ICD-10: What you need to know to start preparing now! Presented by: Stacey Bickford Product Manager, RescueNet Billing
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1 ICD-10: What you need to know to start preparing now! Presented by: Stacey Bickford Product Manager, RescueNet Billing
2 Discussion Topics What is ICD-10 and what does it mean to be ICD-10 Compliant? What can I do right now to prepare? Formatting changes with examples End to End testing information RescueNet Billing ICD-10 changes New 1500 form updates What will be on Helpful Reference Links Q&A
3 General ICD-10 General Review What is ICD-10? How will ICD-10 changes impact me as a Provider? ICD-10 is the latest revision of the International Statistical Classification of Diseases and Related Health Problems (ICD codes) which code for medical conditions such as symptoms, complaints, external causes of injury and diseases. This code set is designed to allow for more specificity compared to ICD-9 codes. As a HIPAA-covered entity, you are required to be ICD-10 compliant by 10/1/14. This may require action by your agency including, but not limited to, end-to-end testing, ICD-10 agency education, and software upgrades.
4 Great Healthcare IT News graphic on wacky ICD-10 codes! *For the full article link see the References slide
5 What does it mean to be ICD-10 Compliant? All claims submitted, no matter the payor, be transitioned to ICD-10 codes for dates of service on or after 10/1/2014 Entities include, but not limited to, Software Vendors, Payors, Clearinghouses, Providers and Suppliers.
6 What can I do right now? Educate yourself Formatting changes and differences (examples to follow) American Medical Association The Differences Between ICD-9 and ICD-10 (see References slide) ICD-10 codes are a lot more specific and may require crew training to enhance documentation!! Mock dual coding period Allocate a certain # of claims to mock-bill in both ICD-9 and ICD-10 ICD-9 to ICD-10 conversion tools available online
7 Format Changes ICD-9 Format 3-5 characters Approx. 17,000 codes First digit may be an E, V or number 2-5 are numeric digits ICD-10 Format 3-7 characters Approx. 80,000 codes 1 st digit is alpha 2 nd and 3 rd digits numeric 4-7 th digits are alpha or numeric
8 Format Changes Ex: Hypertension ICD-9 to ICD-10 Conversion ICD-10 to ICD-9 Conversion I1Ø One to One Approx. I1Ø Essential (primary) hypertension One to Many Approx Malignant essential hypertension Or Benign essential hypertension Or Unspecified essential hypertension Note: Very few 1 to 1 ICD-9 to ICD-10 direct matches due to specificity
9 Format Changes Specificity ICD-9 Example: Malignant neoplasm of pancreas Head of pancreas Body pancreas Tail of pancreas Pancreatic duct Islets of Langerhans Other specified sites of pancreas Pancreas, part unspecified ICD-10 Example: S52 - Fracture of Forearm S52.5 Fracture of lower end of radius S Torus Fracture of lower end of right radius S52.521A Torus fracture of lower end of right radius, initial encounter for closed fracture Note: Very few 1 to 1 ICD-9 to ICD-10 direct matches due to specificity
10 End to End Testing CMS ICD-10 Testing Week March 3-7 CMS MLM Matters MM8465 (see References slide) Testing updates will be posted on the ICD-10 page once available ZOLL will partner with agencies for testing Must be on 4.5 prior to testing ICD-10 ZOLL does not retain live data in-house Live data required for testing For ICD-10 testing questions/concerns,
11 RescueNet Billing ICD-10 Import List Options Full ~80,000 code list from CDC Review list and reduce to desired codes Manual process involved Commonly used ICD-9 to ICD-10 conversion ZOLL Crosswalk / will be posted to Direct and approximate matches indicated for review Current ICD-9 to ICD-10 crosswalk Export current list from RescueNet Reporting and use conversion tool to obtain ICD-10 code and Description that maps Export to Microsoft Excel Data Only, then convert to CSV once complete (remember not to lose any leading zeroes) Import Complaints Option Modified for ICD-10
12 RescueNet Billing Changes RescueNet Dispatch-Billing v4.5 will be ZOLL s ICD-10 compliant version Upgrades included with annual maintenance Hardware updates may be required due to standard technology changes and new functionality requirements Expected release date end of March 2014 New payor setting for ICD-10 transition date Possible to convert for some payors prior to others Based on payor availability and testing
13 RescueNet Billing Changes (cont.) RescueNet Billing updated to automatically prompt for the appropriate ICD-9 or ICD-10 code based on current payor Some crossover claims may need to be manually submitted through the transition period if different ANSI and paper forms will output based on payor ICD- 10 effective date and trip date
14 1500 Claim Form 02/12 Revisions Compliance date is April 1,2014! New 1500 claim form required!! Providers must order 02/12 version from current vendor or visit the NUCC.org page for information on how to order new claim forms (see references page for full link) Changes ranging from field name updates to extensive field expansion (see next slide for some example changes)
15 Minor changes made to these fields Major changes made including 12 diagnosis code fields with a 9 indicating ICD-9 codes and 0 indicating ICD-10
16 ZOLL Availability & Timelines Standard 1500 (VFStandard1500) Available Mid-February Used for most Commercial and Medicaid Payors Standard Medicare 1500 (VFStandardCare1500) Used for Medicare payors that have non-standard requirements Available by end of February State specific forms (Ex: VFMICaid1500) Roughly 200 state-specific forms Non-standard requirements based on State policy Not all states have provided updated 1500 specifications Monitor and E-blast notifications for release updates Note: Both RNDB 4.4 and 4.5 will support the 02/12 version, but only 4.5 will support ICD-10 codes.
17 ZOLL s ICD-10 Webpage ZOLL s ICD-10 page will include (anticipated launch in February): Testing Updates Tip Sheet & FAQ Lists Full ~80,000 full code list from ICD-9/ICD-10 Most Commonly Used Approximate and direct matches indicated Any additional beneficial lists identified ICD-10 Blog Posts Currently available at RNDB 4.5 Hardware/Software Requirements
18 References Top 8 Zaniest ICD-10 Codes - CMS MLN Matters May 3-7 Testing Announcement- Network-MLN/MLNMattersArticles/Downloads/MM8465.pdf CDC.gov ICD-10 code lists - NUCC.org (02/12 Claim Form 1500 Claim Form)- &id=186&itemid=138 AMA The Differences between ICD-9 and ICD differences-fact-sheet.pdf
19 References Gateway EDI ICD-10 Page - ZirMed s ICD-10 Page - 8
20 How will I receive my CEU? If personally registered, you will automatically receive an by the end of this week containing your CEU If you were not registered and attended with someone else, please sbickford@zoll.com to request Due to attendance volume, please allow 3-5 days for these requests to be processed
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22 Contact Information Stacey Bickford General ICD-10/Webinar Questions Provider Relations Forms Related Questions Support Issues Technical Assistance
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