause For laterality 1 is right 2 is left 3 is unspecified Example Pain M79.- M79.6 pain in limb, hand, foot, fingers, toes M79.60 Pain in limb unspecified M Pain in right foot

34 ICD-10 Example 6 th character is even more specific Numeric (0-9) Describes specific location or cause For laterality 1 is right 2 is left 3 is unspecified Example Pain M79.- M79.6 pain in limb, hand, foot, fingers, toes M79.60 Pain in limb unspecified M Pain in right foot

35 ICD-10 Example Dummy 5 th Character Just to confuse you even more To allow for further expansion some codes have a dummy 5 th place character so that the 6 character structure will not be disrupted when changes are added Report these codes as they are in the book including the dummy 5 th character x

36 ICD-10 Example Dummy 5 th Character Example Poisoning T45.- T45.7 poisoning by, adverse effect of, and under dosing of anticoagulant antagonists, Vitamin K, and other coagulants T45.7x the x is holding a space for a future 5 th place character T45.7x1 accidental T45.7x2 intentional, self harm T45.7x3 assault T34.7x4 undetermined

37 ICD-10 Example 7 th Character Some codes have a so-called character extension Typically letters, that describe conditions/timing of the visit Used to give more information about the events related to the reason for the visit or service

38 th Non-fracture care A- initial encounter D- subsequent encounter S- sequela Fracture care A- initial encounter (for closed fracture) B initial encounter for open fracture D- subsequent encounter for normal healing fracture G- subsequent encounter for delayed healing fracture K- subsequent encounter for fracture with non-union P- subsequent encounter for fracture with mal-union S- sequela of fracture

39 NEW ICD-10 Features Laterality C76.51 Malignant neoplasm of right lower limb Combination of certain conditions and common associated symptoms E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy

40 NEW ICD-10 Features Combination codes for poisonings and their associated external cause T36.1x2S Poisoning by cephalosporins and other betalactam antibiotics, intentional self-harm, sequela Character x is used as a 5 th character placeholder T45.7x1A Poisoning by anticoagulant antagonists, vitamin K and other coagulants,accidental (unintentional), initial encounter

41 NEW ICD-10 Features Obstetric codes identify trimester instead of episode of care O excessive weight gain in pregnancy, second trimester Inclusion of clinical concepts that do not exist in ICD- 9 (e.g., underdosing, blood type, blood alcohol level) T45.526D underdosing of antithrombotic drugs, subsequent encounter

42 NEW ICD-10 Features Significantly expanded codes (e.g., injuries, diabetes, substance abuse, postoperative complications) E type 1 diabetes mellitus with diabetic neuropathic arthropathy Distinction between intraoperative complications and postprocedural disorders G97.31 Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating a nervous system procedure G97.51 Postprocedural hemorrhage and hematoma of a nervous system organ or structure following a nervous system procedure

43 Costs of ICD-10 Implementation Overall health care industry $8 Billion Average small practice upgrade $84,000 Average large practice upgrade $3 Million Average health plan upgrade $14 Million Most costs are associated with monies aimed at training, software upgrades and contract negotiations

44 Costs of ICD-10 Implementation- Collateral issues Your practice must have 5010 activated Problems with 5010 implementation will forecast ICD- 10 implementation issues All NCD s and LCD s have to be updated CMS has set this to be completed in April 2014 EHR usage should make it easier Expect income lapse when implementation starts Payment issues may continue for 3-6 months afterwards

45 Strategies for Success The first place to begin in preparing for ICD-10 implementation is with communication Keep everyone updated on what is happening No delay, we need to continue to prepare for the transition If you take it seriously, so will the people you are leading What form of communication will be most effective in your office/institution

46 Impact analysis Create a flow chart to: Demonstrate how the action of each individual impacts the entire process Identify areas of weakness and quickly create a process to strengthen it Clearly illustrates the need for interaction between departments, clinical or business areas Make impacts visible to all areas Generate ownership of each process Provides a clear picture of how things work today and can outline how things should work in the future

47 Impact analysis Determine any area in the practice that currently utilizes an ICD-9-CM code Ask for input from the various departments to ensure that nothing is overlooked How are performance measures captured Prior authorizations Research Tracking and trending

48 Build an action plan Build an action plan based on the results of the impact analysis Create a preliminary needs assessment Establish timeline parameters to create a roadmap Adhere to the timeline, but be open-minded to allow for unexpected circumstances Begin discussion early with vendors to understand their timelines

49 Measure productivity Understand where productivity is at prior to the implementation of ICD-10 Use this as a goal to get back to after the official implementation date Canada indicates that their productivity has not recovered since implementation Different reimbursement system Implemented EMR at same time as ICD-10 Went from DOS system to an electronic world

50 Questions for Consideration: Have you identified all internal systems and processes that will be impacted by the change to ICD- 10? Has your office performed a cost analysis to understand the financial impact for your organization? For example, revenue impacts that could result from improperly coded claims

51 Questions for Consideration: 1. Have you identified all inter-dependencies on external partners such as coding vendors, clearinghouses, etc.? Have you confirmed that all remediation and testing dates are mutually acceptable? 2. Do you know if you will be utilizing the CMS crosswalks and if so, what impact those may have on expected outcomes? 3. Will you be trying to realize any benefit or value from this new code set?

52 TIME PLAN THAT HAS BEEN PUBLISHED: Give your practice at least 18 months prior to the implementation date of Oct 1, 2014 to make sure you are ready. Wait you have only 9 months to go is that a problem?

53 What Are Insurance Companies Doing To Get Ready? United Health Care related they will be ready Aetna relates they will be ready CMS says their contractors will be ready and national testing is week 3/5/2014 Not sure about others

54 /ICD-10/icd-10- mapping.aspx

55 New CMS FORM Effective date 1/1/2014 Transition 1/1/14-4/1/2014 Drop dead date 4/1/2014

56

57 To Know ICD 10 CM You need to know 2 things, #1

58 #2

59

60

61 Let s look at Heel Ulcer example

62

63

64

65

66 ICD-9 to ICD 10 Coding 1) Ulceration right heel. ICD9= ) Ulceration Right Heel. ICD-10=L Non-pressure chronic ulcer of right heel and midfoot with fat layer exposed

67

68

69

70

71

72

73 ICD-9 to ICD 10 Coding 2) Type 2 DM with neuropathy. ICD9= and ) E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy

74 ICD-9 to ICD 10 Coding 2) Type 2 DM with neuropathy. ICD9= and ) E Type 2 diabetes mellitus with foot ulcer Use additional code to identify site of ulcer (L97.4-, L97.5-)

75 In Summary based on ICD-10 Rules the following are coded: 1) E Type 2 diabetes mellitus with foot ulcer Use additional code to identify site of ulcer (L97.4-, L97.5-) 2) Ulceration Right Heel. ICD-10=L Non-pressure chronic ulcer of right heel and midfoot with fat layer exposed 3) E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy

76

77 Cellulitis/Abscess Example Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single MC=$ ICD9: Global toe Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple MC=$ ICD9: Global toe ony/par foot ankle/leg Post-op ony/par foot ankle/leg Post-op

78 I&D Abscess (NOT DEEP) Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single MC=$ ICD9: Global toe Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple MC=$ ICD9: Global toe ony/par foot ankle/leg Post-op ony/par foot ankle/leg Post-op

79

80

81 ICD-9 to ICD 10 Coding 1) Cellulitis toe ICD9= ) Onychia/Paronychia ICD9= ) Cellulitis ankle/leg ICD9= ) Cellulitis Foot ICD0= ) Post-op ICD9=

82

83 ICD-9 to ICD 10 Coding 1) Cellulitis toe ICD9= ) Onychia/Paronychia ICD9= ) L Cellulitis of right toe 2) L Cellulitis of left toe

84 ICD-9 to ICD 10 Coding 1) Cellulitis ankle/leg 2) Cellulitis Foot 1) L Cellulitis of right lower limb 2) L Cellulitis of left lower limb 3) L Acute lymphangitis of right lower limb 4) L Acute lymphangitis of left lower limb

85

86

87

88 ICD-9 to ICD 10 Coding 1) Post-op 1) T81.4XXA Infection following a procedure Initial Encounter

89 Osteomyelitis Example

90

91 ICD-9 to ICD 10 Coding 1) Bone-Acute 1) M Acute hematogenous osteomyelitis, right ankle and foot 2) M Acute hematogenous osteomyelitis, left ankle and foot 3) M Other acute osteomyelitis, right ankle and foot 4) M Other acute osteomyelitis, left ankle and foot

92

93

94 ICD-9 to ICD 10 Coding 1) Bone-Chronic 1) M Chronic multifocal osteomyelitis, right ankle and foot 2) M Chronic multifocal osteomyelitis, left ankle and foot 3) M Chronic osteomyelitis with draining sinus, right ankle and foot 4) M Chronic osteomyelitis with draining sinus, left ankle and foot

95

96

97

98 ICD-9 to ICD 10 Coding 1) Bone-Acute 1) M Acute hematogenous osteomyelitis, right ankle and foot 2) M Acute hematogenous osteomyelitis, left ankle and foot 3) M Other acute osteomyelitis, right ankle and foot 4) M Other acute osteomyelitis, left ankle and foot

99

100

101 ICD-9 to ICD 10 Coding 1) Bone-Chronic 1) M Chronic multifocal osteomyelitis, right ankle and foot 2) M Chronic multifocal osteomyelitis, left ankle and foot 3) M Chronic osteomyelitis with draining sinus, right ankle and foot 4) M Chronic osteomyelitis with draining sinus, left ankle and foot

102 Infection

103 Infection

104 Infection

105

106 ICD-9 to ICD 10 Coding 1) Decubitus ulcer, ankle 2) Decubitus ulcer, heel 3) Decubitus ulcer, other site 1) 2) 3) 4) 5) L L L L L L L L L L89.894

107

108

109

110

111

112

113

114

115

116

117

118