ICD-10 CM: Focus on documentation Physical, occupational & speech therapy, physical medicine and rehab

Transcription

1 ICD-10 CM: Focus on documentation Physical, occupational & speech therapy, physical medicine and rehab 1

2 Should you have technical difficulties during the webinar: ReadyTalk Customer Care Phone:

3 Who we are & why we re here The Payers Collaboration is a group of payers working together to provide a resource for physicians in their ICD-10 readiness activity We are working as one voice to provide valuable information to the provider community about transitioning to ICD-10 and to show that the transition doesn t have to be overly costly or burdensome 3

4 Contact us with questions Please us at: Q&A from todays webinar will be posted on: hannelid=6fa2600ae29fb210vgnvcm f10b10a Humana.com/providerwebinars bcbsm.com/icd10 4

5 Agenda Part 1 Introduction to ICD-10 ICD-10 timeline & billing dates of service Part 2 Specialty specific documentation examples Part 3 Next steps and wrap up 5

6 Objectives Identify the What, Why and When of ICD- 10 implementation Recognize the format of ICD-10 codes Apply documentation tips for the most common diagnoses in a given specialty Value the benefits of ICD-10 documentation 6

7 Part 1 Introduction to ICD-10 ICD-10 Timeline & billing dates of service 7

8 What is ICD-10-CM? International Classification of Diseases- 10 th Revision-Clinical Modification Listed by the World Health Organization (WHO) and the National Center for Health Statistics (NCHS) 8

9 Why are we implementing ICD-10? The Centers for Medicare and Medicaid Services (CMS) announced on July 31, 2014 that the new deadline for ICD-10 Implementation will be October 1, 2015 ICD-9 codes provide limited data about patients medical conditions and hospital inpatient procedures ICD-10 codes allow for greater specificity and accuracy in describing a patient s diagnosis and in classifying inpatient procedures 9

10 ICD-10 world adoption 10

11 How will ICD-10 impact me? The required specificity of ICD-10 documentation will have a positive provider impact in the areas listed to the right. 11

12 Implementation Delays ICD-10 implementation has been delayed several times but the current implementation date is October 1, 2015 Why so many delays? The most common reason cited for delaying ICD-10 is the complexity and cost involved on the health care provider side Another reason is the possibility of rejected claims due to noncompliance and the impact on health care providers and cash flow 12

13 Provider & Payer Concerns Everyone agrees that disruption to the claims processing system is the greatest danger of ICD-10 implementation It could lead to cash flow problems and disruptions It could also increase inquiries and resources straining health plans resources (i.e., longer hold times, response times, etc.) We need to work together to ensure that all stakeholders are ready to minimize disruption 13

14 Fact or Fiction? It can cost (a provider office) $80k to transition from ICD-9 to ICD-10 We too have heard facts like this, but believe that this figure assumes implementation, planning, and costs that will not be seen by the majority of health care providers. For most specialties, costs are much lower. -United HC findings 14

15 What provider documentation will be impacted by ICD-10? Impacted Diagnosis documentation for inpatients Diagnosis documentation for outpatients Not Impacted Procedure documentation for outpatient services Procedure documentation for certain professional services and medical supplies 15

16 What are some key differences between ICD-9 and ICD-10? ICD-9 Diagnosis codes ICD-10 Diagnosis codes 3-5 characters in length 3-7 characters in length Approximately 14,000 codes First digit may be alpha (E or V) or numeric; Digits 2-5 are numeric Limited space for expansion Lacks detail and laterality Difficult to analyze data due to non specific codes Approximately 69,000 codes Character 1 is alpha; character 2 is numeric; characters 3-7 are alphanumeric Room for expansion Very specific and added laterality Specificity improved coding accuracy/richness for data analysis/medical research 16

17 Is ICD-10 required on calendar date or date of service Oct. 1, 2015? Date of service Prior to October 1, 2015 Code set billed ICD-9-CM October 1, 2015 and later ICD-10-CM Provider outpatient AND inpatient claims are based on date of service. (DOS) Note: Overlapping dates require separate claims. 17

18 Part 2 Specialty specific documentation examples 18

19 Rehab for Carpal sequela tunnel of cerebrovascular syndrome: disease: Codes at a glance Codes at a glance ICD-9 ICD Hemiplegia affecting dominant side I Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting right dominant side Fluency disorder following nontraumatic intracerebral hemorrhage 19

20 The patient is admitted to physical and speech therapy following an acute cerebral infarct. I69.30 Unspecified sequelae of cerebral infarction Documentation: Rehab for Documentation: sequela of cerebrovascular Carpal tunnel disease syndrome NOT ICD-10 SPECIFIC The patient is admitted to physical and speech therapy with a diagnosis of an intracerebral infarct with residual hemiplegia of the left dominant side and dysphasia. I Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting left dominant side I Dysphasia following nontraumatic intracerebral hemorrhage ICD-10 SPECIFIC 20

21 Sprains and & strains: strain: Codes at a glance ICD-9 ICD Sprain and strains of other and unspecified parts of back, neck Sprains and strains of other and unspecified parts of back, thoracic S13.4XXD Sprain of ligaments of cervical spine, subsequent encounter S16.1XXD Strain of muscle, fascia, and tendon at neck level, subsequent encounter 21

22 Patient is seen for initial evaluation. She states that she injured her neck in a side impact collision 2 days ago. X-rays taken in the ED at the time of accident did not reveal fracture. She has limited range of motion in her neck. Diagnosis is documented as neck pain due to cervical sprain. S13.4XXA Sprain of ligaments of cervical spine, initial encounter Documentation: Sprains and strains Patient is seen for initial evaluation. She states she injured her neck in a side impact collision 2 days ago. X-rays taken in the ED at the time of accident did not reveal fracture. She has limited range of motion in her neck. Diagnosis is documented as neck pain due to cervical sprain and strain. S13.4XXA Sprain of ligaments of cervical spine, initial encounter S16.1XXA Strain of muscle, fascia and tendon at neck level, initial encounter NOT ICD-10 SPECIFIC ICD-10 SPECIFIC 22

23 Limb Pain: LIMB PAIN: CODES AT A GLANCE Codes at a glance ICD-9 ICD Pain in Limb M Pain in left arm M Pain in right upper arm M Pain in left upper arm M Pain in unspecified upper arm M Pain in right thigh M Pain in left thigh M Pain in right foot M Pain in left foot 23

24 DOCUMENTATION: LIMB PAIN Documentation: Limb Pain Patient presents with complaints of leg pain. The pain is dull in nature and has worsened over the last 2 weeks. Physical exam is unremarkable with normal reflexes and tone. There is no history of trauma. Diagnosis is documented as leg pain, unknown etiology Patient presents with complaints of left lower leg pain. The pain is dull in nature and has worsened over the last 2 weeks. Physical exam is unremarkable with normal reflexes and tone. There is no history of trauma. Diagnosis is documented as left lower leg pain, unknown etiology M Pain in leg, unspecified M Pain in left lower leg NOT ICD-10 SPECIFIC ICD-10 SPECIFIC 24

25 ICD Dysphasia LIMB PAIN: CODES AT A GLANCE Late effects of cerebrovascular disease, aphasia Late effects of cerebrovascular disease, dysphasia Speech deficits: Codes at a glance ICD-10 R47.02 Dysphasia I Dysphasia following nontraumatic intracerebral hemorrhage F80.1 Expressive language disorder F80.2 Mixed receptive-expressive language disorder 25

26 Documentation: Carpal Speech tunnel deficits syndrome Patient is an 8-year-old male who presents with increasing problems remembering words and making complex sentences. Administration of standardized language tests revealed a diagnosis of dysphasia. R47.02 Dysphasia NOT ICD-10 SPECIFIC Patient is an 8-year-old male who presents with increasing problems remembering words, making complex sentences, and improper use of tenses. Administration of standardized expressive language and nonverbal intellectual tests revealed a diagnosis of expressive language disorder. F80.1 Expressive language disorder ICD-10 SPECIFIC 26

27 ICD-9 Fracture Gait abnormality: of humerus: Codes at a glance ICD Abnormality of gait Difficulty in walking R26.0 Ataxic gait abnormality R29.6 Falling gait abnormality R26.1 Paralytic gait abnormality R26.0 Staggering R26.81 Unsteadiness R26.2 Walking difficulty 27

28 Documentation: Carpal Gait tunnel abnormality syndrome Patient presents for her scheduled PT appointment for gait abnormality. Patient was able to perform exercises for strengthening and endurance. Both active and passive exercises were performed. Encouraged patient to continue exercises at home. She will return in 3 days for her next appt. Diagnosis is documented as gait abnormality R26.9 Unspecified abnormalities of gait and mobility NOT ICD-10 SPECIFIC Patient presents for her scheduled PT appointment for ataxic gait abnormality. Patient was able to perform exercises for strengthening and endurance. Both active and passive exercises were performed. Patient was encouraged to continue exercises at home. She will return in 3 days for her next appointment. Diagnosis is documented as ataxic gait abnormality R26.0 Ataxic gait ICD-10 SPECIFIC 28

29 Fracture Muscle of atrophy: humerus: Codes at a glance ICD Muscular wasting and disuse atrophy, not elsewhere classified ICD-10 M Muscle wasting and atrophy, not elsewhere classified, right shoulder M Muscle wasting and atrophy, not elsewhere classified, left shoulder M Muscle wasting and atrophy, not elsewhere classified, right upper arm M Muscle wasting and atrophy, not elsewhere classified, left upper arm 29

30 Patient seen for initial evaluation after injuring his shoulder playing softball 3 months ago. He has limited range of motion and no strength in his right arm. There are no complaints of pain. We will establish a treatment plan for muscular wasting. Diagnosis is documented as muscular wasting with atrophy M62.50 Muscle wasting and atrophy, not elsewhere classified, unspecified site NOT ICD-10 SPECIFIC Documentation: Carpal Muscle tunnel atrophy syndrome Patient seen for initial evaluation after injuring his right shoulder playing softball 3 months ago. He has limited range of motion and no strength in his right arm. There are no complaints of pain. We will establish a treatment plan for muscular wasting and atrophy. Diagnosis is documented as muscle wasting and atrophy of right shoulder M Muscle wasting and atrophy, not elsewhere classified, right shoulder ICD-10 SPECIFIC 30

31 Fracture of aftercare: humerus: Codes at a glance ICD-9 V54.12 Aftercare for healing traumatic fracture of upper arm V54.13 Aftercare for healing traumatic fracture of hip ICD-10 S42.361D Displaced segmental fracture of shaft of humerus, right arm, subsequent encounter for closed fracture with routine healing S72.021G Displaced fracture of epiphysis (separation) (upper) of right femur, subsequent encounter for closed fracture with delayed healing 31

32 Documentation: Carpal Fracture tunnel aftercare syndrome Patient is referred to me after being hospitalized for an open fracture of T7- T8 vertebra with injury to the spinal cord. Patient had surgery to repair the injury and is also suffering from a spinal cord concussion at the T7-T10 level with resulting motor weakness of the upper extremities. Patient to start therapy tomorrow. Diagnosis is documented as rehab status post open fracture of thoracic vertebra Z47.89 Encounter for other orthopedic aftercare NOT ICD-10 SPECIFIC Patient is referred to me for rehab after being hospitalized for an open fracture of T7-T8 vertebra with injury to the spinal cord. Patient had surgery to repair the injury and is also suffering from a spinal cord concussion at the T7-T10 level with resulting motor weakness of the upper extremities. Patient to start therapy tomorrow. Diagnosis is documented as rehab status post open fracture of vertebra at T7-T8. Thoracic spinal cord concussion S24.0XXD Concussion and edema of thoracic spinal cord, subsequent encounter S22.069D Unspecified fracture of T7-T8 vertebra, subsequent encounter ICD-10 SPECIFIC 32

33 Osteochondritis Fracture of humerus: dissecans: Codes at a glance ICD Osteochondritis dissecans ICD-10 M Osteochondritis dissecans, right shoulder M Osteochondritis dissecans, left shoulder M Osteochondritis dissecans, joints of right hand M Osteochondritis dissecans, right ankle and joints of right foot 33

34 Documentation: Osteochondritis Carpal tunnel syndrome dissecans Patient is referred by PCP for osteochonditis dissecans of the knee. Patient states that she experiences popping and clicking of the knee at times which is painful. Patient was shown range of motion and strengthening exercises. Instructions were given and exercises were encouraged at home. Diagnosis is documented as osteochondritis dissecans of the knee M93.20 Osteochondritis dissecans of unspecified site Patient is referred by PCP for osteochondritis dissecans of the right knee. Patient states that she experiences popping and clicking of the right knee at times which is painful. Patient was shown range of motion and strengthening exercises. Instructions were given and exercises were encourage at home. Diagnosis is documented as osteochondritis dissecans of the right knee M Osteochondritis dissecans, right knee NOT ICD-10 SPECIFIC ICD-10 SPECIFIC 34

35 Disc disorders: Codes at a glance ICD Displacement of cervical intervertebral disc without myelopathy Degeneration of cervical intervertebral disc Other and unspecified disc disorder, cervical region ICD-10 M50.01 Cervical disc disorder with myelopathy, high cervical region M50.11 Cervical disc disorder with radiculopathy, high cervical region M50.22 Other cervical disc displacement, mid-cervical region M51.05 Intervertebral disc disorders with myelopathy, thoracolumbar region 35

36 Patient presents for physical therapy with numbness and tingling in her right leg when walking long distances. She has recently been treated by her attending physician for sciatica. Her x- rays confirm lumbar disc disorder. Diagnosis is documented as lumbar disc disorder M51.86 Other intervertebral disc disorders, lumbar region Documentation: Disc disorders Patient presents for physical therapy with complaints of numbness and tingling in her right leg when walking long distances. She has recently been treated by her attending physician for sciatica. Her x-rays confirm degeneration at L4. Diagnosis is documented as lumbar disc disorder at L4. M51.36 Other intervertebral disc degeneration, lumbar region NOT ICD-10 SPECIFIC ICD-10 SPECIFIC 36

37 Fracture Osteoarthritis: of humerus: Codes at a glance ICD Generalized osteoarthrosis, multiple sites Osteoarthrosis, localized, primary, lower leg Osteoarthrosis, localized, secondary Osteoarthrosis, unspecified whether generalized or localized ICD-10 M15.0 Primary generalized osteoarthritis M17.11 Unilateral primary osteoarthritis, right knee M17.31 Unilateral post-traumatic osteoarthritis, right knee M18.2 Bilateral post-traumatic osteoarthritis of first carpometacarpal joints M17.4 Other bilateral secondary osteoarthritis of knee 37

38 Patient presents for physical therapy with a history of having problems with his shoulder since a football injury in high school. The pain sometimes wakes him at night and has worsened over the last week since working in the yard. Patient has limited range of motion on the right side compared to the left. Diagnosis is documented as osteoarthritis M19.90 Unspecified osteoarthritis, unspecified site NOT ICD-10 SPECIFIC Documentation: Carpal Osteoarthritis tunnel syndrome Patients for physical therapy with a history of having problems with his right shoulder since a football injury in high school. The pain sometimes wakes him at night and has worsened over the last week since working in the yard. Patient has limited range of motion in the right shoulder compared to the left. Diagnosis is documented as primary osteoarthritis of the right shoulder M Primary osteoarthritis, right shoulder ICD-10 SPECIFIC 38

39 Part 3 Part 3 Next steps and wrap up 39

40 In summary Physician claims for outpatient and inpatient services will transition to ICD-10 Clinical Modification (ICD-10-CM) for reporting diagnoses on October 1, 2015 Also, please note that ICD-10-PCS will NOT replace the CPT procedure codes Remember, insurers making payment decisions, rating severity of illness or trying to predict recovery time, all need physician documentation that is at the highest level of specificity 40

41 Start with a checklist Obtain a list of your most commonly used ICD-9 codes Use existing tools to develop a list of viable ICD-10 codes Become familiar with the level of detail needed in the medical record Make sure that medical record documentation supports ICD-10 codes Use existing content-based testing environments and practice ICD-10 coding of those scenarios 41

42 Content-based testing objectives Give healthcare professionals (physicians, etc.) pre-defined, clinically-based medical scenarios to review and have them determine the ICD-10 codes they would use on the claim Allow providers to enter the data in an easy, efficient manner Share the effects of their selection in the form of Peer Reports and/or notification of the correlation of their inputs against expected codes 42

43 Content-based testing organization Each Specialty has a maximum of nine Narratives available. Each Narrative defines a specific healthcare encounter Narratives are grouped into Scenarios (3 narratives per Scenario) Providers register via a website, and will receive an inviting them to participate with an embedded link to the testing tool 43

44 Content-based testing specialties Allergy/Immunology Audiologist Cardiovascular Disease Certified Nurse Midwife Chiropractic Clinical Psychologist Dermatology Emergency Medicine Endocrinology Family Practice Gastroenterology General Practice General Surgeon Group Practice Hematology Hematology-Oncology Infectious Disease Internal Medicine Nephrology Neurology Nurse Practitioner Obstetrics & Gynecology Occupational Therapist Ophthalmology Optometry Orthopedic Surgery Otolaryngology Pediatric Medicine Physical Medicine and Rehabilitation Physical Therapist Plastic and Reconstructive Surgery Podiatry Psychiatry Psychologist Pulmonary Disease Radiation Oncology Rheumatology Thoracic Surgery Urology Vascular Surgery 44

45 Humana Content-based testing links BCBSM Michigan Dept of Community Health 45

46 Additional ICD-10 coding resources Crosswalks for the Top 50 codes by specialty ICD-10 CM/PCS documentation tips Tips for ICD-10-PCS coding Free code conversion tool FAQs: ICD-10 transition basics 46

47 Post webinar We want to hear from you, please complete the survey! Today s presentation will be ed to participants Q&A and webinar replay will be posted on Payers website Join us next time on 6/11/2015 Ophthalmology, Optometry, ENT & Audiology 47

48 Thank you! 48

49 Disclaimer This presentation is intended only for information use accompanying a live teleconference by the Payer Collaboration (Collaboration). No copy or use of this presentation should occur without expressed permission from the Collaboration. While our best efforts are to provide accurate and useful information, the Collaboration makes no claim, promise, or guarantee of any kind about the accuracy, completeness, or adequacy of the content of the presentation and expressly disclaims liability for errors and omissions in such content. As diagnostic codes changes annually, you should reference the current version of coding guidelines for the most detailed and up-to-date information. The information contained in this presentation is intended for informational purposes only. The Collaboration has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this seminar, including but not limited to any loss of revenue, interruption of service, loss of business or indirect damages resulting from the use of this program. The Collaboration makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service. The material is designed and provided to communicate information about coding and documentation in an educational format and manner. The presenter(s) are not providing or offering legal advice, but rather, practical and useful information and tools in the area of clinical documentation, data quality and coding. Every reasonable effort has been taken to ensure that the educational information provided is accurate and useful. 49