ICD 10 High Overview

Transcription

1 ICD 10 High Overview 1

2 FAQs: ICD-10 Transition Basics 1. What is the ICD-10 compliance date? October 1, Will the transition to ICD-10 be postponed? No. The October 1, 2014 compliance date is firm. There are no plans to extend the deadline. 3. What does ICD-10 compliance mean? ICD-10 compliance means that all Health Insurance Portability and Accountability Act (HIPAA) covered entities are able to successfully conduct health care transactions on or after October 1, 2014 using the ICD-10 diagnosis and procedure codes. ICD-9 diagnosis and procedure codes can no longer be used for health care services provided on or after this date. 4. Who is affected by the transition to ICD-10? Everyone covered by the HIPAA must transition to ICD-10 on October 1, 2014, including providers and payers who do not deal with Medicare claims. Center for Medicare and Medicaid ICD-10, July

3 FAQ s from CMS 5. Do state Medicaid programs need to transition to ICD-10? Yes. Like all other HIPAA covered entities, state Medicaid programs must comply with ICD-10 by October 1, CMS is continuing to work with Medicaid programs to help ensure they meet the deadline. Entities not covered by HIPAA, will not be required to comply for example, Workman s compensation and automobile insurance carriers. 6. What happens if we don t switch to ICD-10? Claims for all services provided on or after October 1, 2014, must use ICD-10 diagnosis codes. Claims that do not use ICD-10 diagnosis codes cannot be processed. It is important to note, however, that claims for services provided before October 1, 2014, must use ICD-9 codes even if they are submitted after the compliance date. 7. Can we transition early to ICD-10? No. CMS and other payers will not be able to process claims using ICD-10 until the October 1, 2014 compliance date. Center for Medicare and Medicaid ICD-10, July

4 FAQ s from CMS 5. Do state Medicaid programs need to transition to ICD-10? Yes. Like all other HIPAA covered entities, state Medicaid programs must comply with ICD-10 by October 1, CMS is continuing to work with Medicaid programs to help ensure they meet the deadline. Entities not covered by HIPAA, will not be required to comply for example, Workman s compensation and automobile insurance carriers. 6. What happens if we don t switch to ICD-10? Claims for all services provided on or after October 1, 2014, must use ICD-10 diagnosis codes. Claims that do not use ICD-10 diagnosis codes cannot be processed. It is important to note, however, that claims for services provided before October 1, 2014, must use ICD-9 codes even if they are submitted after the compliance date. 7. Can we transition early to ICD-10? No. CMS and other payers will not be able to process claims using ICD-10 until the October 1, 2014 compliance date. Center for Medicare and Medicaid ICD-10, July

5 FAQ s from CMS 8. Why is the transition to ICD-10 happening? The transition is occurring because ICD-9 codes have limited data about patients medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated and obsolete terms, and is inconsistent with current medical practice. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full. 9. Why should we start preparing now for the ICD-10 transition when it doesn t happen until October 2014? The transition to ICD-10 is a major undertaking for providers, payers, and vendors. It will drive business and systems changes throughout the health care industry, from large national health plans to small provider offices, laboratories, medical testing centers, hospitals, and more. 10.What type of training will providers and staff need for the ICD-10 transition? Training should take place in late 2013 or early 2014 for most staff. Training needs will vary for different organizations. Center for Medicare and Medicaid ICD-10, July

6 ICD-9 vs. ICD-10 What is the difference between ICD-9 code and ICD-10 Codes? ICD-10 has a completely different structure from ICD-9. Currently, ICD-9 codes are mostly numeric and have 3 to 5 digits. ICD-10 codes will be alphanumeric and contain 3 to 7 characters. ICD- 10 is more robust and descriptive with one to many matches in some instances. ICD-9 ICD 9 Diagnosis Description ICD-10 ICD 9 Diagnosis Description Cystic Fibrosis w/o Mention of Meconium Ileus E84.9 Cystic Fibrosis Unspecified Cystic Fibrosis Mention of Meconium Ileus E84.11 Meconium Ileus in Cystic Fibrosis Cystic Fibrosis w Pulmonary Manifestation E84.0 Cystic Fibrosis w Pulmonary Manifestation Amyotrophic Lateral Sclerosis G12.21 Amyotrophic Lateral Sclerosis Progressive Muscular Atrophy G12.21 Amyotrophic Lateral Sclerosis 340 Multiple Sclerosis G35 Multiple Sclerosis Unspecified Infantile Cerebral Palsy G80.9 Unspecified Infantile Cerebral Palsy Unspecified Quadriplegia G82.50 Quadriplegia, Unspecified Hereditary Progressive Muscular Dystrophy G71.0 Muscular Dystrophy Obstructive Chronic Bronchitis w/o Exacerbation J44.9 Chronic Obstructive Pulmonary Disease NOS Bronchiectasis w/out acute exacerbation J47.9 Bronchiectasis Uncomplicated 496 (COPD) Chronic Airway Obstruction NEC J44.9 Chronic Obstructive Pulmonary Disease NOS 6

7 ICD-10 Better Reflects the Problem Combinations of codes will become more frequent and will include External Causes of Morbidity For example: V91.07XA V97.33XA W22.02XA Burn due to water skis on fire Sucked into jet engine, initial encounter Injury occurred walking into a lamppost On a more serious note: J44.0 COPD with acute lower respiratory infection Z Personal Hx of nicotine dependence 7

8 Codes May Be Combined In some instances multiple codes are combined into one code for a more accurate description. 8

9 Rumors & Concerns Higher level of specificity needed in clinical documentation Productivity will decrease by up to 50% The code set has grown to over 68,000 codes Nearly 50% (34,250) of the changes are related to the Musculoskeletal section. 36% (25,000) are related to Left and Right Time to start thinking about revenue cycles, testing strategies and training plans. Just because we re ready, does not mean we will be paid in a timely manner. Rule of thumb for small practices is to have 3-6 months of revenue reserved. 9

10 Where Do We Stand Today? ORI has a project plan in place and we are on track! A schedule of testing and implementation is established We have a work group meeting bi-weekly, assigning tasks and follow-up Ensuring our existing vendors and systems are moving through preparation stages Reviewing new systems, software and vendors We have our coding staff accessing training and preparing for certification and hiring of additional coders is in progress We are designing a coding process which complements our current workflow 10