Medicare 101 Series: Part 3- ICD-10
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1 Medicare 101 Series: Part 3- ICD-10 Part B Provider Outreach and Education Cahaba GBA January 22, 2014
2 Housekeeping Tips When you called in, did you enter your attendee code? Dial-in number: Attendee (participant) Code: The audio portion of the conference may be accessed via the telephone or by using your computer's speakers. The preferred method of listening is via the toll-free number Ensure the address provided during registration is correct and make sure that your SPAM filter is turned off for items coming from 2
3 Disclaimer This resource is not a legal document. This presentation was prepared as a tool to assist our providers. This presentation was current at the time it was created. Although every reasonable effort has been made to assure accurate information, responsibility for correct claims submission lies with the provider of services. Reproduction of this material for profit is prohibited. 3
4 Agenda ICD-10 Implementation Benefits Similarities and Differences National Testing Week Additional Website Resources 4
5 Benefits of ICD-10 Organizational Monitoring & Performance Improved efficiencies and lower costs Recognition of advances in medicine and technology Improved ability to analyze trend and cost data More effective monitoring of resource and service utilization Reduce coding errors 5
6 ICD-10 Implementation October 1, 2014 Compliance date for implementation of ICD-10-CM (diagnoses) ICD-10-CM (diagnoses) will be used by all providers in every healthcare setting No impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes 6
7 ICD-10 Implementation Single implementation date of October 1, 2014 for all users) ICD-9-CM codes will not be accepted for services provided on or after October 1, 2014 ICD-10-CM codes will not be accepted for services prior to October 1,
8 ICD-10-CM Structure ICD-9-CM 3-5 characters First character is numeric or alpha (E or V) Characters 2-5 are numeric Always at least 3 characters Use of decimal after 3 characters ICD-10-CM 3-7 characters Character 1 is alpha (all letters except U are used) Character 2 is numeric Characters 3-7 are alpha or numeric (not case sensitive) Use of decimal after 3 characters (e.g., Right ankle sprain, initial encounter: S93.401A, S93.401a, s93.401a, s93.401a) 8
9 Similarities to ICD-9-CM Tabular List Chronological list of codes divided into chapters based on the body system or condition Same hierarchical structure Chapters in Tabular structured similarly to ICD-9-CM, with minor exceptions A few chapters have been restructured Sense organs (eye and ear) separated from Nervous System chapter and moved to theirown chapters 9
10 Differences from ICD-9-CM Expanded detail and specificity Laterality (side of the body affected) has been added to relevant codes Expanded use of combination codes certain conditions and associated common symptoms or manifestations 10
11 Differences from ICD-9-CM Poisonings and associated external cause 7 th character used in certain chapters (e.g., Obstetrics, Injury, Musculoskeletal, and External Cause chapters) Dummy placeholder X ( or x ) 11
12 Questions to Ask Your Vendor Will you install products well before the October 1, 2014, deadline, so I can begin testing? Will support for my current products be discontinued after the October 1, 2014, ICD-10 deadline? Will I need new hardware to accommodate ICD-10-related software changes? Will you offer product support? If so, how long will the vendor support the application? Will you help me test my system with payers and other trading partners? Will your product allow for coding in both ICD-9 and ICD-10 to accommodate transactions with dates of service before October 1, 2014, and transactions with dates of service after October 1, 2014? 12
13 ICD-10 Testing Week Registration is required Test claims with ICD-10 codes must be submitted with current dates of service Test claims will receive the 277CA or 999 Testing will not confirm claim payment or produce remittance advice Real-time help desk support Test files must include T indicator in ISA15 Test environment 13
14 CMS ICD-10 Website The CMS ICD-10 website provides the latest ICD-10 information and links to resources for providers to prepare for ICD-10 implementation Sign up for CMS ICD-10 Industry Updates The CMS Sponsored ICD-10 Teleconferences web page provides information on upcoming and previous CMS ICD-10 National Provider Calls, including registration, presentation materials, video slideshow presentations, written transcripts and audio recordings 14
15 CMS ICD-10 Website Medicare Fee-for-Service Provider Resources web page and Provider Resources (for all providers) web page provide links to a variety of related educational resources and information ICD-10-CM Official Guidelines for Coding and Reporting accompany and complement ICD-10-CM conventions and instructions 15
16 MLN Matters Articles: MLN Resources MLN Matters Special Edition Article SE1239, Updated ICD-10 Implementation Information MLN Matters Special Edition Article SE1240, Partial Code Freeze Prior to ICD-10 Implementation MLN Matters Article MM7492, "Medicare FFS Claims Processing Guidance for Implementing ICD-10 MLN Products: ICD-10-CM/PCS Myths and Facts" Fact Sheet "ICD-10-CM/PCS The Next Generation of Coding" Fact Sheet "ICD-10-CM Classification Enhancements" Fact Sheet "General Equivalence Mappings Frequently Asked Questions" Booklet 16
17 FAQs Q: Are ICD-10-CM code books available? A: ICD-10-CM code books are already readily available from existing ICD-9-CM code book publishers. ICD-10-CM is also available free of charge in PDF and XML formats from the National Center for Health Statistics website: 17
18 FAQs Q: Where can physician practices obtain a list of ICD-10-CM codes applicable to their particular specialty? A: Contact the appropriate medical specialty society. 18
19 Fore See Survey 19
20 Questions? 20
21 Evaluate Your Experience with Today s Educational Event To ensure that the Provider Outreach and Education department continues to be responsive to your needs, we are providing you with the opportunity to evaluate today s event. To complete the evaluation, access the following link: All registrants will also receive a reminder immediately after the call. Please disregard this if you have already completed the evaluation. 21
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Financial Disclosure. Teri Thurston does not have any relevant financial relationships with any commercial interests
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