11/30/2010. Genius Solutions, Inc. TM Presents: Yes, the 5010 format and the ICD-10 codes do go together.

Transcription

1 Sg July Genius Solutions, Inc. TM Presents: 5010 & July 2010 Genius Focus Group 5010 & Yes, the 5010 format and the codes do go together is the new, upcoming electronic claims format, whereas is the new, upcoming healthcare diagnosis & inpatient procedure code format reporting. 1

2 5010 The 5010 e-claims format is necessary to accommodate the changes coming with the codes. You will not have to worry about buying or doing anything to incorporate the 5010 e-forms. As the time approaches your THOMAS system will be updated with the proper forms automatically. You will receive them as you AutoUpdate your system The 5010 e-claims format is due to Go Live January 1 st Testing for the 5010 format will begin January 1 st Per the CMS, the current paper forms are NOT heading for another change. (The current format was already designed to incorporate the upcoming changes.) 2

3 WHO are you?, or Oh, please, not another coding change. Let s bring things into perspective: ICD stands for International Classification of Disease and was created for mortality reporting. The World Health Organization (WHO) published (and owns the copyright to) both ICD-9 and listings. Most countries create their own unique clinical modifications (CMs) to the ICD codes to make the codes work for them, as well as, for international mortality reporting. WHO first published ICD-9 in 1975; it was adopted in the U.S. around 1979, with its primary purpose being government reporting and research, NOT reimbursement, edits for medical necessity, health care funding, or strategic health care planning. WHO published the list in It is in general use everywhere, except in the United States and in Italy. (We use it for mortality reporting only, not for clinical use.) Even with around 13,500 ICD-9 codes, it is running out of room. ICD numbers are organized in a hierarchical rubric system (i.e. all codes that begin with the same "rubric", or 3-digit category number, are part of the same disease "group". Part of the problem with ICD-9 coding is not only finding a code, but finding one that really seems to mean what you need it to mean, to be specific enough to report what you are actually trying to do, and to document properly for payment. Add to this, all of the emerging medical technologies, procedures and options that come out every year, and you are constantly behind. 3

4 offers codes up to seven characters long beginning with an alpha character. There are many more options for detail and specificity with coding. # of Characters ICD numeric (+V and E codes) 3-7 Alphanumeric # of Codes ~13,500 ~68,000 Example of an -CM code w/ specificity: S9030xA Contusion of unspecified foot, initial encounter S9030xD Contusion of unspecified foot, subsequent encounter S9030xS Contusion of unspecified foot, sequela S9031xA Contusion of right foot, initial encounter S9031xD Contusion of right foot, subsequent encounter S9031xS Contusion of right foot, sequela S9032xA Contusion of left foot, initial encounter S9032xD Contusion of left foot, subsequent encounter S9032xS Contusion of left foot, sequel 4

5 Comes in Two Flavors: CM & PCS The CM stands for Clinical Modification and is supposed to replace the current Volumes 1 & 2 from ICD-9CM. It will be for healthcare diagnosis reporting in all situations, whereas, the PCS codes are for inpatient procedures only. The PCS stands for Procedure Code Summary and is supposed to replace the current Volume 3 from ICD-9-CM. Per CMS** **,, regarding CPT & HCPCS codes: No impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes These will continue to be used for physician and ambulatory services The implementation was extended, and will not occur until October 1 st Implementation will be applied by Date of Service (on the claim) for offices, and will be applied by Discharge Date if in a hospital. This changeover includes the - CM (diagnosis) code implementation, as well as the -PCS (inpatient procedure) code implementation. 5

6 Benefits: More code options that are more specific, with greater detail for better reporting and better reimbursement. More accurate billing and recording of patient treatment, and work done for medical necessity recording, etc. Better data for actual mortality and morbidity documentation and research. Better data for health care research and program planning. Better and more easily definable reimbursement guidelines. Side Effects: Recertification will be required for coders, for coding. More detailed codes will require better trained coders and possibly more input from the physicians to get the coding correct. The terms, definitions, and specifics will be much more difficult for a layperson biller. Professional coders may be a must to be effective. More reporting options will likely cause an increase in documentation requirements for study and for reimbursement. Increased coding options will likely lead to increased queries (rejections) for coding clarification while everyone gets used to the new codes and coding more specifically. This may also cause reimbursement delays. EMRs and good practice management systems will become a must to keep things organized, trackable, and manageable in a functional work environment. 6

7 CMS Recommends: CMS mentioned, even as of June (this year ) that it recommends that you do not get a new code book or coder training for until 6-9 months before implementation (Oct 1, 2013). They want you to be prepared, but they do seem to want you to make sure that things are finalized and proceeding on schedule. For the Most Current & Accurate Information on ICD- 10 and 5010: You will want to stay in touch with the CMS web site. They have current information, they are offering a sign-up for news, as information becomes available, and they also have options for you to sign up for their informational teleconferences. They also have information about GEMS (an aid for cross-mapping ICD-9 codes to codes and vice versa). CMS also said to look for the following logo, as it is their icon for official information. 7