Welcome to How to Make a Successful Transition to ICD 10 CM. IHS Organizers: Housekeeping

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1 Welcome to How to Make a Successful Transition to ICD 10 CM Presenter: Amy Hayes MBA, CCS, CCS P, CHA, CMBS Owner The Office Assistant, LLC IHS Organizers: Suzanne Hill Professional Development Supervisor Carrie Pedersen Member Services Supervisor Housekeeping This presentation is being recorded CE credit is available! Visit ihsinfo.org for details Note taking handouts are available at ihsinfo.org on the webinar page. Feel free to download now! 1

2 Agenda High level overview of ICD 10 CM code structure ICD 10 CM specifics for hearing professionals Superbill and charge slip updates Key steps in ICD 10 CM preparations Q&A (enter your questions in the Question Box any time) Before We Begin Please note that this presentation is based around the United States federal, state and local requirements to implement and use the ICD 10 code sets All information contained herein is specific to the United States and may not be applicable in other areas 2

3 ICD 10 CM OVERVIEW All US healthcare entities must implement ICD 10 CM (diagnosis codes) on October 1,

4 ICD 10 is Part of HIPAA Please note that ICD 10 is a part of the HIPAA transaction standards and is applicable to entities that submit electronic claims and meet certain other requirements. If you do not submit electronic claims and you are not a covered entity under HIPAA, you are not required to use the ICD 10 code sets. For example, Workers Compensation is not a HIPAA covered entity Essentially We Have May 27 October 1, 2015 Approximately 5 months Approximately 90 working days 720 working hours (assume 8 hour days) to be prepared for ICD 10 coding structure 4

5 Code Structure of ICD 10 CM While there is a substantial increase in codes Laterality is key There are still unspecified codes when needed Focused categories Exponential Increase ICD 9 CM Diagnosis Codes 14,025 codes ICD 10 Diagnosis Codes 54,000 additional codes 68,069 Codes 5

6 70% of the code volume increase is due to laterality ICD 10 did not add 54,000 more health conditions ICD 10 CM Code Structure Category Etiology, Anatomic Site, Severity Extension First character will always be an alpha character Second character will always be a numeric value Third seventh characters can be alpha or numeric 12 6

7 ICD 10 CM Code Structure Category Etiology, Anatomic Site, Severity Example: Bilateral abnormal auditory perception = H Extension Example: Disorders of bilateral acoustic nerve = H93.3X3 13 The Good News for Hearing Professionals Most of the codes in Chapter 8 (Diseases of the Ear and Mastoid Process) are only 5 characters A few will require a 6 th character Keep in mind that payers will be able to deny claims for lack of specificity 7

8 Since this is not coding class Alpha numeric code structure Up to 7 characters in length Laterality and placeholders (X) Requires training and education for staff and providers ICD 10 CM FOR HEARING PROFESSIONALS 8

9 Chapter 8 Diseases of the Ear and Mastoid Process Most diagnosis codes for the hearing professionals can be selected from Chapter 8 in ICD 10 CM Routine hearing tests (V72.19) Z01.10 exam without abnormal findings Z exam following failed hearing screening Z exam with other abnormal findings and an additional code for the abnormal findings No FDA Red Flags Since the FDA specifically allows a patient to waive the requirement for a patient to see a physician before getting hearing aids, many times there is a lack of specificity to the type of hearing loss. 9

10 Hearing Loss Unspecified hearing loss H91.90 unspecified ear H91.91 right ear H91.92 left ear H91.93 bilateral ears When there is a referral Type of loss Laterality Other medical diagnoses (e.g., history of chronic otalgia or trauma) 10

11 Reimbursement Still Based on CPT/HCPCS Codes Remember that your professional services are still reimbursed based on your CPT and/or HCPCS codes the importance of ICD 10 CM is to capture diagnoses to the highest degree of specificity when possible. There will be times for hearing professionals when unspecified is the only option. ICD 10 CM SUPERBILLS 11

12 Changing the Superbill While codes are more characters Unilateral is now coded right or left RT and LT modifiers for CPT and HCPCS codes may not be required due to specificity of ICD 10 CM Check with your payers You may want to run a list of your top 25 diagnosis codes currently used to create/update to ICD 10 Superbill Example ICD 10 Code Description H90.0 Conductive hearing loss, bilateral H90.1 Conductive hearing loss, unilateral with unrestricted hearing on the contralateral side (not valid must get to 5 th digit) H90.11 Conductive hearing loss, right, with unrestricted hearing on the contralateral side H90.12 Conductive hearing loss, left, with unrestricted hearing on the contralateral side H90.2 Conductive hearing loss, unspecified H90.3 Sensoineural hearing loss, bilateral H90.4 Sensoineural hearing loss, unilateral with unrestricted hearing on the contralateral side (not valid must get to 5 th digit) H90.41 Sensoineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side H90.42 Sensoineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side H90.5 Unspecified sensorineural hearing loss 12

13 Superbill Recommendations Only put frequently used ICD 10 codes on your superbill Leave space(s) to write less frequently seen conditions such as signs, symptoms, or other diagnostic information Put the valid code descriptors if possible use bold for laterality to help mitigate errors ICD 10 CM PREPARATIONS 13

14 PAYERS AND REVENUE Professional Services The most important thing to remember is that professional services will continue to be reimbursed based on CPT and HCPCS codes. The concern regarding revenue may be more from the perspective of payer ability to process claims with the new code set. 14

15 Payers It is unknown if all payers will test prior to implementation What if they aren t ready? Revenue may not stop What if it is sporadic or delayed? Identify your top 5 10 payers Are they testing? Revenue Industry recommendation is that entities have a cash reserve Delayed revenue can cause hardship May have to increase staff (short term) to manage requests for additional information May need additional time to review claims for accuracy before submitting There will be a period of time (approximately 12 months) when you are working claims in ICD 9 and ICD 10 15

16 Key Considerations Will the payer be ready to accept ICD 10 CM codes? Medicare currently testing Check with Medicaid in your area for testing requirements Not all payers are testing Even if a medical practice accepts just cash and no insurance, some patients will submit medical bills to healthcare payers. Those claims will need ICD 10 codes and CPT codes. 16

17 United Healthcare Testing Aetna Testing Medicare Testing Claims Statistic Information According to CMS, it accepted 81% of claims sent during a week long ICD 10 end to end testing period (Source: Health Data Management) 1 week in length 661 participants 15,000 claims 17

18 Statistically CMS is pleased This means that approximately 2,800 claims were rejected Of these 2,800 claims that were rejected 13% were rejected for reasons not related to ICD 10 There is a significant risk that when the deadline comes, if there is still a 19% rejection rate, your claims could be in that 19% Communicating About ICD 10 CM Communication between health care providers, software vendors, clearinghouses, and billing services is an important part of the transition process. Learn how to get the conversation started. Talking to Your Vendors About ICD 10: Tips for Medical Practices Questions to Ask Your Systems Vendors about ICD 10 The Role of Clearinghouses in ICD

19 Role of the Clearinghouse Software vendors are still preparing for ICD 10 CM If you haven t heard from your vendor reach out to them Your clearinghouse is just the mailman Your software needs to be ready The mailman delivers what you send Vendor Relationships Working with your vendor is key to testing Have an ICD 10 work plan with your Vendor Ask for formal documentation/confirmation that testing has occurred and the results Testing needs to occur with your top payers 19

20 RECAP Recap ICD 10 CM codes required for U.S. healthcare professionals by October 1, 2015 All codes are alpha numeric Some codes will require specificity for laterality Practices need training on ICD 10 Testing of claims is recommended before implementation of ICD 10 20

21 Recap Look internally at your forms, documents, contracts If you give courtesy claim forms to patients for insurance submittal, they will have to have ICD 10 codes Set some current benchmarks You can t measure future performance if you don t have current statistics Questions Enter your question in the Question Box on your webinar dashboard 21

22 Contact: Amy Hayes, MBA, CCS, CCS P, CHA, CMBS For more info on obtaining a CE credit for this webinar, visit THANK YOU FOR ATTENDING! 22