ICD-10. Implementation

Transcription

1 ICD-10 Implementation

2 Mein McCabe AAPC Cetified Pofessional Code (CPC) AAPC Cetified Coding Instucto (PMCC and ICD-10) Code/Bille Independent Contacto Medical Business Advocates, LLC

3 WHAT CM=Patients eason fo encounteing health cae PCS = Pocedues (in-patient) WHY Moe Infomative Codes Impoved Quality Repoting Impoved Risk & Seveity WHO All HIPAA coveed entities Auto-liability and Wokes Compensation exclusion WHEN? = Octobe 1, 2015

4 THE IMPACT

5 THE LOOK

6 Cosmetic Changes ICD-9-CM = 3-5 Chaactes ICD-10-CM = 3-7 Chaactes All codes ae alphanumeic 14,000 ICD-9 to 69,000 ICD-10 codes

7 Naative ICD-9-CM ICD-10-CM DM Type II, uncontolled with stage 4 kidney disease Asthma, modeate pesistent with acute exacebation DM Type II, uncontolled w enal manifestations Stage 4 CKD Asthma unspecified with acute exacebation E11.22 DM 2 w CKD N18.4 Stage 4 CKD in Chonic Disease E11.65 DM2 w hypeglycemia J45.41 Modeate pesistent asthma with acute exacebation RULE: Code also tobacco use o exposue CVA 2006, left am weakness Othe late effects of ceebovascula disease Sequela of ceebovascula disease and need the following additional infomation: 1) Non-taumatic Subaachnoid hemohage, intaceebal hemohage; ceebal infaction; othe ceebovascula disease 2) Left dominant/non-dominant o ight dominant/non-dominant

8 Hypetension I10 = Essential (pimay) hypetension. Includes hypetension (ateial) (benign) (essential) (malignant) (pimay) (systemic) No longe sepaate Benign fom Malignant Hypetension table eliminated

9 Behavioal/Mental Health Added Behavioal and Neuodevelopmental Disodes to heading, was Mental Health Continuous and Episodic ae emoved Histoy of = Remission Hieachy: Use Abuse Dependence ADD/ADHD = ADHD pedominantly inattentive; pedominantly hypeactive; combined

10 Majo ICD Concept Changes # Weeks and Timeste fo matenity cae; fom pe-post peiod Acute Cae timeline fo MI changed fom 8 weeks to 4 weeks Fetal death now 20 weeks gestation not 22 weeks Initial v Subsequent v Sequela Cae fo injuies, no longe late effects Lateality Right, Left, Bilateal Undedosing and toxic effects codes 1 need fo vaccination code WWE/WCC c/s abnomal findings

11 Social Deteminants of Health Envionmental Factos Socio-Economic Factos Household Factos Behavioal Factos Social & Community Factos Health System Factos Psychological Factos Biological Factos Woking and Living Conditions

12 Z73.- Life Management Bun out Type A Behavio Patten Lack of elaxation and leisue Stess, NEC Inadequate social skills Social Role Conflict Z91.-Undedosing due to financial hadship

13 PREPARATION

14 PLAN Impact Analysis: High impact codes & documentation equiements Whee ICD touches the pogam now PREPARE Tain/educate High impact pocess changes Pocess impovements IMPLEMENT Test Intenal & Extenal Readiness Octobe 1, 2015 Dates of Sevice

15 Plan A CHAMPION: A PROVIDER OR ADMINISTRATOR WHO UNDERSTANDS THE BREADTH AND SIGNIFICANCE OF THE CHANGE; HOLDS OVERALL RESPONSIBIILTY AND DECISION MAKING AUTHORITY; ENSURES INVOLVEMENT OF ALL STAKEHOLDERS FROM PROVIDERS TO CLEARINGHOUSES AND SOFTWARE VENDORS.

16 High Level Impact Analysis HIGH IMPACT CODES Highest evenue impact Highest fequency TOUCHES Refeals and authoizations Pay fo Pefomance Pogams Cleainghouse Coding & Billing 100% of you 3pb evenue Quality Impovements Billing Sevice Softwae definitely hadwae too?

17 Impact Analysis deepe dive Which ae you High Revenue Codes could be most common o highe eimbusement isk Evaluate high evenue codes used ove the past yea. Exclude those codes that ae not coss-walking (vaccines) Evaluate ICD coding skills now. What ae losses due to Medical Necessity? How can othe staff assist? Injuy Details, pegnancy # weeks, episode of cae Look at business pocesses Refeals, authoizations and pe-cetifications Patient scheduling Povide odes Public Health Repoting Contacts linked to diagnoses; payment timeliness Financial opeations (how ae denials managed now; how cuent ae billes/codes; evenue to cay though bumps in tansition)

18 Extenal eadiness Softwae Vendos: When can you use the codes fo testing? Additional costs fo the update(s)? How will issues be managed? If a softwae upgade is equied, how will the installation be handled (downtime)? Ae thee any hadwae equiements associated with this upgade? Maintenance costs? How ae you to epot issues and what is the esponse plan including timeliness? Cleainghouse: Check on thei ICD-10 pepaation and eadiness; when and how can you test; how will ejections be managed? Billing sevice: Have they obtained appopiate taining? How will povide queies and claim ejections be handed? What ae compliance pogam updates fo you contact? Payes: Ask payes if they ae evising contacts o policies based on ICD-10 and if so do you need to negotiate; Ask about testing plans

19 EMR Upgades Cost and Schedule Downtime Staff taining absence Impact to cae and access Slowdown fo staff (povide, suppot, code, bille)

20 Skill in Business Office What date of sevice ae you billing fo? Ae you following up on denials? Ae you pefoming dual coding now?

21 Fomal Taining & Education Full taining = days Povide documentation = ~1 day Administation = 2-4 hous Softwae changes =?? Coding taining Who is poviding the taining? What qualifications do they have to tain you and what mateials ae they using and poviding. Who needs taining and to what extent, at you pogam?

22 Code Set Obtain ICD-10-CM Code books Veify softwae capability Look-up functionality in softwae o othe esouce Code set available Documentation Adequate Staff tained to use coectly Uses ae poficient Dual Coding peiod (90days) Quey pocess in place

23 Documentation Documentation equiements fo ICD-10 should: Suppot the diagnosis Justify the teatment/pocedue Document the couse of cae Identify teatment/test esults Pomote continuity of cae among healthcae povides Payos ae looking fo: Knowledge of seveity of patient s complaint o condition All facts egading signs, symptoms, complaints, o backgound descibing eason fo cae

24 Clinical Documentation Thee ae Magic Wods that will coect high numbe of documentation poblems (cedit D. Jonathan Elion) DUE TO MANIFESTED BY COMPLICATION OF

25 Intenal Readiness - Softwae Softwae functional Templates pepaed Repots functional Claims tested

26 Intenal Testing Policies and pocesses Paye eadiness Test claim submission and emittance eceipt (end-to-end) Test veification of eligibility, efeal and pe-authoizations Test quality management epots Test all existing pocesses to be sue none wee negatively affected by this update

27 End to End Testing, next ound Sign up in Apil (CMS) Test in July

28 PREPARE FOR IMPACT Povide poductivity Coding poductivity Coding accuacy Vendo esponsiveness Paye pepaedness Reimbusement

29 BEST RECOMMENDATIONS Eliminate coding and billing backlogs a full 45 days pio to 10/01/2015 Pioitize medical ecods fo coding Povide efeshe taining to addess poductivity and accuacy issues Develop the pocess fo managing eos and esolving vendo issues

30 RESOURCES /icd-10-pepaation-esouces

31 Ask the Contacto Teleconfeence - ICD-10 - Apil 30, 2015 Join us at the upcoming Ask the Contacto Teleconfeence (ACT) fo ICD-10 elated questions o concens. Date: Thusday, Apil 30, 2015 Time: 1-2 p.m. PT Toll Fee Numbe: Noidian epesentatives fom vaious depatments including Appeals, Claims Pocessing, Electonic Data Intechange Suppot Sevices (EDISS), Medical Review (MR), Povide Contact Cente (PCC), Povide Enollment, Povide Outeach and Education (POE), and System Suppot will be available to addess you questions. No egistation is equied fo this call. Please call in ten minutes pio, the call will stat pomptly at the time designated in the schedule listing. Afte placing the call, you will be asked fo the following: Confeence Name Facility Name Location Numbe of people in attendance ACTs ae designed to open communication between povides and Noidian, which allows fo timely identification of poblems, and shaing infomation in an infomal and inteactive question and answe (Q&A) fomat. No Pesonal Health Infomation (PHI) is allowed. Noidian ceated the "Ask the Contacto Teleconfeence Question Submission Fom" which can be used to submit questions up to five days pio to the ACT. Questions submitted using this fom will be answeed fist duing the ACT; lines will then be opened as time allows. Do not include any PHI o claim specific inquiies on this fom. If you have claim specific questions, contact the Povide Contact Cente. Povides will need to have Vesion 7 o highe of Adobe Reade to use this fom. Q&As will be posted on the Noidian website at

32 Medi-Cal FAQ Handout Highlight How is Medi-Cal addessing the implementation of ICD-10? Medi-Cal will be using a cosswalk solution in the legacy Califonia Medicaid Management Infomation System (CA-MMIS). Medi-Cal has mapped all ICD-10 codes to coesponding ICD-9 codes stating with the Geneal Equivalence Mappings (GEMs) povided by the Centes fo Medicae & Medicaid Sevices (CMS) and modifying the mappings to align with existing Medi-Cal policy. Claims will be un against the cosswalk to detemine the ICD-9 value to pocess though the system. The cosswalk will only be used tempoaily fo ICD-10 claim adjudication while the implementation of ou new MMIS system is being completed. Once the new system is online, Medi-Cal will adjudicate all claims natively using ICD-10 and the cosswalk will no longe be used.

33 Pesented by Cencal Health Cencal Health

34 Discussion

35

36 Mein McCabe AAPC Cetified Pofessional Code (CPC) AAPC Cetified Coding Instucto (PMCC and ICD-10) Code/Bille Independent Contacto Medical Business Advocates, LLC

37 ICD BEGINNER» The ICD-10 Tansition: AN INTRODUCTION ICD-10 DEADLINE OCT 1, 2015 he ICD-9 code sets used to epot medical diagnoses and inpatient pocedues will be eplaced by ICD-10 code sets. This fact sheet povides backgound on the ICD-10 tansition, geneal guidance on how to pepae Tfo it, and esouces fo moe infomation.»

38 01 About ICD-10 ICD-10-CM/PCS (Intenational Classification of Diseases, 10th Edition, Clinical Modification/ Pocedue Coding System) consists of two pats: BEGINNER ICD-10-CM fo diagnosis coding ICD-10-CM is fo use in all U.S. health cae settings. Diagnosis coding unde ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the fomat of the code sets is simila. ICD-10-PCS fo inpatient pocedue coding ICD-10-PCS is fo use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeic digits instead of the 3 o 4 numeic digits used unde ICD-9- CM pocedue coding. Coding unde ICD-10-PCS is much moe specific and substantially diffeent fom ICD-9-CM pocedue coding. The tansition to ICD-10 is occuing because ICD-9 poduces limited data about patients medical conditions and hospital inpatient pocedues. ICD-9 is 30 yeas old, has outdated tems, and is inconsistent with cuent medical pactice. Also, the stuctue of ICD-9 limits the numbe of new codes that can be ceated, and many ICD-9 categoies ae full. Health cae povides, payes, cleainghouses, and billing sevices must be pepaed to comply with the tansition to ICD-10. Who Needs to Tansition ICD-10 will affect diagnosis and inpatient pocedue coding fo eveyone coveed by the Health Insuance Potability and Accountability Act (HIPAA), not just those who submit Medicae o Medicaid claims. The change to ICD-10 does not affect CPT coding fo outpatient pocedues. Health cae povides, payes, cleainghouses, and billing sevices must be pepaed to comply with the tansition to ICD-10, which means: l All electonic tansactions must use Vesion 5010 standads, which have been equied since Januay 1, Unlike the olde Vesion 4010/4010A standads, Vesion 5010 accommodates ICD-10 codes. l ICD-10 diagnosis codes must be used fo all health cae sevices povided in the U.S., and ICD-10 pocedue codes must be used fo all hospital inpatient pocedues. Claims with ICD-9 codes fo sevices povided on o afte the compliance deadline cannot be paid. -2-

39 01 BEGINNER Tansitioning to ICD-10 It is impotant to pepae now fo the ICD-10 tansition. The following ae steps you can take to get stated: l Povides Develop an implementation stategy that includes an assessment of the impact on you oganization, a detailed timeline, and budget. Check with you billing sevice, cleainghouse, o pactice management softwae vendo about thei compliance plans. Povides who handle billing and softwae development intenally should plan fo medical ecods/coding, clinical, IT, and finance staff to coodinate on ICD-10 tansition effots. l l Payes Review payment policies since the tansition to ICD-10 will involve new coding ules. Ask you softwae vendos about thei eadiness plans and timelines fo poduct development, testing, availability, and taining fo ICD-10. You should have an implementation plan and tansition budget in place. Softwae vendos, cleainghouses, and thid-paty billing sevices Wok with customes to install and test ICD-10 eady poducts. Take a poactive ole in assisting with the tansition so you customes can get thei claims paid. Poducts and sevices will be obsolete if steps ae not taken to pepae. ICD-10 Resouces Thee ae many pofessional, clinical, and tade associations offeing ICD-10 infomation, educational esouces, and checklists. Call o check the websites of you associations and othe industy goups to see what esouces ae available. The CMS website has official esouces to help you pepae fo ICD-10. CMS will continue to add new tools and infomation to the site thoughout the couse of the tansition. Sign up fo ICD-10 Updates on Twitte fo the latest news and esouces. Last Updated: August

40 Official CMS Industy Resouces fo the ICD-10 Tansition ICD-10 Basics fo Medical Pactices Backgound The ICD-10 tansition takes planning, pepaation, and time, so medical pactices should continue woking towad compliance. The following quick checklist will assist you with peliminay planning steps. Identify you cuent systems and wok pocesses that use ICD-9 codes. This could include you clinical documentation, encounte foms/supebills, pactice management system, electonic health ecod system, contacts, and public health and quality epoting potocols. It is likely that wheeve ICD-9 codes now appea, ICD-10 codes will take thei place. Talk with you pactice management system vendo about accommodations fo ICD-10 codes. Confim with you vendo that you system has been upgaded to Vesion 5010 standads, which have been equied since Januay 1, Unlike the olde Vesion 4010/4010A standads, Vesion 5010 accommodates ICD-10 codes. Contact you vendo and ask what updates they ae planning to make to you pactice management system fo ICD-10, and when they expect to have it eady to install. Check you contact to see if upgades ae included as pat of you ageement. If you ae in the pocess of making a pactice management o elated system puchase, ask if it is ICD-10 eady. Discuss implementation plans with all you cleainghouses, billing sevices, and payes to ensue a smooth tansition. Be poactive, don t wait. Contact oganizations you conduct business with such as you payes, cleainghouse, o billing sevice. Ask about thei plans fo ICD-10 compliance and when they will be eady to test thei systems fo the tansition. Talk with you payes about how ICD-10 implementation might affect you contacts. Because ICD-10 codes ae much moe specific than ICD-9 codes, payes may modify tems of contacts, payment schedules, o eimbusement. Identify potential changes to wok flow and business pocesses. Conside changes to existing pocesses including clinical documentation, encounte foms, and quality and public health epoting. ICD-10 DEADLINE OCT 1, 2015 About ICD-10 ICD-10 CM/PCS (Intenational Classification of Diseases, 10th Edition, Clinical Modification/ Pocedue Coding System) consists of two pats: ICD-10-CM (diagnosis coding) was developed by the Centes fo Disease Contol and Pevention fo use in all U.S. health cae settings. Diagnosis coding unde ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the fomat of the code sets is simila. ICD-10-PCS (inpatient pocedue coding) was developed by the Centes fo Medicae & Medicaid Sevices (CMS) fo use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeic digits instead of the 3 o 4 numeic digits used unde ICD-9-CM pocedue coding. Coding unde ICD-10- PCS is much moe specific and substantially diffeent fom ICD-9-CM pocedue coding. The tansition to ICD-10-CM/PCS does not affect Cuent Pocedual Teminology (CPT) codes, which will continue to be used fo outpatient sevices. Visit fo ICD-10 and Vesion 5010 esouces fom CMS.

41 I061 Rheumatic aotic insufficiency I062 Rheumatic aotic stenosis with insufficiency I068 Othe heumatic aotic valve diseases I069 Rheumatic aotic valve disease, unspecified I070 Rheumatic ticuspid stenosis I071 Rheumatic ticuspid insufficiency I072 Rheumatic ticuspid stenosis and insufficiency I078 Othe heumatic ticuspid valve dis Assess staff taining needs. Identify the staff in you office who code, o have a need to know the new codes. Thee ae a wide vaiety of taining oppotunities and mateials available though pofessional associations, online couses, webinas, and onsite taining. If you have a small pactice, think about teaming up with othe local povides. Fo example, you might be able to povide taining fo a staff peson fom one pactice, who can in tun tain staff membes in othe pactices. Coding pofessionals ecommend that taining take place appoximately six months pio to the ICD-10 compliance deadline. Budget fo time and costs elated to ICD-10 implementation, including expenses fo system changes, esouce mateials, and taining. Assess the costs of any necessay softwae updates, epinting of supebills, tainings, and elated expenses. Conduct test tansactions using ICD-10 codes with you payes and cleainghouses. Testing is citical. You will need to test claims containing ICD-10 codes to make sue they ae being successfully tansmitted and eceived by you payes and billing sevice o cleainghouse. Check to see when they will begin testing, and the test days they have scheduled. This fact sheet was pepaed as a sevice to the health cae industy and is not intended to gant ights o impose obligations. The infomation povided is only intended to be a geneal summay. It is not intended to take the place of eithe the witten law o egulations. We encouage eades to eview the specific statutes, egulations, and othe intepetive mateials fo a full and accuate statement of thei contents. Official CMS Industy Resouces fo the ICD-10 Tansition AUGUST 2014

42 Intenational Classification of Diseases 10th Revision (ICD-10) Complete between Octobe Decembe 2013 Ae you eady?* The deadline fo tansitioning to ICD-10 is Octobe 1, Don t wait to stat this impotant pocess. Desciption Owne Stat Date Due by Date Completed Select intenal Champion and/o committee. Set a schedule fo poject meetings (had and fim dates and times). Identify and list all wok pocesses and systems that utilize ICD-9 today. Conduct inventoy of cuent coding tools/esouces. Become familia with ICD-10. Obtain code set and guidelines (electonic files available fom Reseach ICD-10 taining. Reseach taining pogams/esouces (e.g., online couses, local o egional seminas). Detemine level of staff taining needed by ole (compehensive, intemediate, o basic). Review status of and impact to electonic systems (see AAFP ICD-10 Systems Checklist). Appoint staff to act as pimay/seconday contact with system vendos. Cost fo tempoay help o ovetime cost duing taining and go-live. If using an outside souce fo coding and/o billing, lean vendo s ICD-10 implementation plan. Budget Identify ICD-10 elated intenal costs (see AAFP Cost Calculato Intoduce concept and plans fo ICD-10 to staff. Complete between Januay Apil 2014 Complete between Apil August 2014 Septembe 2014 Octobe 2014 and ongoing Evaluate cuent cash flow (age of account balances, billing lag time). Set goals and plan to coect and pevent ecuing eos/issues and optimize cash flow. Detemine impact, if any, on quality initiatives (e.g., PQRS, EHR). Should 2014 epoting be completed pio to system upgades? Complete ICD-10 taining at all levels. Follow-up with electonic system vendos. Ae upgades completed o scheduled? Is taining on upgaded system necessay and if so, scheduled? Note paye news egading ICD-10 claims testing equiements/oppotunities. Review insuance contacts fo diagnosis-based payment impact (if any). Revise/develop/puchase intenal coding esouces (encounte foms, coding quick efeences). Re-evaluate cash flow (Ae goals met and cuent pocesses efficient?). Review budget fo any changes and accuacy. Conside opening a line of cedit to offset potential cash-flow disuption. Review and ensue that physicians and coes have completed taining. Test ability to apply ICD-10 codes to documentation as a taining execise. Do coding esouces suppot efficient and accuate coding? Follow up with system vendos and/o outsouced business patnes. Complete intenal testing. Investigate options fo extenal testing with cleainghouse/payes. Review and update contact infomation fo suppot sevices. Review paye ICD-10 communications (include non-coveed entities such as woke s compensation). Watch fo and disseminate ICD-10 changes in payment policies (e.g., Medicae local coveage decisions). Develop and assign wokflow and pocesses effective 10/01/14. Veify that all testing was successfully completed. Conside diect-to-paye o othe altenative claims submission esouces (if testing has not been successful). Monito paye news egading eadiness and changes to payment policies. Monito all claims acknowledgement (997) and acceptance/ejection (277) epots. Pomptly coect and esubmit all ejected/denied claims. Evaluate post-implementation cash flow until claims filed with ICD-10 ae consistently paid. Evaluate need fo contingency activities (e.g., ovetime, consultant, cedit line). Monito paye news egading claims adjudication issues and esolutions. Monito eimbusement accuacy and timeliness of paye pe contact. Conduct coding eview fo accuacy and compliance. *This timeline is a genealized esouce fo use in ceating an individualized timeline specific to the needs of you pactice. Successful ICD-10 tansition may equie diffeent appoaches based on pactice size and esouces.

43 ICD BEGINNER» ICD-10 Fact Sheet: BASICS FOR SMALL AND RURAL PRACTICES Octobe ICD-10 DEADLINE 1, 2014 ICD-10 DEADLINE OCT 1, 2015 n Octobe 1, 2015, the health cae industy will tansition fom ICD-9 to ICD-10 codes fo diagnoses and inpatient pocedues. This means eveyone coveed by HIPAA must use ICD-10 codes fo health Ocae sevices povided on o afte Octobe 1, 2015.»

44 01 The following is a list of impotant questions to addess now to help you pepae you pactice fo ICD-10. BEGINNER Talk to you EHR vendo about you system s capabilities fo ICD Will you be able to submit claims? If you use an electonic system fo any o all payes, you need to know if it will be able to submit ICD-10 codes. If you system uses Vesion 5010 fo electonic tansactions, you should be able to submit ICD-10 codes. Howeve, check with you pactice management system o softwae vendo to make sue. Will you be able to complete medical ecods? If you use any type of electonic health ecod (EHR) system in you office, you need to know if it will captue ICD-10 codes. Look at how you ente ICD-9 codes (e.g., do you type them in o select fom a pogam) and talk to you EHR vendo about you system s capabilities fo ICD-10. How will you code you claims unde ICD-10? If you want to keep coding the same way you ae now, and you only use books to code, puchase an ICD-10 code book in ealy If you code o whoeve is esponsible fo coding in you pactice cannot identify codes accuately using the code book o look-up functionality in you softwae, exploe thei ICD-10 taining options and detemine if fomal taining is necessay. Then, take a look at the codes most commonly used in you office and pactice coding ove the summe in Whee do you use ICD-9 codes? Is thee anywhee you use ICD-9 codes othe than claims submission o you EHR? Talk to you colleagues and keep tack of you own activities fo a couple of weeks. Wite down o use a sticky note to mak eveywhee you see an ICD-9 code as you do you job. If the code is on pape, you will need new foms (e.g., patient encounte fom). If you see the code on you compute, check with you EHR o pactice management system vendo to see if you system will accept ICD-10 codes. 5 Ae thee ways to make coding moe efficient? Fo example, develop a list of you most commonly used ICD-10 codes, o invest in an inexpensive softwae pogam that helps small pactices with coding. Also, think about ways to make sue the new coding does not delay payments. Look at you most common non-visit sevices do any sometimes tigge eviews o denials elated to medical necessity? It is impotant to undestand how to code these sevices coectly unde ICD

45 01 BEGINNER ICD-10 Resouces Visit the CMS ICD-10 website fo infomation and esouces on ICD-10. The Povide Resouces section of the website has helpful fact sheets, checklists, timelines, and othe esouces to help pactices tansition to ICD-10. Also, be sue to check out ICD-10 esouces and tainings available fom you payes, vendos, and pofessional associations such as the Ameican Academy of Pofessional Codes and the Ameican Health Infomation Management Association. Backgound About ICD-10 ICD-10 CM/PCS (Intenational Classification of Diseases, 10th Edition, Clinical Modification/ Pocedue Coding System) consists of two pats: ICD-10-CM (diagnosis coding) was developed by the Centes fo Disease Contol and Pevention fo use in all U.S. health cae settings. Diagnosis coding unde ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the fomat of the code sets is simila. ICD-10-PCS (inpatient pocedue coding) was developed by the Centes fo Medicae & Medicaid Sevices (CMS) fo use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeic digits instead of the 3 o 4 numeic digits used unde ICD-9-CM pocedue coding. Coding unde ICD-10-PCS is much moe specific and substantially diffeent fom ICD-9-CM pocedue coding. The tansition to ICD-10-CM/PCS does not affect Cuent Pocedual Teminology (CPT) codes, which will continue to be used fo outpatient sevices. Visit fo ICD-10 esouces fom CMS. Last Updated: August

46 Official CMS Industy Resouces fo the ICD-10 Tansition Small and Medium Pactices ICD-10 Tansition Checklist The following is a checklist of ICD-10 tasks, including estimated timefames fo each task. Depending on you oganization, many of these tasks can be pefomed on a compessed timeline o pefomed at the same time as othe tasks. This checklist is designed to povide a viable path fowad fo oganizations just beginning to pepae fo ICD-10. CMS encouages those who ae ahead of this schedule to continue thei pogess fowad. NOW Planning, Communication, and Assessment Actions to Take Immediately To pepae fo testing, make sue you have completed the following activities. If you have aleady completed these tasks, eview the infomation to make sue you did not ovelook an impotant step. Review ICD-10 esouces fom CMS, tade associations, payes, and vendos Infom you staff/colleagues of upcoming changes (1 month) Ceate an ICD-10 poject team (1-2 days) Identify how ICD-10 will affect you pactice (1-2 months) How will ICD-10 affect you people and pocesses? To find out, ask all staff membes how/whee they use/see ICD-9 Include ICD-10 as you plan fo pojects like meaningful use of electonic health ecods Develop and complete an ICD-10 poject plan fo you pactice (1-2 weeks) Identify each task, including deadline and who is esponsible Develop plan fo communicating with staff and business patnes about ICD-10 Estimate and secue budget (potential costs include updates to pactice management systems, new coding guides and supebills, staff taining) (2 months) Ask you payes and vendos softwae/systems, cleainghouses, billing sevices about ICD-10 eadiness (2 months) Review tading patne ageements Ask about systems changes, a timeline, costs, and testing plans

47 Small and Medium Pactices ICD-10 Tansition Checklist Ask when they will stat testing, how long they will need, and how you and othe clients will be involved Select/etain vendo(s) 2013 Review changes in documentation equiements and educate staff by looking at fequently used ICD-9 codes and new ICD-10 codes (ongoing) Tansition and Testing Mach 2013 to Septembe 2014 Mach 1, 2013 Decembe 31, 2013: Conduct high-level taining on ICD-10 fo clinicians and codes to pepae fo testing (e.g., clinical documentation, softwae updates) (ongoing) Apil June 2013: Stat testing ICD-10 codes and systems with you pactice s coding, billing, and clinical staff (9 months) Use ICD-10 codes fo diagnoses you pactice sees most often Test data and epots fo accuacy 2014 Monito vendo and paye pepaedness, identify and addess gaps (ongoing) Octobe 2013 Januay 2014: Begin testing claims and othe tansactions using ICD-10 codes with business tading patnes such as payes, cleainghouses, and billing sevices (10 months minimum) Januay 1, 2014 Apil 1, 2014: Review code and clinician pepaation; begin detailed ICD-10 coding taining (6-9 months) Wok with vendos to complete tansition to poduction-eady ICD-10 systems Complete Tansition/Full Compliance Octobe 1, 2014 Complete ICD-10 tansition fo full compliance ICD-9 codes continue to be used fo sevices povided befoe Octobe 1, 2014 ICD-10 codes equied fo sevices povided on o afte Octobe 1, 2014 Monito systems and coect eos if needed CMS consulted esouces fom the Ameican Medical Association (AMA), the Ameican Health Infomation Management Association (AHIMA), the Noth Caolina Healthcae Infomation & Communications Alliance (NCHICA) and the Wokgoup fo Electonic Data Intechange (WEDI) in developing this timeline. Official CMS Industy Resouces fo the ICD-10 Tansition JANUARY 2013

48 ICD-10 Timeline fo Small-Medium Pactices at a Glance Jan Feb Ma Ap May Jun Jul Aug Sep Oct Nov Dec Jan Feb Ma Ap May Jun Jul Aug Sep + Oct Nov Dec PLANNING Identify esouces Ceate poject team Assess effects Ceate poject plan Secue budget COMMUNICATIONS Infom staff Contact vendos Contact payes Monito vendo pep Monito paye pep TESTING High-level taining fo test team Level 1: intenal Level 2: extenal COMPREHENSIVE TRAINING Documentation Coding Ongoing pactice befoe go live Ongoing pactice befoe go live D E A D L I N E O C T 1, Januay 2013

49 Official CMS Industy Resouces fo the ICD-10 Tansition Lage Pactices ICD-10 Tansition Checklist The following is a checklist of ICD-10 tasks, including estimated timefames fo each task. Depending on you oganization, many of these tasks can be pefomed on a compessed timeline o pefomed at the same time as othe tasks. This checklist is designed to povide a viable path fowad fo oganizations just beginning to pepae fo ICD-10. CMS encouages those who ae ahead of this schedule to continue thei pogess fowad. NOW Planning, Communication, and Assessment Actions to Take Immediately To pepae fo testing, make sue you have completed the following activities. If you have aleady completed these tasks, eview the infomation to make sue you did not ovelook an impotant step. Review ICD-10 esouces fom CMS, tade associations, payes, and vendos Infom you staff/colleagues of upcoming changes (1 month) Ceate an ICD-10 poject team (1 month) Identify how ICD-10 will affect you pactice (3 months) How will ICD-10 affect you people and pocesses? To find out, ask all staff membes how/whee they use/see ICD-9 Include ICD-10 as you plan fo pojects like meaningful use of electonic health ecods Develop and complete an ICD-10 poject plan fo you oganization (1 month) Identify each task, including deadline and who is esponsible Develop plan fo communicating with staff and business patnes about ICD-10 Estimate and secue budget (potential costs include updates to pactice management systems, new coding guides and supebills, staff taining) (2 months) Ask you payes and vendos softwae/systems, cleainghouses, billing sevices about ICD-10 eadiness (2 months) Ask about systems changes, a timeline, costs, and testing plans Ask when they will stat testing, how long they will need, and how you and othe clients will be involved

50 Lage Pactices ICD-10 Tansition Checklist Review tading patne ageements Select/etain vendo(s) 2013 Review changes in documentation equiements and educate staff by looking at fequently used ICD-9 codes and new ICD-10 codes (ongoing) Tansition and Testing Mach 2013 to Septembe 2014 Mach 1, 2013 Decembe 31, 2013: Conduct high-level taining on ICD-10 fo clinicians and codes to pepae fo testing (e.g., clinical documentation, softwae updates) (ongoing) Apil 1, 2013: Stat testing ICD-10 codes and systems with you pactice s coding, billing, and clinical staff (9 months) Use ICD-10 codes fo diagnoses you pactice sees most often Test data and epots fo accuacy 2014 Monito vendo and paye pepaedness, identify and addess gaps (ongoing) Octobe 1, 2013: Begin testing claims and othe tansactions using ICD-10 codes with business tading patnes such as payes, cleainghouses, and billing sevices (10 months minimum) Januay 1, 2014 Apil 1, 2014: Review code and clinician pepaation; begin detailed ICD-10 coding taining (6-9 months) Wok with vendos to complete tansition to poduction-eady ICD-10 systems Complete Tansition/Full Compliance Octobe 1, 2014 Complete ICD-10 tansition fo full compliance ICD-9 codes continue to be used fo sevices povided befoe Octobe 1, 2014 ICD-10 codes equied fo sevices povided on o afte Octobe 1, 2014 Monito systems and coect eos if needed CMS consulted esouces fom the Ameican Medical Association (AMA), the Ameican Health Infomation Management Association (AHIMA), the Noth Caolina Healthcae Infomation & Communications Alliance (NCHICA) and the Wokgoup fo Electonic Data Intechange (WEDI) in developing this timeline. Official CMS Industy Resouces fo the ICD-10 Tansition JANUARY 2013

51 ICD-10 Timeline fo Lage Pactices at a Glance Jan Feb Ma Ap May Jun Jul Aug Sep Oct Nov Dec Jan Feb Ma Ap May Jun Jul Aug Sep + Oct Nov Dec PLANNING Identify esouces Ceate poject team Assess effects Ceate poject plan Secue budget COMMUNICATIONS Infom staff Contact vendos Contact payes Monito vendo pep Monito paye pep TESTING High-level taining fo test team Level 1: intenal Level 2: extenal COMPREHENSIVE TRAINING Documentation Coding Ongoing pactice befoe go live Ongoing pactice befoe go live D E A D L I N E O C T 1, Januay 2013

52 News Updates Decembe 27, 2012 Simple Steps to Impove Clinical Documentation On Octobe 1, 2014, you pactice and the cleainghouses, payes, and billing companies that you wok with will need to use ICD-10 codes. One way to help you pactice pepae fo ICD-10 is to wok on impoving how you document you clinical sevices. This will help you and you coding staff become moe accustomed to the specific, detailed clinical documentation needed to assign ICD- 10 codes. Take a look at documentation fo the most often used codes in you pactice, and wok with you coding staff to detemine if the documentation would be specific and detailed enough to select the best ICD-10 codes. Fo example, lateality is expanded in ICD-10-CM. Theefoe, clinical documentation fo diagnoses should include infomation on which side of the body is affected (i.e., ight, left, o bilateal). Below ae additional examples of the specific infomation needed to accuately code the following common diagnoses: Diabetes Mellitus: Factues: Type of diabetes Body system affected Complication o manifestation If type 2 diabetes, long-tem insulin use Site Lateality Type Location

53 Injuies: Extenal cause Povide the cause of the injuy; when meeting with patients, ask and document how the injuy happened. Place of occuence Document whee the patient was when the injuy occued; fo example, include if the patient was at home, at wok, in the ca, etc. Activity code Descibe what the patient was doing at the time of the injuy; fo example, was he o she playing a spot o using a tool? Extenal cause status Indicate if the injuy was elated to militay, wok, o othe. Remembe, ICD-10 will not affect the way you povide patient cae. It will just be impotant to make you documentation as detailed as possible since ICD-10 gives moe specific choices fo coding diagnoses. This infomation is likely aleady being shaed by the patient duing you visit it s just a matte of ecoding it fo you coding staff. Good documentation will also help educe the need to follow-up on submitted claims saving you time and money. Keep Up to Date on ICD-10 Visit the CMS ICD-10 website fo the latest news and esouces to help you pepae. Fo pactical tansition tips: Read ecent ICD-10 update messages Access the ICD-10 continuing medical education modules developed by CMS in patneship with Medscape Questions? Contact Us Stay Connected: Subscibe Sevices: Manage Pefeences Unsubscibe This sevice is povided to you by the Office of E-Health Standads & Sevices, ICD-10.

54 ICD ADVANCED» Talking to You Vendos About ICD-10: TIPS FOR MEDICAL PRACTICES Stat the Convesation with You Vendos Octobe 1, 2015 is the ICD-10 tansition deadline. Begin testing now. 1 Talk with you vendos now to be sue that you can count on them to: l Have fully functional, compliant poducts and sevices eady in plenty of time to allow fo thoough ICD-10 testing l Help you avoid potential eimbusement issues and inteuptions to wokflow You vendos will need to have poducts and sevices on a schedule that allows adequate time fo you to conduct testing. 2 Ask you vendos to establish a compehensive appoach that will ICD-10 delive compatible poducts when you need them. Points to conside Resouces discussing with you vendos include: An impotant step in The CMS website has pepaing fo the change l System upgades/eplacements official esouces to help you needed to accommodate ICD-10 to ICD-10 is to talk with pepae fo ICD-10. CMS will l Costs involved and whethe upgades any softwae vendos, continue to add new tools will be coveed by existing contacts and infomation to the site cleainghouses, o l When upgades o new systems will be thoughout the couse of the billing sevices you available fo testing and implementation tansition. use to be sue they ae l Custome suppot and taining that they will povide Official CMS Industy eady to povide the l How thei poducts and sevices will Resouces fo the ICD-10 suppot you need. accommodate both ICD-9 and Tansition ICD-10 as you wok with claims fo sevices povided both befoe and afte the tansition deadline fo code sets 3 Talking to you vendos now about ICD-10 will help ensue that you tansition goes smoothly. Last Updated: Septembe 2014

55 Official CMS Industy Resouces fo the ICD-10 Tansition Questions to Ask You Systems Vendos about ICD-10 As the health cae industy embaces boade use of health IT, many povides ae looking to puchase o upgade thei clinical and administative health IT systems. ICD-10 should be a consideation when choosing eithe clinical o administative health IT systems. ICD-10 DEADLINE OCT 1, 2015 ICD-10 is the next code set fo diagnosis and inpatient pocedue coding. The switch to the ICD-10 code set is mandated fo Octobe 1, The new codes will impact many pats of the health cae pocess, fom patient efeals to billing and payment. Asking the ight questions about ICD-10 will help ensue that a new system will meet you pactice s health IT goals. Questions to Ask You Pactice Management Vendo You cuent health IT vendo may be planning to upgade you pactice management system to function with ICD-10. To check whethe a pactice management vendo s ICD-10 upgades o poducts will meet you needs, ask vendos these questions: Will you install poducts well befoe the Octobe 1, 2015, deadline, so I can begin testing them in 2014? Will suppot fo my cuent poducts be discontinued afte the Octobe 1, 2015, ICD-10 deadline? When will you update my cuent poducts and applications fo ICD-10? Will you povide peiodic updates fo new poducts? Will thee be a chage fo these updates? Will I need new hadwae to accommodate ICD-10-elated softwae changes? What ae the costs associated with maintaining new poducts? Will you offe poduct suppot? If so, how long will the vendo suppot the application? How do I epot issues and how quickly will you espond? Will you povide taining on you softwae? Will you offe suppot duing and afte intenal ICD-10 testing? Will you help me test my system with payes and othe tading patnes? Does you poduct give me the ability to seach fo codes by the ICD-10 alphabetic and tabula indexes? By clinical concept? Will you poduct allow fo coding in both ICD-9 and ICD-10 to accommodate tansactions with dates of sevice befoe Octobe 1, 2015, and tansactions with dates of sevice afte Octobe 1, 2015?

56 I061 Rheumatic aotic insufficiency I062 Rheumatic aotic stenosis with insufficiency I068 Othe heumatic aotic valve diseases I069 Rheumatic aotic valve disease, unspecified I070 Rheumatic ticuspid stenosis I071 Rheumatic ticuspid insufficiency I072 Rheumatic ticuspid stenosis and insufficiency I078 Othe heumatic ticuspid valve dis Questions to Ask You EHR Vendo Clinical health IT systems, such as electonic health ecods (EHRs), will also need to be compatible with ICD-10 in ode to make the most of you health IT investment. When puchasing o upgading an EHR system, be sue to ask the following questions about ICD-10: Ae you EHR poducts ICD-10 eady? If not, when will they be? Can you poducts help me with the ICD-10 tansition? Fo example, will the poducts suggest ICD-10 codes based on the clinical data I ente about specific patients? Do you poducts map SNOMED-CT to ICD-10 codes to help connect clinical and administative data? Patne with You Vendo Afte assessing you vendos capabilities, continue to wok with them thoughout the ICD-10 tansition. Ask you vendo to shae stategies that othe clients have used successfully. Fo Moe Infomation To lean moe about woking with vendos and othe business patnes, consult the ICD-10 esouces available on the CMS ICD-10 website. Official CMS Industy Resouces fo the ICD-10 Tansition SEPTEMBER 2014

57 ICD 10: FAQs MEDI CAL The fedeal govenment has postponed the implementation of ICD 10 codes in all billing activities pusuant to the Potecting Access to Medicae Act of 2014, House Resolution 4302, Section 212, Delay in Tansition fom ICD 9 to ICD 10 Code Sets: The Secetay of Health and Human Sevices may not, pio to Octobe 1, 2015, adopt ICD 10 code sets as the standad fo code sets unde section 1173(c) of the Social Secuity Act (42 U.S.C. 1320d 2(c)) and section of title 45, Code of Fedeal Regulations. On July 31, 2014, the Centes fo Medicae & Medicaid Sevices (CMS) eleased a final ule that will equie ICD 10 to be implemented on Octobe 1, 2015, and that will equie HIPAA coveed entities to continue to use ICD 9 until Septembe 30, What does Intenational Classification of Diseases, 10th Revision (ICD 10) compliance mean? ICD 10 compliance means that all HIPAA coveed entities ae able to successfully conduct health cae tansactions on o afte Octobe 1, 2015, using the ICD 10 diagnosis and pocedue codes. ICD 9 diagnosis and pocedue codes can no longe be used fo health cae sevices povided on o afte this date. 2. Why is the ICD 10 tansition necessay? ICD 10 is a povision of HIPAA, as egulated by the U.S. Depatment of Health and Human Sevices (HHS), Centes fo Medicae & Medicaid Sevices (CMS). This fedeal mandate petains to all HIPAA coveed entities. The tansition fom ICD 9 to ICD 10 is occuing fo the following easons: ICD 9 codes have limited data about patient s medical conditions and hospital inpatient pocedues. ICD 9 codes use outdated and obsolete tems and ae not consistent with cuent medical pactices. The stuctue of ICD 9 limits the numbe of new codes that can be ceated, and many ICD 9 categoies ae full. A successful tansition to ICD 10 is vital to tansfoming ou nation s health cae system. 3. Codes change evey yea, so why is the tansition to ICD 10 any diffeent fom the annual code changes? ICD 10 codes ae diffeent fom ICD 9 codes in seveal ways. Cuently, ICD 9 codes ae fo the most pat numeic and have thee to five digits. ICD 10 codes ae alphanumeic and contain thee to seven chaactes. ICD 10 codes povide a highe level of desciption. Howeve, like ICD 9 codes, ICD 10 codes will be updated evey yea. 4. Will ICD 10 eplace Cuent Pocedual Teminology (CPT) pocedue coding? No. The tansition to ICD 10 does not affect CPT coding fo outpatient pocedues. Fo hospital inpatient pocedues, ICD 9 codes will be tansitioned to ICD 10 PCS (Pocedue Coding System). 5. What is the implementation date fo ICD 10? On Octobe 1, 2015, medical coding in U.S. health cae settings will change fom ICD 9 code sets to ICD 10 code sets. 6. Afte the Octobe 1, 2015, implementation date, when do I use ICD 9 vesus ICD 10 on my claim? Please efe to the chat below, using the date specified in the date field, to detemine the ICD code vesion to use. If the value of the date field is befoe Octobe 1, 2015, use ICD 9 to code the diagnosis. If the value of the date field is on o afte Octobe 1, 2015, use ICD 10. Claim Type Claims Date Field To Be Used Fo Detemining ICD Code Vesion 1 Phamacy Date of sevice 2 Long Tem Cae (LTC) Though date 3 Inpatient Though date 4 Outpatient Fom date 5 Medical Fom date 7. Will thee be a gace peiod fo conveting to ICD 10? No. 8. How is Medi Cal addessing the implementation of ICD 10? Medi Cal will be using a cosswalk solution in the legacy Califonia Medicaid Management Infomation System (CA MMIS). Medi Cal has mapped all ICD 10 codes to coesponding ICD 9 codes stating with the Geneal Equivalence Mappings (GEMs) povided by the Centes fo Medicae & Medicaid Sevices (CMS) and modifying the mappings to align with existing Medi Cal policy. Claims will be un against the cosswalk to detemine the ICD 9 value to pocess though the system. The cosswalk will only be used tempoaily fo ICD 10 claim adjudication while the implementation of ou new MMIS system is being completed. Once the new system is online, Medi Cal will adjudicate all claims natively using ICD 10 and the cosswalk will no longe be used.

58 9. What is a cosswalk solution? Medi Cal has mapped all ICD 10 codes to coesponding ICD 9 codes stating with the Geneal Equivalence Mappings (GEMs) and Reimbusement Mappings povided by the Centes fo Medicae & Medicaid Sevices (CMS) and modifying the mappings to align with existing Medi Cal policy. Claims that ae submitted with ICD 10 stating Octobe 1, 2015, will un against this cosswalk in ode to identify the appopiate ICD 9 code that will be used to pocess the claim. The cosswalk will only be used tempoaily fo ICD 10 claim adjudication while the implementation of ou new MMIS system is being completed. Once the new system is online, Medi Cal will adjudicate all claims natively using ICD 10 and the cosswalk will no longe be used. 10. Will an ICD 10 to ICD 9 cosswalk be published? Medi Cal will not publish the cosswalk. The cosswalk will not be published since thee is aleady a pocess fo appeal of claim adjudication whee thee ae disageements between the amount paid and the amount submitted. Howeve, the povide manuals will be updated with the ICD 10 codes as appopiate, allowing povides to efe to the manual fo guidance. 11. Who is affected by the tansition to ICD 10? If I don t deal with Medicae claims, will I have to tansition? Eveyone coveed by HIPAA must tansition to ICD 10. This includes povides and payes who do not deal with Medicae o Medicaid claims. 12. What if I don t make the tansition to ICD 10? Fo HIPAA coveed entities, tansition to ICD 10 is not an option. Claims fo all sevices and hospital inpatient pocedues pefomed on o afte the compliance deadline must use ICD 10 diagnosis and inpatient pocedue codes. This change does not apply to Cuent Pocedual Teminology (CPT) coding fo outpatient pocedues. Without ICD 10, povides will expeience delayed payments o even non payments; inceased ejected, denied o pending claims; educed cash flows and ultimately lost evenues. It is impotant to note, howeve, that claims fo sevices and inpatient pocedues povided befoe the compliance date must use ICD 9 codes. 13. Is Medi Cal policy going to change with ICD 10? Medi Cal will be updating the povide manuals to account fo the change to ICD 10 in Howeve, due to the size of the ICD 10 code set and limitations in the legacy MMIS, policy will not change. 14. Will Medi Cal accept claims with both ICD 10 and ICD 9 codes on the same claim fom? No. Medi Cal will accept claim foms containing only ICD 9 o ICD 10 codes. 15. If I tansition ealy to ICD 10, will Medi Cal be able to pocess my claims? Pusuant to the CMS final ule issued on July 31, 2014: "This final ule implements section 212 of the Potecting Access to Medicae Act of 2014 by changing the compliance date fo the Intenational Classification of Diseases, 10th Revision, Clinical Modification (ICD 10 CM) fo diagnosis coding, including the Official ICD 10 CM Guidelines fo Coding and Repoting, and the Intenational Classification of Diseases, 10th Revision, Pocedue Coding System (ICD 10 PCS) fo inpatient hospital pocedue coding, including the Official ICD 10 PCS Guidelines fo Coding and Repoting, fom Octobe 1, 2014 to Octobe 1, It also equies the continued use of the Intenational Classification of Diseases, 9th Revision, Clinical Modification, Volumes 1 and 2 (diagnoses), and 3 (pocedues) (ICD 9 CM), including the Official ICD 9 CM Guidelines fo Coding and Repoting, though Septembe 30, 2015." Medi Cal will tansition to the use of ICD 10 on Octobe 1, 2015, and ealy o late tansitions will not be allowed. 16. Ae pape claims affected by the tansition to ICD 10? Yes. All claim tansactions, whethe pape o electonic, except dental claims, will be equied to be submitted using ICD 10 codes. 17. What type of taining will povides and staff need fo the ICD 10 tansition? Medi Cal will be poviding education about the use of ICD 10 fo submitting claims to Medi Cal. Povides ae encouaged to visit the Medi Cal website egulaly thoughout the couse of the tansition to access the latest infomation about education oppotunities. In addition, ICD 10 esouces and taining mateials may be available though the Centes fo Medicae & Medicaid Sevices (CMS), many pofessional associations and societies, and softwae/system vendos. 18. Do Teatment Authoization Requests (TARs) that have been appoved pio to Octobe 1, 2015 with appoval extending past Octobe 1, 2015, need to be esubmitted with ICD 10 codes? No. All active TARs based on the submission of ICD 9 on o befoe Octobe 1, 2015, that span the ICD 10 implementation date will emain valid. Claims containing ICD 10 in adheence with the ICD 10 implementation ules will not be negatively impacted by the ICD 9 TAR appovals.