Demystifying ICD 10. Beyond the Hype. What Therapists Should Know about ICD 10.

Transcription

1 Demystifying ICD 10 Beyond the Hype. What Therapists Should Know about ICD 10.

2 Welcome This session will be recorded Link to the recording and resources will be ed to all registrants Jim Plymale President Clinicient Questions can be asked in the Question panel Webinar will be extended an additional 1/2 hour for Q & A

3 Welcome Jerry Henderson Physical Therapist, Co Founder of Clinicient Founder Physical Therapy Clinics, Inc. Co founder Integrated Rehabilitation Group Founder Physiocare Physical Therapy Jerry Henderson, PT VP of Clinical Community Clinicient Co founded PT Link, one of the first developers of physical therapy EMR software Avid Blogger on Industry Topics

4 Welcome David Stockman David Stockman Product Manager Clinicient Clinicient Product Manager Responsible for the ICD 10 Implementation at Clinicient Background in product and solution management for technology and education companies BA is History for University of Washington Masters degree in Education

5 Today s Agenda ICD 10: The Basics The Chatter Versus the Reality about ICD 10 Why Payer Readiness May be the Biggest Challenge The Impact on Therapists and Why ICD 10 is Good The Clinicient Advantage What You Can Do Now to Prepare

6 ICD 10: The Basics

7 Example: Back Pain ICD 9 Code = Lumbago Used to report diagnoses and inpatient procedures Provide greater specificity than ICD 9 codes Used internationally US is just now getting up to speed Used in paperwork, electronic systems, and other processes, such as submitting reimbursement claims, identifying patient eligibility, getting prior authorization from a payer, reporting quality data ICD 10 CM not PCS

8 Example: Back Pain ICD 10 = M54.5 Low Back Pain Everyone covered by HIPAA must use the codes for claims with a Date of Service of October 1, 2014 No dual code transition timeline The new codes represent an increase from 13,600 diagnosis codes to over 69,000 PT/OT/SLP only use a small set of these

9 ICD 9 vs. ICD 10 Organization and Structure X X X. X X X X X. X X X X Category Etiology, Anatomic Site, Manifestation Category Etiology, Anatomic Site, Manifestation Extension ICD 9 Consists of three to five characters First character is numeric or alpha (0 or E) Second, third, fourth, and fifth characters are numeric Always at least three characters ICD 10 Consists of three to seven characters First character is alpha All letters are used except U Second and third characters are numeric Fourth, fifth, sixth, and seventh characters can be alpha or numeric

10 Top 10 Codes Used by PTs ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) Lumbago M54.5 Low back pain Pain in joint, lower leg M Pain in unspecified knee Pain in joint, shoulder region M Pain in unspecified shoulder Cervicalgia M54.2 Cervicalgia Muscle weakness (generalized) Abnormality of gait M62.81 Muscle weakness (generalized) R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified Pain in joint, pelvic region and thigh Pain in joint, ankle and foot M M Pain in unspecified hip Pain in unspecified ankle and joints of unspecified foot Pain in limb M Pain in unspecified limb * Based on Clinicient Data

11 ICD 10 Transition Timeline

12 The Chatter Versus the Reality about ICD 10 4 Common Misconceptions

13 The Chatter: ICD 10 will be Hard for Therapists

14 The Reality: ICD 10 will be Hard for Therapists It will be Easier for Therapists than other specialties

15 The Reality: ICD 10 will be hard for therapists It will be Easier for Therapists than other specialties Choose a code based on what the payer needs Use tools to move back and forth between new and old codes Education and training will be part of the solution Early preparation will have you ready by the cut off date

16 The Chatter: ICD 10 is Complicated with so Many Codes

17 The Reality: ICD 10 is Complicated with so Many Codes It s not the Doomsday that some make it out to be

18 The Reality: ICD 10 is complicated with so many codes It s not the Doomsday that some make it out to be Therapists use a fraction or subset of the codes It is not as complex as for other disciplines 75% of new codes have a 1:1 mapping with an ICD 9 code Most of the silly codes used as examples are already in ICD 9

19 The Chatter: No worries Another Delay is Coming

20 The Reality: No worries Another Delay is Coming There will be No Change in the Deadline For ICD 10

21 The Reality: No worries Another Delay is Coming There will be No Change in the Deadline For ICD 10 We have already delayed the adoption standard, a standard the rest of the world has adopted many years ago, and we have delayed it several times, most recently last year. CMS Administrator Marilyn Tavenner At the HIMSS 2014 Annual Conference and Exhibition

22 The Reality: No worries Another Delay is Coming There will be No Change in the Deadline For ICD 10 We have already delayed the adoption? standard, a standard the rest of the world has adopted many years ago, and we have delayed it several times, most recently last year. CMS Administrator Marilyn Tavenner At the HIMSS 2014 Annual Conference and Exhibition

23 The Chatter: ICD 10 is Costly and Needs a lot of Training

24 The Reality: ICD 10 is Costly and Needs a lot of Training With the, With the right system, There is no Cost, and Little Training

25 The Reality: ICD 10 is Costly and Needs a lot of Training With the right system,, There is no Cost, and Little Training Understand where diagnosis codes are used and by whom Understand your top 10 ICD 9 codes and how they translate to the new ICD 10 code set Communicate to your team about the transition deadlines Determine whether your payers will be ready

26 Why Payer Readiness May be the Biggest Challenge

27 The Challenge for Therapy Practices: Payers May Not Be Ready History indicates that some payers may not be ready by October 1 Not all payers are required to use ICD 10 Challenge will be: Knowing who is ready and who is not Knowing who to send what *Source: ICD10watch.com

28 Examples of Different Payer Scenarios 1) All payers are ready to accept ICD 10 codes by October 1 2) Primary payer is ready by 10/1 but Secondary is not 3) Secondary is ready by 10/1 but Primary is not 4) Payer mix changes after 10/1 5) Primary is not ready by 10/1 but is ready on 10/15

29 Separate Systems May Increase Risk Old Way: Paper/ EMR Billing If you don t have a single system with payer rules, you won t know which codes to send to which payers Patient data lives in 2 separate systems New Way: EMR + Billing Payer Rules Documentation may not match the claim using separate systems All patient data lives in 1 system; Payer rules prompt staff on correct action to ensure payment

30 The Impact on Therapists and Why ICD 10 is Good

31 ICD 10 is Better for Our Profession More specific Better description of function

32 ICD 10 is Better for Our Profession More specific Better description of function. well, a little better anyway

33 Therapy Professions Playing in a Medical World CPT = procedures defined and designed by the AMA to explain medical procedures ICD 9 = international classification system for diseases ICD 10 = new version of ICD 9 Do therapists perform medical procedures? Do therapists treat diseases?

34 Source: ICD 10 Overview from CMS APTA? ASHA? AOTA?

35 Making Sense of ICD 10 for Therapists Concepts Most specific code available Describing what you are treating as the primary diagnosis Codes describing loss of function

36 Trivia How many ICD 9 CM codes are usable to describe ambulation problems?

37 Describing Functional Deficits with ICD 10 Pretty Specific ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) Abnormality of gait R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified not so much

38 Case Study: Meet Mary 16 year old female basketball player with anterior knee pain following anterior blunt trauma during a game. Unable to play because of continued patello femoral irritation. Treatment consists of : soft tissue mobilization taping shoe orthotics strengthening to improve patellar tracking ice prn to decrease inflammation

39 Don t Get Stuck in a Crosswalk

40 Which Code? X X X. X X X X X. X X X X Category Etiology, Anatomic Site, Manifestation Category Etiology, Anatomic Site, Manifestation Extension ICD Other internal derangement of knee M22.2X1 ICD 10 Patellofemoral disorder, right knee Pain in joint, lower leg M Pain in right knee Abnormality of gait R26.89 Other Abnormalities of gait and mobility Difficulty in walking R26.2 Difficulty in walking, not otherwise classified Chondromalacia M Chondromalacia, right knee

41 Which Code? X X X. X X X X X. X X X X Category Etiology, Anatomic Site, Manifestation Category Etiology, Anatomic Site, Manifestation Extension ICD Other internal derangement of knee ICD 10 M22.2X1 Patellofemoral disorder, right knee Pain in joint, lower leg Abnormality of gait Difficulty in walking Chondromalacia M Pain in right knee? X R26.89 Other Abnormalities of gait and mobility R26.2 Difficulty in walking, not otherwise classified? M Chondromalacia, right knee X

42 Which Code? Treatment: soft tissue mobilization, taping, shoe orthotics, and strengthening M22.2X1 ICD 10 Patellofemoral disorder, right knee Ice prn to decrease inflammation M Pain in right knee soft tissue mobilization, taping, shoe orthotics, and strengthening R26.89 Other Abnormalities of gait and mobility

43 Describing Functional Deficits with ICD 10 ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) Abnormality of gait R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified

44 Describing Functional Deficits with ICD 10 ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) Abnormality of gait R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified

45 Describing Functional Deficits with ICD 10 ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) Abnormality of gait R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified

46 Describing Functional Deficits with ICD 10 ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) Abnormality of gait R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified

47 Describing Functional Deficits with ICD 10 ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) Abnormality of gait R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified

48 Describing Functional Deficits with ICD 10 ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) Abnormality of gait R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified

49 Unspecified Codes Source: CDC Website Example ICD 9 ICD 10 Specific ICD 10 Specific ICD 10 Specific Myalgia and myositis, unspecified M60.9, Myositis, unspecified M79.1 Myalgia M79.7 Fibromyalgia

50 Let s talk about Specificity and Laterality Non specific ICD 10 codes cannot be used to indicate a medical diagnosis ICD 9 ICD 10 Non Specific ICD 10 Specific ICD 10 Specific ICD 10 Specific Pain in joint, lower leg M25.56 Pain in knee M Pain in right knee M Pain in left knee M Pain in unspecified knee This is Non specific but this is Specific?

51 Let s talk about Specificity and Laterality Where is the ICD 10 for bilateral knee pain? ICD 9 ICD 10 Non Specific ICD 10 Specific ICD 10 Specific ICD 10 Specific Pain in joint, lower leg M25.56 Pain in knee M Pain in right knee M Pain in left knee M Pain in unspecified knee

52 Specificity and Laterality Source: CDC Website If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.

53 Bilateral Problems ICD 9 Claim ICD 10 Claim Pain in joint, lower leg M Pain in right knee M Pain in left knee ICD 9 Claim ICD 10 Claim Stiffness of joint, NEC, shoulder region M Stiffness of right shoulder, NEC M Stiffness of left shoulder, NEC

54 Which Code Would You Use for an Antalgic Gait? ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) Abnormality of gait R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified

55 Things to Remember Crosswalks are not enough Need more definition for accurate diagnosis

56 What You Can Do Now to Prepare

57 What You Can Do Now to Prepare Understand where diagnosis codes are being used and by whom Understand your top 10 ICD 9 codes being used today and how they translate to the new ICD 10 code set (Be sure to use our Cheat Sheet) Communicate to your team about the transition and deadlines Talk to your payers to see if they will be ready by Oct. 1, 2014

58 Questions to Ask Software Providers About ICD 10 What is their plan to support ICD 10? How do they manage payer data and settings? Do they have a simple way to add the new codes to the patient record and claims? Are they on track to hit the ICD 10 cut off date? Is there an additional cost for upgrading? Will the system work with both ICD 9 and ICD 10 codes? Will there be training and support for the new ICD 10 codes? Will there be an additional cost for ICD 10 training and support?

59 The Clinicient Advantage

60 Our Approach We are prepared and have a plan Front office and therapists will select the diagnosis code They can use either ICD 9 or ICD 10 or a word description of the diagnosis Testing will occur throughout Q2 and Q3 Therapists will be able to practice in the system before the transition date

61 The Single System Advantage Clinicient provides a single system for both EMR and Billing All patient information lives in one place We have the industry s largest payer database, with over a decade of payer data, constantly updated Payer requirements are built into workflows for all staff from front desk to therapist to billing, alerting what is needed and when Clinicient manages the change to help clinics be successful Will provide a tool to look up the appropriate code Dual ICD 9 and ICD 10 coding to support all payers System knows when to use which code set

62 Benefits of Clinicient s Single System System knows when to use ICD 9 and ICD 10 codes Fast and efficient for PTs Therapists just select a diagnosis, the system does the rest Coding easy and automatic No added resources and minimal business disruptions Clinicient does the heavy lifting not your staff Claims processing continues as usual No added costs for ICD 10 upgrades, testing or education

63 Our Experience We ve been planning and collecting data for ICD 10 for several years to make this an easy transition for our customers We have embedded workflows combined with a rules engine that simplifies these types of reforms for our customers: Functional Limitation Reporting, PQRS, MMR Our proven solution works for multiple disciplines PT/OT/SLP and many other specialties Free resources and education

64 Thank You! Questions? Please Ask in the Questions Pane.

65 Resources Clinicient Resources: ICD-10 Cheat Sheet ICD-10 Blog Posts ICD-10 FAQs Clinicient Overview on ICD-10 Industry Resources: APTA Website: apta.org/payment/coding/icd10/ ICD-10 Watch Website: icd-10watch.com CMS Website: cms.gov/medicare/coding/icd10/index.html?redirect=/icd10

66 Contact Info EMR and Billing Solutions for Outpatient Rehabilitation Practices Visit our website to Learn More Schedule a Demo Get a @jimply

67 Thank You! 2014 Clinicient Inc. All Rights Reserved. This webinar and related materials are registered and protected by US copyright laws. No materials may be used without written consent from Clinicient, Inc.