Dial-In: (800)

Transcription

1 GE Healthcare Dial-In: (800) Coding in ICD-10 Planning and Executing for Success

2 2011 General Electric Company All rights reserved. This does not constitute a representation or warranty or documentation regarding the product or service featured. All illustrations are provided as fictional examples only. Your product features and configuration may be different than those shown. Information contained herein is proprietary to GE. No part of this publication may be reproduced for any purpose without written permission of GE. DESCRIPTIONS OF FUTURE FUNCTIONALITY REFLECT CURRENT PRODUCT DIRECTION, ARE FOR INFORMATIONAL PURPOSES ONLY AND DO NOT CONSTITUTE A COMMITMENT TO PROVIDE SPECIFIC FUNCTIONALITY. TIMING AND AVAILABILITY REMAIN AT GE S DISCRETION AND ARE SUBJECT TO CHANGE AND APPLICABLE REGULATORY CLEARANCE. GE, the GE Monogram, Centricity and imagination at work are trademarks of General Electric Company. General Electric Company, by and through its GE Healthcare division. 2 12/7/2011

3 Portions of this presentation and content herein are the opinions and experiences, and represent the views, of the specific authors and presenters and are not statements of advice, opinion or information from GE Healthcare. These portions have not been prepared, screened, approved, reviewed or endorsed by GE Healthcare.

4 Agenda Kickoff GE s Support of ICD-10 Readiness GE s Training Services for IDC-10 Readiness AAPC Wrap and Q&A Lynn Wasielewski Senior Field Marketing Manager - Services GE Healthcare IT Barbara Bambic Senior Director, Business Solutions Group GE Healthcare IT Donna Akers Senior Director, Knowledge Services Org GE Healthcare IT Kim Reid, CPC, CPC-I, CEMC, CPMA Director, ICD-10 Development and Training AAPC Lynn Wasielewski 3 12/7/2011

5 Centricity Business Solutions Group GE s Support of ICD-10 Readiness Barbara Bambic Senior Director, Business Solutions Group GE Healthcare IT

6 ICD-10: Are You on Track? NCHICA and WEDI estimates: 13 months to organize implementation 36 months to identify process improvements 14 months for internal system design 12 months each for internal testing 12 months for vendor code deployment 10 months for external testing CMS recommended timeline: Assessment and Planning: Q Q Implementation Prep: Q Q Go-Live Preparation: Q Q Follow-Up: Q Q /7/2011

7 GEHC s Commitment to You Compliant software delivered well in advance of the 10/1/2013 deadline Centricity Business version 5.0 General Release was released in Q3, 2011 Over 100 customers are currently on our slot schedule for the 5.0 release ICD-10 support release file for Centricity Business version 4.3 slated for Q Beta testing is complete 6 12/7/2011

8 GEHC s Commitment to You Discovery Report and report Guided Review ICD-10 Customer Focus Groups Webinars and bulletins to keep you informed ICD-10 Site on GE Centricity Business Knowledge Center ICD-10 consulting and training from services team 7 12/7/2011

9 Centricity Business ICD-10 Services ICD-10 impact assessment Preparedness and impact report Discovery report analysis and estimates System upgrade and ICD-10 remediation Dictionary cross mapping and updates Test plan development, CD-10 customization remediation Organizational Training Training plan and curriculum development Train your trainers for success Project management and functional consulting Project planning and oversight Resource estimates, risk mitigation and testing coordination 12/7/2011

10 Centricity Business Knowledge Services Partnering With You to Prepare for the Change Donna Akers Senior Director, Knowledge Services Organization GE Healthcare IT

11 Centricity Business Knowledge Services ICD-10 Training Services Knowledge Center ICD-10 Courses Application Training ICD elearning Course Courseware Development Resources Education Planning and Project Resources Trainers 10 12/7/2011

12 Knowledge Center 11 12/7/2011

13 Centricity Business Knowledge Services ICD-10 Training Courses ICD-10 System Setup Course - 1 day course - next offering: 1/10/2012 and 1/12/2012 ICD-10 Application Remediation Courses - BAR/TES Remediation (1 day) - next offering is 2/15/2012 and 2/16/ Additional application remediation courses (1/2 day or 1 day) 12 12/7/2011

14 Are you on our mailing list? 13 12/7/2011

15 Knowledge Service Organization ICD-10 Training Services How is our training different from AAPC? KSO will train your staff on how to enter the diagnosis codes into Centricity Business KSO does not train your staff on which code is the right one to use Coders are key to the ICD-10. How are you going to get them trained? 14 12/7/2011

16 AAPC Training Your Coders This presentation and the content herein are the opinions and experiences, and represent the views, of the specific authors and presenters and are not statements of advice, opinion or information of GE Healthcare. This presentation has not been prepared, screened, approved, reviewed or endorsed by GE Healthcare. Kim Reid, CPC, CPC-I, CEMC, CPMA Director, ICD-10 Development and Training AAPC

17 Presented by: Kim Reid, CPC, CPC-I, CEMC, CPMA Director, ICD-10 Development and Training, AAPC

18 No part of this presentation may be reproduced or transmitted in any form or by any means (graphically, electronically, or mechanically, including photocopying, recording, or taping) without the expressed written permission of AAPC.

19 ICD-10 Final Rule Issues Single implementation date for all users Date of service for ambulatory and physician reporting Date of discharge for inpatient settings ICD-9-CM codes will not be accepted for services provided on or after October 1, 2013 ICD-9-CM claims for services prior to implementation date will continue to flow through systems for a period of time 4010 electronic transaction standard to 5010 January 1, 2012 THERE WILL BE NO DELAY!!!

20 ICD-10 Changes From 14,000 codes to approximately 69,000 ICD-10 codes All codes have full descriptions for both ICD-10-CM and ICD- 10-PCS ICD-9-CM ,000 codes ICD-10-CM ,000

21 Physician Practices: What Will Change?

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30 Coding Transitions

31 Format and Structure Categories Alphanumeric 3 characters Subcategories 4 or 5 characters Codes Up to 7 characters

32 ICD-10 CM Format Category Etiology, Anatomical site, Severity Extension

33 Diabetes mellitus Significant Change to Diabetes Mellitus There are six (6) Diabetes Mellitus categories in the ICD-10- CM. They are: E08 Diabetes Mellitus due to an underlying condition E09 Drug or chemical induced diabetes mellitus E10 Type I diabetes mellitus E11 Type 2 diabetes mellitus E13 Other specified diabetes mellitus

34 Diabetes Mellitus Diabetes mellitus codes expanded to include the classification of the diabetes and the manifestation. Category for diabetes mellitus has been updated to reflect the current clinical classification of diabetes No longer classified as controlled/uncontrolled: E08.22, Diabetes mellitus due to an underlying condition with diabetic chronic kidney disease E09.52, Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene E10.11, Type 1 diabetes mellitus with ketoacidosis with coma E11.41, Type 2 diabetes mellitus with diabetic mononeuropathy

35 Combination Codes ICD-10-CM consists of greater specificity. Examples I25.110, Arteriosclerotic heart disease of native coronary artery with unstable angina pectoris K50.013, Crohn s disease of small intestine with fistula K71.51, Toxic liver disease with chronic active hepatitis with ascites

36 Complication Example ICD-10-CM provides 50 different codes for complications of foreign body accidently left in body following a procedure Only one code in ICD-9-CM.

37 Complication Example T Perforation due to foreign body accidently left in body following heart catheterization T Perforation due to foreign body accidently left in body following surgical operation T Obstruction due to foreign body accidently left in body following endoscopic examination T Adhesions due to foreign body accidently left in body following aspiration, puncture or other catheterization

38 Fractures Fracture codes require seventh character to identify if fracture is open or closed The fracture extensions are: A Initial encounter for closed fracture B Initial encounter for open fracture D Subsequent encounter for fracture with routine healing G Subsequent encounter for fracture with delayed healing K Subsequent encounter for fracture with nonunion P Subsequent encounter for fracture with malunion S Sequelae S Displaced fracture of shaft of left clavicle initial encounter for closed fracture Requires 7 th character A for initial encounter S42.022A

39 Fracture Coding A patient underwent surgery for an open burst fracture of the lumbar vertebra which became unstable. First listed diagnosis: S32.012B Seventh character B identifies the initial encounter for the open fracture.

40 Case Examples Fracture Clavicle 24 choices for fracture of clavicle (only 1 in ICD-9-CM) Documentation must include: Laterality Displaced (anterior or posterior displacements) Nondisplaced Location; sternal end, shaft, lateral end, unspecified 7 th digit extender; A, B, D, G, K, P, S Example: S42.011B Anterior displaced fracture of sternal end of right clavicle initial encounter open fracture

41 Case Examples Malignant Neoplasm Breast 54 choices for male/female breast Documentation must include: Laterality Location Use of an additional code to identify estrogen receptor status Example: C Malignant neoplasm of upper-outer quadrant of the left male breast

42 Neoplasm Case Example Large and small intestine 26 choices available Documentation must include: Specific site Appendix, caput coli, cecum, colon and rectum, ascending, caput, descending, distal, left, overlapping, pelvic, right, sigmoid, hepatic flexure, sigmoid flexure, duodenum, ileum, jejunum Example: C18.5 Malignant neoplasm of splenic flexure

43 What Can Today s Practices Do To Prepare?

44 Updating skills Many coders will retire rather than go through the process of updating skills: Anatomy and Pathophysiology Medical terminology Going back to the basics Training in areas of deficiency

45 Documentation: Compliance and Quality In the clinical area, the largest impact to ICD-10- CM implementation is the documentation Since ICD-10-CM is more robust and has up to seven digits of specificity, will documentation currently be in the medical record to support ICD-10-CM on the Golive date? By analyzing the documentation and conducting medical record documentation audits, the impact can be assessed

46 Documentation Impacts Documentation of diagnoses and procedures Codes must be supported by medical documentation ICD-10-CM codes are more specific Revenue Impacts of specificity Denials Additional Documentation 45

47 Performing an ICD-10-CM Readiness Evaluation Practitioners either have staff that conduct audits in your medical practice or routinely have a consultant audit for appropriate documentation and coding Important element of compliance and many practitioners have undergone this process from a comprehensive coding perspective But take a different approach Review the patient chart note to make sure the physician or non-physician practitioner is documenting a complete diagnosis to support an ICD-10-CM code. 46

48 Performing an ICD-10-CM Readiness Evaluation ICD-10-CM readiness evaluation different than the typical medical record documentation and coding audit Auditor will assess the documentation and make a determination if: 1. does the documentation support the current diagnosis reported, and 2. will the documentation support an ICD-10-CM code(s)? 47

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54 AAPC s ICD-10 Plan for our Certified Coders ICD-10-CM proficiency testing will begin October 1, 2012 and end September 30, 2014 Every certified coder must take and pass a proficiency examination on ICD-10-CM to maintain certification Open book 75 question test. Coder may use any resource available to complete examination May take the examination twice for a cost of $60.00 Test is taken on line and is a timed

55 Resources Resources for all medical practices solo practitioners-large medical groups Complete list of code sets for ICD-10-CM and ICD-10 PCS; final rule and Official ICD-10-CM Guidelines

56 Questions?

57 Closing Remarks Footer

58 Take Action Now! 1. Develop a plan and budget for your ICD-10 project 2. Join the GE Centricity Business ICD-10 Focus Group 3. Attend ICD-10 seminars at the 2012 Regional User Group meetings 4. Explore & monitor ICD-10 websites 5. Contact your account manager for assessment, consulting and training needs A copy of this presentation will be made available shortly on our external website: /7/2011

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