CODING CHANGESICD-10!! Presented by: Colleen Grope CPC, CCS-P

Transcription

1 CODING CHANGESICD-10!! Presented by: Colleen Grope CPC, CCS-P 1

2 AGENDA Differences between ICD-9 and ICD-10 Basic ICD-10 Coding Guidelines Implementation Strategies Potential Revenue Ramifications 2

3 ICD-9 vs. ICD-10 Process of code look-up will remain the same as ICD-9, however the need for 5 th, 6 th or 7 th characters will force Tabular reference ICD-10 has unspecified codes similar to ICD-9 but payors may refuse to pay claims reported with them- CODE TO THE HIGHEST LEVEL OF SPECIFICITY ICD-10 remains in draft form 3

4 ICD-9 vs. ICD-10 ICD-9 Approximately 14,000 codes 3-5 characters 1 st character always a number (except V&E) 17 Chapters Alphabetic and Tabular Indexes ICD-10 Approximately 70,000 codes 3-7 characters 1 st character always a letter 21 Chapters Alphabetic and Tabular Indexes 4

5 ICD-9 vs. ICD-10 New Chapters for Eye and Adnexa as well as Ear, which were part of the nervous system in ICD-9 V & E codes in ICD-9 are no longer supplemental classifications, but chapters in ICD-10 Combination codes for conditions and common symptoms or manifestations 5

6 ICD-10 Basics X is used as a placeholder at certain codes to allow for future expansion. 7 th characters must always be in the 7 th field If a code requires the 7 th character and is not 6 characters long, placeholder X must be used to fill in the empty characters. 6

7 ICD-10 Basics 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 Sequela 7

8 ICD-10 Basics Episode of Care: First encounter Subsequent encounter Sequela (late effect) EXAMPLE: Age related osteoporosis with current pathological fracture of the left femur, first encounter ANSWER: M80.052A 8

9 ICD-10 Basics Laterality- when appropriate, we must know: Right side (1) Left side (2) Bilateral (3) Unspecified (0 or 9) Unilateral or Bilateral in some instances 9

10 ICD-10 Basics Trimester and weeks of gestation EXAMPLE: Gestational diabetes mellitus in pregnancy, insulin controlled for a patient 28 weeks 3 days ANSWER: O24.414, Z3A.28 10

11 ICD-10 Basics Male vs. Female Malignant neoplasm of lower outer quadrant of LEFT MALE breast = C

12 ICD-10 Basics Combination codes: conditions with associated common symptoms or manifestations I Atherosclerotic heart disease of native coronary artery with unstable angina pectoris E Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema 12

13 ICD-10 Basics Stages of healing EXAMPLE: Stage 3 pressure ulcer of the left heel ANSWER: L With or Without EXAMPLE: Epileptic spasms Not intractable, with status epilepticus G Not intractable, without status epilepticus G Intractable, with status epilepticus G Intractable, without status epilepticus G

14 ICD-10 Guidelines Workers Compensation and Auto Accident Companies do not fall under HIPAA and therefore DO NOT have to change to ICD- 10. Check with your state BWC to see if they plan to change to ICD-10, and if so, WHEN?? You may be using both ICD-9 AND ICD-10! 14

15 ICD-10 Guidelines Providers need to know and understand the new ICD-10 concepts in order to document with more specificity, which will allow appropriate coding with ICD-10 An estimated 70% of current documentation does not have enough specificity to code with ICD-10 diagnoses 15

16 Implementation Strategies Choose a team leader/coordinator Involve someone from each department Include at least one doctor/extender Divide responsibilities Plan regular monthly meetings, then weekly meetings as Implementation date approaches 16

17 Potential Revenue Ramifications Consider- from the time the patient schedules an appointment until the last cent is collected Think about every position in the office that involves patient care Follow the paper (or non-paper) trail Every person in the office involved in patient care is involved in the revenue cycle! WHO CHOOSES ICD CODES??? WHOSE DOCUMENTATION MUST SUPPORT THE ICD CODE??? 17

18 Potential Revenue Ramifications Billing Charge entry- significant extra time if coding Front end denials Claim delays Claim denials LCDs and NCDs 18

19 Potential Revenue Ramifications Administration Reports Policies and Procedures Increased payroll Decreased productivity by staff and providers Cash flow delays 19

20 Tools and Resources GET A BOOK! If you don t already have one, you should get one. Even if you plan on using online tools, a paper book will help you learn. GEMs, or General Equivalency Mappings, are online tools to help guide you from an ICD-9 code to an approximate ICD-10 code. GEMs SHOULD NOT be used to replace actual coding, but merely as a tool! 20

21 Websites: Tools and Resources 21

22 QUESTIONS?? Colleen Grope, CPC, CCS-P President Medsys Consulting, Inc. (866)