ICD-10 in the Provider Newsletter

Transcription

1 ICD-10 in the Provider Newsletter ICD-10 CM Code Structure, July 2013 ICD-10 Implementation, April 2013 ICD-10 Manual, January 2013 ICD-10 Back on Track, October 2012 ICD-10 Training, July 2012 ICD-10 Delay, April 2012 ICD-10 Preparation, January 2012 More to follow... i

2 ICD-10 CM Code Structure July 2013 ICD-10 is scheduled to be effective on October 1, It is important to begin to plan the necessary training for your office now. Some estimates are that training will take up to 80 hours including anatomy and physiology training and the actual code set training. To help you get started, here is some information regarding the ICD-10-CM code structure that you may find helpful. ICD-10-CM or diagnosis codes are made up of 3 to 7 alphanumeric characters. Each code begins with a 3 character category code. The first digit is always a letter. Additional characters make the code a subcategory code. The 2 nd through the 7 th character can be either a letter or a number. An example of a 3 digit category code is: A08 Viral and other specified intestinal infections Be careful as some category codes begin with the letter I and L do not confuse them with each other or with the number 1. Another category of codes begins with the letter O do not confuse this with the number 0. The 4 th character of the code defines the site, etiology, manifestations or state of the disease or condition. For example, C15 is the category code for malignant neoplasm of the esophagus. Code C15.3 is the code for malignant neoplasm of the upper third of the esophagus. The 5 th and 6 th characters of the code define the most precise level of specificity. For example, J15.2 is the code for Pneumonia due to staphylococcus but J15.21 is the code for Pneumonia due to staphylococcus aureus. Some ICD-10-CM codes require a 7 th digit extension. When this is required, there will be specific notes given in the ICD-10-CM code manual. For example, instructions for code T25 state the appropriate 7 th digit extensions are: A Initial encounter D Subsequent encounter S Sequela encounter Based on this information then code T25.111A, would be burn of the first degree of the right ankle, initial encounter. Many organizations are offering ICD-10-CM training on-line. Please refer to the websites for AAPC, AHIMA or other healthcare training providers.

3 ICD-10 Implementation April 2013 The effective date for ICD-10 compliance is October 1, If you have not yet begun your ICD-10 implementation for your practice, now is the time to begin. The following steps will take approximately 2 to 3 months to complete: Identify resources Create a Project Team Assess the effects ICD-10 will have on your practice Draft Project Plans Secure your budget Once the above steps are completed then use the next month to: Inform your staff Contact your vendors determine their ICD-10 readiness Contact your payers determine their ICD-10 readiness During the latter half of 2013: Work with vendors and payers to update software programs to be ICD-10 compliant Begin internal testing during the last quarter of 2013 Begin anatomy and physiology refresher courses for your coding staff During the 1 st quarter of 2014: Begin external testing with your vendors and payers Begin ICD-10 coder training Begin ICD-10 documentation training for your physicians During the 2 nd quarter of 2014 Complete external testing with your vendors and payers Review/Practice ICD-10 skills learned in training by documenting and coding charts in both ICD- 9 and ICD-10 CMS has prepared implementation guidelines, timelines and checklists for providers. Use these resources as you move through your ICD-10 implementation. These resources and many other ICD- 10 resources are available at:

4 ICD-10 Manual: Differences in Format and Structure January 2013 Once you receive your first ICD-10 Manual for your office, you will see several differences in the format and structure of the manual. ICD- 9 has 17 chapters, while ICD-10 has 21 chapters. The ICD-10 manual includes separate chapters for the eye and adnexa and the ear. In addition the V and E codes are not considered supplemental classifications in ICD-10 but have their own chapters, Chapters 20 and 21. The differences you will see between ICD-9 and ICD-10 include: ICD-10 is printed in a three-volume set compared with ICD-9 two-volume set ICD-10 has alphanumeric categories rather than numeric categories Some chapters have been rearranged Some titles have been changed Conditions have been regrouped ICD-10 has almost twice as many categories as ICD-9 Minor changes have been made in the coding rules for mortality The ICD-10 manual includes: Tabular lists containing cause-of-death titles and codes (Volume 1) Inclusion and exclusion terms for cause-of-death titles (Volume 1) Alphabetical index to diseases and nature of injury External causes of injury Description, guidelines, and coding rules (Volume 2) Table of drugs and chemicals (Volume 3) Improvements in the contents and layout include: Addition of information relevant to ambulatory and managed care encounters Expanded injury codes in which ICD-10 groups injuries by site of injury not by type of injury Creation of combination diagnosis/symptom codes to reduce the number of codes needed to fully describe a condition Incorporation of common fourth and fifth digit sub classifications Laterality Greater specificity in code assignments The ICD-10 Chapter titles are: Chapter 1: Certain Infectious and Parasitic Diseases Chapter 2: Malignant Neoplasms Chapter 3: Disease of the Blood and Blood-Forming Organs and Certain Disorders involving the Immune Mechanism Chapter 4: Endocrine, Nutritional, and Metabolic Diseases Page 1 of 2

5 Chapter Titles Continued... Chapter 5: Mental and Behavioral Disorders Chapter 6: Diseases of the Nervous System Chapter 7: Diseases of the Eye and Adnexa Chapter 8: Diseases of the Ear and Mastoid Process Chapter 9: Diseases of the Circulatory System Chapter 10: Diseases of the Respiratory System Chapter 11: Diseases of the Digestive System Chapter 12: Diseases of the Skin and Subcutaneous Tissue Chapter 13 Diseases of the Musculoskeletal System and Connective Tissue Chapter 14: Diseases of the Genitourinary System Chapter 15: Pregnancy, Childbirth and Puerperium Chapter 16: Certain Conditions Originating in the Newborn Period Chapter 17: Congenital Malformations, Deformations and Chromosomal Abnormalities Chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes Chapter 20: External Causes of Morbidity Chapter 21: Factors Influencing Health Status and Contact with Health Services Page 2 of 2

6 ICD-10 Back on Track October 2012 On August 24, 2012, CMS approved the one year delay for implementation of ICD-10 to October 1, With this announcement, University of Arizona Health Plans is now Back on Track with ICD- 10. Below is a list of the items we have begun to work on in preparation for the ICD-10 implementation: ICD-10 capacity was added to our claims payment system in August, 2012 Review of all current Policies and Procedures is underway to determine the best way to incorporate ICD-10 guidelines Review of all current reporting has begun for including ICD-10 coding Teams have been created in the areas of Claims Processing, Financial Reporting, Information Services, Medical Management and Network Development. These teams will begin meeting in November and will be addressing ICD-10 issues in their respective areas. Staff members from the University of Arizona Health Plans will be participating in the selection process of an ICD-10 education vendor for all of the University of Arizona Health Network. This education vendor will be responsible for the training of all of our coders, clinical documentation, and medical staff for the entire corporation for ICD-10. This selection process is scheduled to begin in October While implementation is 2 years away, it is important to get on track now with your ICD-10 planning and education. If you have questions, feel free to contact your provider relations representative who will be happy to assist you.

7 Training for ICD-10 July 2012 The implementation for ICD-10 continues to loom before us and training will be an important aspect for all provider offices. Recommendations from both AHIMA and AAPC include not only training on the new ICD-10 codes but also refresher courses on Medical Terminology and Anatomy and Physiology. These refresher courses are needed due to the additional specificity that is inherent in ICD-10. If CMS decides that the ICD-10 implementation date will remain 10/1/2013, then training on Medical Terminology and Anatomy and Physiology should be started in the Fall of 2012 and completed in the Spring of Specific ICD-10 coding training would be recommended for Summer If CMS decides to change the implementation date to 10/1/2014, then it is recommended that Medical Terminology and Anatomy and Physiology training take place in the Fall of 2013, completing in the Spring of Then the specific ICD-10 coding training can take place in the Summer of Scheduling training for coders is key so that your coders have time to learn the information while not affecting your billing cycles of current claims. Training on the specific ICD-10 codes too early could result in needed re-training if the ICD-10 codes are not being used on a daily basis. You will need to decide what is best for your own individual practice. Both AHIMA and AAPC are offering on-line classes in Medical Terminology, Anatomy and Physiology and ICD-10 coding. There is a fee for these classes but discounts are offered if classes are bundled as a package. Discounts are also offered to members of each organization respectively. Visit the AHIMA and/or AAPC websites for more information.

8 ICD-10 Delayed to October 1, 2014 April 2012 CMS has announced a one year delay in the implementation of ICD-10. The new implementation date is October 1, The main reason for the delay was based on surveys conducted by CMS which confirmed that many vendors, providers and health plans did not feel that the October 1, 2013 date gave them enough time for proper implementation and testing. University of Arizona Health Plans will currently be continuing our work on the ICD-10 implementation, extending our timelines for additional testing with our vendors and additional training for our staff. Please feel free to contact your Provider Representative for any question you may have regarding ICD-10.

9 Preparation for ICD-10 January 2012 UAHP is beginning their preparation for the conversion on October 1, 2013 to the use of ICD-10 codes. ICD-10 codes will be replacing ICD-9 codes as mandated by CMS. Many notices have been received from CMS stating that the October 1, 2013 date will not change. It is important that you begin now to prepare your office for the change to ICD-10. The biggest change in ICD-10 codes is the increased specificity of the codes. Professional coders are being urged to review/refresh their knowledge on Anatomy and Physiology. It is suggested that these refresher courses be taken during Some fun facts regarding ICD-9 versus ICD-10: 1. ICD-9 diagnosis codes contain approximately 13,000 codes. ICD-10 will contain approximately 120,000 codes. 2. ICD-9 diagnosis codes contain 3-5 alphanumeric digits. ICD-10 will contain 5-7 alphanumeric digits. 3. ICD-9 procedure codes contain approximately 4000 codes. ICD-10 will contain approximately 200,000 codes. 4. ICD-9 procedure codes contain 3-4 numeric digits. ICD-10 will contain 7 alphanumeric digits. 5. Crosswalks will be available but difficult to manage due to the 1 to many relationships that will be present between ICD-9 and ICD-10. As you can see there will be a lot of preparation that will need to be done just based on these few facts alone. Watch for more information regarding ICD-10 in future provider newsletters. If you have any questions, please feel free to contact your provider relations representative.