Welcome to the ICD-10 Webinar

Transcription

1 Welcome to the ICD-10 Webinar For the listening benefit of webinar attendees, we have muted all lines and will be starting our presentation shortly This helps prevent background noise (e.g. unmuted phones or phones put on hold) during the webinar This also means we are unable to hear you during the webinar Please submit your questions directly through the webinar platform only How to submit questions: Open the Q&A feature at the top of your screen to type your question related to today s ICD-10 webinar Once your question is typed in, hit the ask a question button to send it to the presenter We will address submitted questions at the end of the webinar A printable PDF of this slide presentation is available online at >ICD-10 Conversion 1

2 ICD10 Are you ready? July 22, Aug. 5, 19, Sept. 9, 23, 2015 Blue Cross and Blue Shield of Louisiana incorporated as Louisiana Health Service & Indemnity Company Presented by Kelly Smith Provider Relations Department Blue Cross and Blue Shield of Louisiana 2

3 Webinar Objectives 1. Assist the provider community with ICD-10 readiness 2. Share resources and educational opportunities 3. Provide information on how Blue Cross will handle the transition process for claims and authorizations 4. Answer electronically submitted questions 3

4 What Is Replacing ICD-9? ICD-10-CM ICD-10-CM (clinical modification) is a classification of diagnosis codes developed by the CDC and formatted much like the ICD-9-CM codes ICD-10-CM codes are expanded to include sixth and seventh characters/digits and fourth and fifth digit sub-classifications Used in all healthcare treatment settings ICD-10-PCS ICD-10-PCS (procedure classification system) is a classification of procedure codes developed by CMS to be used to report procedures performed in an inpatient hospital setting only ICD-10-PCS codes will consist of a seven alpha-numeric code structure (compared to ICD-9-CM procedures codes that only use three or four numeric codes) 4

5 Why the Change to ICD-10? The transition to ICD-10 codes will allow for necessary details on: Patient medical conditions Procedures performed during a patient s hospitalization ICD-9 codes are outdated, use obsolete terminology and are inconsistent with current medical practices. 5

6 Tips to Prepare for ICD-10 Compliance Develop a plan for implementing the upcoming ICD-10 code changes Reach out to your information technology system vendors, medical management software vendors, trading partners, etc. Assess the impact of converting to ICD-10 codes Develop a strategy for implementing system changes including testing and go-live dates Evaluate and prepare for any financial impacts this change may create Develop a plan for training your employees on this change Acquire necessary resources to implement your transition to ICD Test claims with your information technology system vendors, medical management software vendors, trading partners, etc. 6

7 CMS Flexibility to ICD -10 Implementation In early July 2015, CMS granted providers a one-year flexibility regarding the specificity of coding on professional claims when using ICD-10 codes. This does not mean that CMS will accept non-billable codes or ICD-9 codes. Blue Cross requires that providers should always code claims with the most specific ICD-10 codes available. The instructions included on the following slides can be used to ensure proper coding and authorization practices. ICD-10 is effective October 1,

8 Specificity of Codes Example of specific ICD-10 coding: not billable* preferred preferred M86.44 Chronic osteomyelitis with draining sinus, hand M Chronic osteomyelitis with draining sinus, right hand M Chronic osteomyelitis with draining sinus, left hand Only bill the unspecified code when no other code is appropriate not preferred M Chronic osteomyelitis with draining sinus, unspecified hand * Header codes are considered incomplete and are not valid billable codes 8

9 Claims on October 1? Let s talk about claims BCBSLA WILL NOT ACCEPT claims that contain both ICD-9 and ICD-10 codes on a single claim BCBSLA WILL REJECT electronic claims not adhering to these guidelines/conditions on the Electronic Not Accepted Report BCBSLA WILL REJECT paper claims not adhering to the guidelines/conditions above. Claims will be returned to the provider in a send back letter Make sure claims include For inpatient claims: the most specific ICD-10 the grouper will compute DRGs based on the codes and can be Discharge Date supported by the patient s medical records 9 Benefits and reimbursement will be based on the Admit Date

10 Claims on October 1? Facility Inpatient Claims Scenarios Claim Coding Requirements Claim Processing Rules Admit and Discharge Dates before Oct. 1, 2015 The claim should be coded with ICD-9 codes 1. The claim will be accepted for processing by BCBSLA if it is coded with ICD-9 codes 2. The claim will be rejected by BCBSLA if it is coded with ICD-10 codes and will need to be resubmitted using ICD-9 codes Admit Date before Oct. 1, 2015, and Discharge Date on or after Oct. 1, 2015 Admit and Discharge Dates on or after Oct. 1, 2015 The claim should be coded with ICD-10 codes The claim should be coded with ICD-10 codes 1. The claim will be accepted for processing by BCBSLA if it is coded with ICD-10 codes 2. The claim will be rejected by BCBSLA if it is coded with ICD-9 codes and will need to be resubmitted using ICD-10 codes 1. The claim will be accepted for processing by BCBSLA if it is coded with ICD-10 codes 2. The claim will be rejected by BCBSLA if it is coded with ICD-9 codes and will need to be resubmitted using ICD-10 codes 10

11 Claims on October 1? Facility Outpatient Claims Scenarios Claim Coding Requirements Claim Processing Rules Statement From and Through Dates before Oct. 1, 2015 The claim should be coded with ICD-9 codes 1. The claim will be accepted for processing by BCBSLA if it is coded with ICD-9 codes 2. The claim will be rejected by BCBSLA if it is coded with ICD-10 codes and will need to be resubmitted using ICD-9 codes Statement From Date before Oct. 1, 2015, and Statement Through Date on or after Oct. 1, 2015 Statement From and Through Dates on or after Oct. 1, 2015 Claim should be split: 1.Services provided before Oct. 1, 2015, should be coded on the first claim with ICD-9 codes 2.Services provided on or after Oct. 1, 2015, should be coded on the second claim with ICD-10 codes The claim should be coded with ICD-10 codes 1. The claim will be rejected by BCSBLA if it is not split and contains services spanning the ICD-10 implementation date of Oct. 1, The claim which contains services provided before Oct. 1, 2015, will be accepted for processing by BCBSLA if it is coded with ICD- 9 codes and rejected if it is coded with ICD-10 codes 3. The claim which contains services provided on or after Oct. 1, 2015, will be accepted for processing by BCBSLA if it is coded with ICD-10 codes and rejected if it is coded with ICD-9 codes 4. The rejected claims will need to be resubmitted with the appropriate version of ICD codes 1. The claim will be accepted for processing by BCBSLA if it is coded with ICD-10 codes 2. The claim will be rejected by BCSBLA if it is coded with ICD-9 codes and will need to be resubmitted using ICD-10 codes 11

12 Claims on October 1? Professional Claims (excluding anesthesia and DME) Scenarios Claim Coding Requirements Claim Processing Rules All Dates of Service before Oct. 1, 2015 The claim should be coded with ICD-9 codes 1. The claim will be accepted for processing by BCBSLA if it is coded with ICD-9 codes 2. The claim will be rejected by BCBSLA if it is coded with ICD-10 codes and will need to be resubmitted using ICD-9 codes Dates of Service span Oct. 1, 2015 Statement From and Through Dates on or after Oct. 1, 2015 Claim should be split as per the rules provided below: 1. Services provided before Oct. 1, 2015, should be coded on the first claim with ICD-9 codes 2. Services provided on or after Oct. 1, 2015, should be coded on the second claim with ICD-10 codes The claim should be coded with ICD-10 codes 1. The claim will be rejected by BCBSLA if it is not split and contains services spanning the implementation date 2. The claim which contains services provided before Oct. 1, 2015, will be accepted for processing by BCBSLA if it is coded with ICD-9 codes and rejected if it is coded with ICD-10 codes 3. The claim which contains services provided on or after Oct. 1, 2015, will be accepted for processing by BCBSLA if it is coded with ICD-10 codes and rejected if it is coded with ICD-9 codes 4. The rejected claims will need to be resubmitted with the appropriate version of ICD codes based on the date of service 1. The claim will be accepted for processing by BCBSLA if it is coded with ICD-10 codes 2. The claim will be rejected by BCSBLA if it is coded with ICD-9 codes and will need to be resubmitted using ICD-10 codes 12

13 Claims on October 1? Anesthesia Claims Scenarios Claim Coding Requirements Claim Processing Rules All Dates of Service before Oct. 1, 2015 (Procedures beginning and ending before Oct. 1, 2015) Dates of Service span Oct. 1, 2015 (Procedures beginning on Sept. 30, 2015, and ending on Oct. 1, 2015) All Dates of Service on or after Oct. 1, 2015 (Procedures beginning and ending after Oct. 1, 2015) The claim should be coded with ICD-9 codes The claim should be coded as a single claim with ICD-9 codes. The Service From and Service Through dates should be coded as Sept. 30, 2015, on the claim even if the procedure actually ended on Oct. 1, No splitting is needed for the claim. The claim should be coded with ICD- 10 codes 1. The claim will be accepted for processing by BCBSLA if it is coded with ICD-9 codes 2. The claim will be rejected by BCBSLA if it is coded with ICD-10 codes and will need to be resubmitted using ICD-9 codes 1. The claim will be accepted for processing by BCBSLA if it is coded with ICD-9 codes and the Service From and Service Through Dates on the claim are before or on Sept. 30, The claim will be rejected for processing by BCBSLA if the claim is coded with ICD-9 codes and the Service From Date is on or before Sept. 30, 2015, and the Service Through Date is on or after Oct. 1, The claim will be rejected for processing by BCBSLA If the claim is coded with ICD-10 codes and the Service From Date is on or before Sept. 30, 2015, and the Service Through Date is on or after Oct. 1, The claim will be accepted for processing by BCBSLA if it is coded with ICD-10 codes 2. The claim will be rejected by BCBSLA if it is coded with ICD-9 codes and will need to be resubmitted using ICD-10 codes 13

14 Claims on October 1? Durable Medical Equipment (DME) Claims Scenarios Claim Coding Requirements Claim Processing Rules All Dates of Service before Oct. 1, 2015 Dates of Service span Oct. 1, 2015 (for items like capped rentals or monthly supplies where Service From Date is before Oct. 1, 2015, and the Service Through Date is on or/after Oct. 1, 2015) The claim should be coded with ICD-9 codes The claim should be coded as a single claim with ICD-9 codes. No splitting is needed for the claim. 1. The claim will be accepted for processing by BCBSLA if it is coded with ICD-9 codes 2. The claim will be rejected by BCSBLA if it is coded with ICD-10 codes and will need to be resubmitted using ICD-9 codes 1. The claim will be accepted for processing by BCBSLA if it is coded with ICD-9 codes 2. The claim will be rejected by BCBSLA if it is coded with ICD-10 codes and will need to be resubmitted using ICD-9 codes All Dates of Service on or after Oct. 1, 2015 The claim should be coded with ICD-10 codes 1. The claim will be accepted for processing by BCBSLA if it is coded with ICD-10 codes 2. The claim will be rejected by BCBSLA if it is coded with ICD-9 codes and will need to be resubmitted using ICD-10 codes 14

15 Authorizations on October 1? Let s talk about authorizations The authorization request date will determine the version of ICD diagnosis codes to be used: Authorization requests and extensions that are submitted prior to Oct. 1, 2015, should include ICD-9 diagnosis codes Blue Cross will begin accepting authorization requests and extensions with ICD-10 diagnosis codes starting on Oct. 1, 2015 Procedure codes are not impacted by the ICD-10 transition and should continue to be reported/coded in CPT-4 or HCPCS Note: A new authorization request is not required even if the services span Oct. 1,

16 Authorizations on October 1? Facility Inpatient Authorizations Scenarios Authorization Requirements Authorization Rules Request Date of authorization is before Oct. 1, 2015 Request Date of authorization is on or after Oct. 1, 2015 Authorization requests need both diagnosis and procedure codes. 1. Diagnosis should be coded with ICD-9 2. Procedures should be coded with CPT-4 or HCPCS Authorization requests need both diagnosis and procedure codes. 1. Diagnosis should be coded with ICD Procedures should be coded with CPT-4 or HCPCS 1. Authorizations will be accepted by BCBSLA if it is submitted with ICD-9 diagnosis codes 2. Authorizations will not be accepted by BCBSLA if ICD-10 diagnosis codes are provided and will need to be resubmitted with ICD-9 diagnosis codes 1. Authorizations will be accepted by BCBSLA if it is submitted with ICD-10 diagnosis codes 2. Authorizations will not be accepted by BCBSLA if ICD-9 diagnosis codes are provided and will need to be resubmitted with ICD-10 diagnosis codes 16

17 Authorizations on October 1? Facility Outpatient Authorizations Scenarios Authorization Requirements Authorization Rules Request Date of authorization is before Oct. 1, 2015 Request Date of authorization is on or after Oct. 1, 2015 Authorization requests need both diagnosis and procedure codes. 1. Diagnosis should be coded with ICD-9 2. Procedures should be coded with appropriate CPT-4 or HCPCS Authorization requests need both diagnosis and procedure codes. 1. Diagnosis should be coded with ICD Procedures should be coded with appropriate CPT-4 or HCPCS Please note the following requirements for extension requests: 1. For extension requests for services to be rendered on or after Oct. 1, 2015 but ending before Jan. 1, 2016, ICD-10 codes will be captured when provided, but will not be made mandatory 2. For service extensions extending into 2016, the requests will need to be split between services extending through Dec. 31, 2015, and services to be rendered on or after Jan. 1, 2016, with the following rules: a. Request for services extending through Dec. 31, 2015, will be processed with the same rules provided in authorization requirement 1 above b. For services to be rendered on or after Jan. 1, 2016, a new authorization request will be needed with ICD-10 codes 1. Authorizations will be accepted by BCBSLA if it is submitted with ICD-9 diagnosis codes 2. Authorizations will not be accepted by BCBSLA if ICD-10 diagnosis codes are provided and will need to be resubmitted with ICD-9 diagnosis codes 1. New Authorization requests will be accepted by BCBSLA if it is submitted with ICD-10 diagnosis codes 2. New Authorizations requests will not be accepted by BCBSLA if ICD-9 diagnosis codes are provided and will need to be resubmitted with ICD-10 diagnosis codes 3. Authorization extension requests for services from Oct. 1, 2015, through Dec. 31, 2015, providers will not need to provide ICD-10 codes, but will be captured when provided 17

18 Authorizations on October 1? Professional Authorizations Scenarios Authorization Requirements Authorization Rules Request Date is before Oct. 1, 2015 Request Date is on or after Oct. 1, 2015 Authorization requests need both diagnosis and procedure codes. 1. Diagnosis should be coded with ICD-9 2. Procedures should be coded with appropriate CPT-4 or HCPCS Authorization requests need both diagnosis and procedure codes. 1. Diagnosis should be coded with ICD Procedures should be coded with appropriate CPT-4 or HCPCS Please note the following requirements for extension requests: 1. For extension requests for services to be rendered on or after Oct. 1, 2015, but ending before Jan. 1, 2016, ICD-10 codes will be captured when provided, but will not be made mandatory 2. For service extensions extending into 2016, the requests will need to be split between services extending through Dec. 31, 2015, and for those with services to be rendered on or after Jan. 1, 2016, with the following rules: a. Request for services extending through Dec. 31, 2015, will be processed with the same rules provided in authorization requirement 1 above b. For services to be rendered on or after Jan. 1, 2016, a new authorization request will be needed with ICD-10 codes 1. Authorizations will be accepted by BCBSLA if it is submitted with ICD-9 diagnosis codes 2. Authorizations will not be accepted by BCBSLA if ICD-10 diagnosis codes are provided and will need to be resubmitted with ICD-9 diagnosis codes 1. New Authorization requests will be accepted by BCBSLA if it is submitted with ICD-10 diagnosis codes 2. New Authorizations requests will not be accepted by BCBSLA if ICD-9 diagnosis codes are provided and will need to be resubmitted with ICD-10 diagnosis codes 3. Authorization extension requests for services from Oct. 1, 2015 through Dec. 31, 2015, providers will not need to provide ICD-10 codes, but will be captured when provided 18

19 Scenario-based Testing We offer scenario-based testing to help you prepare for ICD-10! Participation is easy! Testing does not require your systems to be ICD-10 ready Our scenario-based testing allows you to: Review assigned clinical narratives, determine the ICD-10 codes you would enter on the claim for that clinical narrative, and populate these ICD-10 codes in the portal View peer reports comparing your coding results to other providers who test the same scenario with Blue Cross You can win a prize just for testing with us! Each month we will conduct a random drawing of providers who complete scenario-based testing. Winners will receive an ICD-10 coding book, delivered to their office. Testing closes on October 30, 2015 Go to >ICD-10 Conversion for the testing link. 19

20 Helpful ICD-10 Resources BCBSLA Click on: ICD-10 Conversion CMS /icd10/providerresources.html WEDI AAPC HIMSS y/topicdetail.aspx?itemnumber =

21 Future ICD-10 Webinar Dates For attending this webinar! Know a coworker or billing personnel that would have also benefited from attending this webinar? Blue Cross will hold this webinar again on the following dates from 11 a.m. to 12 p.m.: September 9, 2015 September 23, 2015 Full webinar details including the webinar link and a printable PDF of this presentation are available online at >ICD-10 Conversion. 21

22 ADDRESSING YOUR At this time, we will address the questions you submitted electronically through the webinar platform 22