What s Up Wednesday. Together Let s Get ICD-10 Ready. Date: February 18, 2015 Time: 2 3 p.m. Phone Number: Pass code:

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1 What s Up Wednesday Together Let s Get ICD-10 Ready Date: February 18, 2015 Time: 2 3 p.m. Phone Number: Pass code: Presented by the Pennsylvania Blues Plans

2 2 What s Up Wednesday and ICD-10 Increase Collaboration, communication, education and coordination between hospitals, physicians, payers and vendors Expand Understanding of the current state of ICD-10, recent regulatory decisions and industry perspectives Raise Awareness and understanding of the unique challenges that ICD-10 brings to the entire health care industry Provide Tools, techniques, best practices, and helpful hints that can be used to support ICD-10 implementation Please remember that during the call all attendees are on mute except for any guest speakers and panelists. Please any questions you would like addressed during or after the call to ICD10ProviderCommunication@capbluecross.com.

3 3 Today s ICD-10 Agenda Geisinger Health Systems Meghna Patel, ICD-10 Program Manager Stephanie Snyder, Director, Revenue Management Practice Consultants Yvonne Krashkevich, Technical Analyst Lead, IT Hospital and Professional Billing and ICD-10 Testing Lead Kohler HealthCare Consulting, Inc. Charlotte L. Kohler, President, Kohler HealthCare Consulting, Inc. Catherine (Kate) H. Clark, Vice President, Kohler HealthCare Consulting, Inc. Update: House of Representatives Committee on Energy & Commerce Subcommittee Hearing: Examining ICD-10 Implementation Presented by Deb Cotter, Director of Highmark s Strategic Programs

4 ICD-10 Update on What s up Wednesday Call February 18, 2015

5 5 Agenda/Updates GHS Demographics Collaboration Approach Where are we? ICD-10 EMR Early Adoption ICD-10 Education ICD-10 Testing Appendices

6 6 Geisinger Health System Main campus located in Danville, PA 6 Inpatient facilities and campus & 1 affiliated hospital 96 outpatient clinic locations 3 research centers and a tertiary care teaching hospital Serving 44 PA counties Geisinger Health Plan, an independent business entity, with approximately 480,000 members serving 43 counties in PA

7 7 ICD-10 Collaboration Approach Where are we? Tracking assets readiness & testing plans Continuous communication with payers for end to end testing Sending surveys out to know more about readiness, testing and medical policy updates (Appendix 2) Continuous collaboration for enterprise wide education efforts Tracking critical workflow scenarios for testing Engaging referring physicians and provide education sessions Developing a solution design through which we would be able to send ICD-9 codes to our non-hipaa compliant payers (WC/Auto)

8 8 ICD-10 EHR Early Adoption New functionalities built in EHR system to support ICD- 10 required specificity and documentation. Providers will see and use the new updated smart tools, preference lists, diagnosis calculator, etc. in the EHR system. Why before 10/01/2015? Providers will have more time to become familiar with the new expanded specificity and terminology. Reduces the big bang risk.

9 9 ICD-10 Improved Clinical Documentation Education Physician Education Revenue Management Practice Consultants education approach. ICD-10 EHR early adoption and CBT training. CDI query template updates. Coder Education Approx. 70 e-learning courses completed. Monthly DRG review (high to medium level risk) and audit meetings. Exploring options for dual coding. Nursing Education Clinical level training through Nurse Educators. Specific examples of detailed documentation (ulcers, alcohol, drug usage, etc.)

10 10 ICD-10 Testing ICD-10 Testing Payers ICD-10 Payer Testing Dashboard Annual Average Claim Volumes Testing Schedule Start date Testing Schedule End Date EDI Gateway Testing Claims Adjudication Testing End to End Testing Risk Flags Payer 1 1,928, Feb Sep % 0% 0% 33% Payer 2 860, Apr Aug-15 N/A N/A 0% 0% ICD-10 Ready ICD-10 IT Assets Integration Testing Dashboard ICD-10 Impacted Assets Asset Category Business Impact Risk Level Testing Testing Schedule Start Schedule End Date Date DEPENDENT ASSETS Phase II System Configuration Testing Test Phases Phase III & IV - Billing & Ancillary System Interface (Inbound & Outbound) Phase V - End to End Testing Overall Testing %Complete Asset 1 DEP Low Low 1-Jul Jul-15 0% 0% N/A 0% RED Asset 2 STD Moderate Low 5-Dec Jul % 39% N/A 70% YELLOW Asset 3 INT Moderate Low 18-Dec-13 9-Oct % 100% N/A 100% GREEN Testing Score Indicator Testing Status Appendix 1 Testing Phases

11 11 Appendix 1: ICD-10 Testing Phases Phase I - Payer EDI Gateway Testing (Prior to E2E) Payer Specific Phase II System Configuration (Unit, Regression, User Acceptance Testing (UAT)) Asset Specific Phase III/IV - Billing Systems & Ancillaries Integration (Pair Testing Inbound & Outbound Interfaces) Asset Specific Phase V - E2E System Integration (Basic Scenarios) Asset/Payer Specific Phase VI - Standalone Claims Adjudication Testing Payer Specific

12 Appendix 2: Payer Readiness Survey 12

13 13 Reduce Anxiety, Increase Understanding and Maybe Have Some Fun with ICD-10 CM Charlotte Kohler, RN, CPA, CVA, CRCE-I, CPC, CHBC President Catherine (Kate) Clark, CPC, CRCE-I Vice President Kohler HealthCare Consulting, Inc. February 18,

14 14 Why Anxiety Deadline for ICD-10 is less than 8 months from now Concern (fear?) because there are so many codes and structure is so different from ICD-9 Training sessions mostly for coders doesn t meet needs for physicians and medical practices

15 15 Putting ICD-10 CM in Perspective A physician documents a recurrent right acute suppurative otitis media, with rupture of the ear drum. *Key will be documentation a few more words.

16 16 Increased Specificity Helps But Needs Supporting Documentation Demonstrate severity of disease Acute suppurative otitis media of right ear, recurrent (H66.004) Seizure disorder, poorly controlled with break-through seizures, without status epilepticus (G40.919) Better quality metrics Mild persistent asthma, uncomplicated (J45.30) Intentional under-dosing of medication due to financial hardship (Z91.120) Differentiate specific primary care services Routine child health examination with abnormal findings (Z00.121) Sports physicals (Z02.5) Demonstrate health risks Exposure to second hand tobacco smoke (Z77.22) Severe obesity due to excess calories (E66.01)

17 17 Understanding How the ICD 10 CM Code Structure Works Will Reduce Anxiety Tabular List contains Categories, Subcategories and Codes Subcategories are either 4 or 5 characters 6th character shows anatomical site or additional clinical details 7th character provides details of encounter X is used in certain cases as a 5 th or 6 th character placeholder when a code requires a full 7 digits All placeholders of an applicable code must be reported. = Alpha N = Numeric Category Anatomical Site Extension Base Code

18 18 But There Are Nuances to the ICD 10 CM Code Structure Placeholder X is used as a 5th character placeholder at certain 6 character codes to allow for future expansion When a base 3-5 character code requires a 7th digit x7th means X is placed in otherwise unfilled placeholder as the 5th and/or 6th character Example: Base code S50.02 Contusion of left elbow Use S50.02xD to report a subsequent encounter (NOT S50.02D)

19 19 Adult Learning Our goal today is to provide some helpful thoughts on how to become knowledgeable about ICD-10. Think about adult learning: Explain what we will end up with and the components to learn to get there Show examples Use Car-buying concept (touch it, feel it, drive it) Use existing strengths there are already doctors Compare to secondary school: a step at a time building blocks.

20 20 Touch It, Feel It, Drive It Use the ICD-10 book Show specific examples by going to specific pages

21 21 We Do Start With the ICD-10-Guidelines, But Incorporate Them In the Examples Set of rules used in addition to the official conventions and instructions provided within the ICD-10-CM itself. Adherence to these guidelines is required under HIPAA. Section I: Conventions, general coding guidelines and chapter specific guidelines The structure and conventions of the entire classification General guidelines that apply to the entire classification Chapter-specific guidelines that correspond to the chapters as they are arranged in the classification. Section II: Selection of Principal Diagnosis In determining principal diagnosis the Tabular List and Alphabetic Index take precedence over the official coding guidelines.

22 22 We Do Start With the ICD-10-Guidelines, But Incorporate Them In the Examples Section III: Reporting Additional Diagnoses For reporting purposes the definition for other diagnoses is interpreted as additional conditions that affect patient care in terms of requiring: Clinical evaluation; or Therapeutic treatment; or Diagnostic procedures; or Extended length of hospital stay; or Increased nursing care and/or monitoring Section IV: Diagnostic Coding and Reporting Guidelines for Outpatient Services Coding guidelines for inconclusive diagnoses (probably, suspected, rule out, etc.) were developed for inpatient reporting and do not apply to outpatients.

23 23 Orient the Physicians By Looking At the ICD-10 Book-See How the Chapters Are Put Together 1. Certain infectious and parasitic diseases (A00-B99) 2. Neoplasms (C00-D49) 3. Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) 4. Endocrine, nutritional and metabolic diseases (E00-E89) 5. Mental, behavioral and neurodevelopmental disorders (F01-F99) 6. Diseases of the nervous system (G00-G99) 7. Eye and adnexa (H00-H59) 8. Ear and mastoid process (H60-H95) 9. Circulatory system (I00-I99) 10. Respiratory system (J00-J99) 11. Digestive system (K00-K95)

24 24 Orient the Physicians By Looking At the ICD-10 Book-See How the Chapters Are Put Together 12. Skin and subcutaneous tissue (L00-L99) 13. Musculoskeletal system and connective tissue (M00-M99) 14. Genitourinary system (N00-N99) 15. Pregnancy, childbirth and the puerperium (O00-O9A) 16. Certain conditions originating in the perinatal period (P00-P96) 17. Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) 18. Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) 19. Injury, poisoning and certain other consequences of external causes (S00-T88) 20. External causes of morbidity (V00-Y99) 21. Factors influencing health status and contact with health services (Z00-Z99)

25 25 Focus On the Specific Needs If internal medicine select a well used diagnosis like diabetes and infection. Infections in particular allow for looking at J, L, B, A, Z. Key is to have the physician looking at the ICD- 10 book and finding a code.

26 26 Use Grand Rounds Concept in Education In our training we use a clinical example and have the doctors find the code. Utilize the experience to discuss how the book is put together, the coding guidelines, pertinent traps and how to get the right answer. Point out the need for improved documentation.

27 27 Let s Look At A Few More Examples

28 28 Diabetes Mellitus Patient presents for a check up related to their uncomplicated type II diabetes. Patient is on long term insulin. E11.9 Type 2 diabetes mellitus without complications Z79.4 Long term (current) use of insulin A patient has secondary diabetes mellitus without complications due to cystic fibrosis. E84.8 Cystic fibrosis with other manifestations - code the underlying condition first E08.9 Diabetes mellitus due to underlying condition without complications

29 29 This is Where We Can Have Fun Using diabetes as an example: Have the doctors go to the index to find the chapter (E:E08-EB). Focus on how the codes are presented and the way in which the base code is modified. Point out the nuances of assigning as many codes as needed and the need for specific documentation. Look at the directions to go to Z79.4 for long term (current) use of insulin. How some other examples as indicated on next page. KEY: Discussion and use of book

30 30 Go To A More Difficult Example Coding for Infections If the code contains the causative agent in the title no additional code needs to be reported otherwise report the causative agent as an additional code. A patient is diagnosed with acute streptococcal tonsillitis. J03.00 Acute streptococcal tonsillitis A patient with a skin abscess of the right hand that is culture positive for methicillin susceptible Staph aureus (MSSA). L Cutaneous abscess of right hand B95.61 Methicillin susceptible Staph aureus infection as the cause of diseases classified elsewhere

31 31 Break Into Meaningful Sessions Session 1-Introduction to book, a few specific specialty related examples to work up using book. Session 2-Work on Use of Sign and Symptom Coding. Session 3-Select some specific problematic ICD-10 Code areas for your practice.

32 32 Concepts to Be Addressed in Every Session Coding guidelines - Include, Excludes 1, Excludes 2 condition considered to be inherent, etiology/manifestation (code first, use additional code, in diseases classified elsewhere), general terminology, punctuation. Documentation needs not just more but specific to requirements. Use the book create familiarity.

33 33 Thank You! Charlotte Kohler, [RN], CPA, CVA, CPAM, CPC, CHBC President (443) Cell Catherine (Kate) Clark, CPC, CRCE-I Vice President (410) (410) Office Kohler HealthCare Consulting, Inc.

34 34 Could the stars be aligned on ICD-10? Government Accountability Office (GAO) Report: GA Efforts by the Centers for Medicare and Medicaid Services (CMS) to prepare providers, clearinghouses, and health plans for the ICD-10 deadline are on track. CMS is ready to process claims using the new codes. House of Representatives Committee on Energy & Commerce Subcommittee Hearing: Examining ICD-10 Implementation Testimony from seven healthcare industry professionals, representing vendors, health insurance plans, physicians, and health information management experts The majority of speakers called on federal lawmakers to issue no more delays.

35 Questions 35

36 36 If You Have A Question. If you have a question, please it to ICD10ProviderCommunication@capbluecross.com so we can address it during the call. We would like to hear from you so please send your feedback to: o Capital BlueCross: ICD10PC@capbluecross.com o Highmark: ICD-10Inquiries@highmark.com o Independence BlueCross: icd10@ibx.com o BCNEPA: ICD10Inquiries@bcnepa.com

37 37 Helpful Links Pennsylvania Medical Society The Hospital & Healthsystem Association of Pennsylvania CMS (Center for Medicare & Medicaid Services ICD-10 WATCH ZIRMED Innovating Connected Healthcare WEDI ICD-10 HUB

38 38 Next What s Up Wednesday Call Next What s Up Wednesday Call: March 18, 2015 from 2 to 3PM EST Visit a PA Blue s Plan website for more information: Capital BlueCross Blue Cross Northeastern PA Independence Blue Cross Highmark Blue Shield nts/prof-pub/icd10-library.html We would like to hear from you so please send your feedback to ICD10ProviderCommunication@capbluecross.com

39 THANK YOU 39