ICD-10: A Coders Perspective

Transcription

1 ICD-10: A Coders Perspective Karla VonEschen, CPC AHIMA Approved ICD-10 Trainer 1 1

2 ICD-10 REFRESHER 2

3 What is ICD-10? ICD-10 is the new coding system that will take the place of our current system, ICD-9. ICD-10 is broken in 2 classifications: ICD-10-CM: diagnosis coding for all claims; inpatient or outpatient ICD-10-PCS: procedure coding system for inpatient physician procedures only The implementation of ICD-10 does not impact CPT or HCPC codes 3

4 Who is impacted? Any organization covered under HIPAA is impacted by ICD-10. This includes but is not limited to: Physicians Facilities Payers Skilled Nursing Facilities Home Health Providers ICD-10 is effective 10/1/2014. Transitioning is not an option! 4

5 PERSPECTIVE 5

6 Perspective There are many personalities among physicians, coders, billers and office staff No two practice environments are the same An eclectic mix of personalities A broad variety of specialties Many different opinions of the ICD-10 transition 6

7 Perspective ICD-10 as a whole is overwhelming One solution does not fit all A belief that the transition to ICD-10 should be tailored to the specific clinic For a successful transition, we need to take in to account the organization specialty (hospital, senior living, clinic, DME, home health, etc.), organization size, population served, motivation of staff and provider support for the transition 7

8 WHAT ORGANIZATIONS WANT TO KNOW 8

9 What Coders Want to Know Will current ICD-9 codes crosswalk to the same ICD- 10 code? Will I have to go back to the provider for clarification? Will it take me longer to code with ICD-10? Will I have a loss of productivity? When do I need to learn the new codes? Will an EMR take care of the coding for me? 9

10 What Physicians Want to Know How will this impact my reimbursement? Will my work flow change? 10

11 What Administrators Want to Know How will this impact productivity? What changes need to occur? How many areas of my organization are impacted? How much will the transition cost? 11

12 What The Consultant Hears Do you see any common themes? Reimbursement Work flow disruption 12

13 WORKFLOW 13

14 Workflow Provider impact is limited on the front end Bigger changes behind the scenes or the back end A successful transition is dependent on how well the providers and coders work together 14

15 Workflow Don t procrastinate! Now is a great time to evaluate your front end and back end Make a list of what will impact workflow within your organization 15

16 CODING 16

17 Coding This change will be painful, but helpful in the long run We need to be able to code more accurately ICD-10-CM codes tell a story Use of unlisted diagnosis and procedure codes Physician payment 17

18 Coding The biggest job falls on the coder Look at most commonly billed ICD-9 codes now Not all ICD-9 codes crosswalk to 1 ICD-10 code Increased knowledge of Anatomy and Physiology is a must 18

19 Coding ICD-10-CM The basic structure of the ICD-10 manual is the same as ICD-9 The number of available diagnosis codes will change Not all diagnosis codes apply to all specialties Organizations can focus on those diagnosis codes they bill most often 19

20 Coding What the coder sees today when coding ICD-9 diagnosis codes: Closed fracture of head of radius 20

21 Coding What the coder will see on 10/1/2014 when billing ICD-10 diagnosis codes: S52.121A- Displaced fracture of head of right radius, initial encounter for closed fracture S52.122A- Displaced fracture of head of left radius, initial encounter for closed fracture S52.123A- Displaced fracture of head of right radius, initial encounter for closed fracture S52.124A- Nondisplaced fracture of head of right radius, initial encounter for closed fracture S52.125A- Nondisplaced fracture of head of left radius, initial encounter for closed fracture S52.126A- Nondisplaced fracture of head of unspecified radius, initial encounter for closed fracture 21

22 Coding What the coder sees today when billing ICD-9-PC codes: ICD-9-PC 21.22: Nose biopsy 22

23 Coding What the coder will see when coding ICD-10-PCS: ICD-10-PCS ICD-9-PC crosswalks to 31 different ICD- 10-PCS codes depending on the root operation: Excision/Head and Facial Bones Drainage/Head and Facial Bones Drainage/Ear, Nose, Sinus Excision/Skin and Breast Excision/Ear, Nose, Sinus 23

24 COMPLIANCE 24

25 Compliance This change is not an option! A change this large does carry risks that could lead to non-compliance: Risk due to failure of billing or EMR systems Risk due to lack of education Risk due to insufficient review and training of revised carrier documentation and policies & procedures for ICD-10 25

26 Compliance There are many impacts of reporting incorrect ICD- 10 codes: Code reported is not supported by documentation Payment for an incorrect ICD-10 code when the correct code may not pay Underpayment or payment delay Use of unspecified code and post payment risks 26

27 Compliance Limiting compliance risk is important Perform an internal review of your business processes Test your systems! Staff training Review policies and procedures 27

28 WHAT YOU CAN DO NOW! 28

29 What You Can Do Now! Begin the conversation about ICD-10 Create an inventory Have a cushion Physician involvement EMR templates Keep in contact with your software vendor Remember, the transition process to ICD-10 will not be easy, but the earlier you start, the better off you ll be on 10/1/2014! 29

30 Contact Us Thank you for attending! If you have questions around ICD-10 please feel free to contact me! Karla VonEschen, CPC AHIMA Approved ICD-10 Trainer twitter.com/cla_cpas m/cliftonlarsonall en y/cliftonlarsonallen 30