Preparing for ICD-10. Preparing for ICD-10. Preparing for ICD-10

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1 Preparing for ICD-10: What You Should Be Doing Now PHCA November 11, 2014 Presented by: Reinsel Kuntz Lesher LLP Senior Living Services Consulting Stephanie Kessler, Partner Karin Sherman, Senior Consultant Timeline 1979 ICD-9 was introduced 1990 ICD-10 was endorsed by The World Health Assembly The UK & France implemented ICD Australia transitioned to ICD Canada moved to ICD United States scheduled to implement ICD-10 Preparing for ICD-10 Implementation of the International Classification of Diseases, 10th Edition, Clinical Modification and Procedure Coding System (ICD-10-CM/ICD-10-PCS) within the United States health care industry from ICD-9-CM for medical diagnosis and inpatient hospital procedure coding is scheduled for October 1, The ICD-10-related implementation date of October 1, 2015, was announced in final rule published in the federal register on August 4, This final rule is available at 1

2 Preparing for ICD-10 Are you ready?? Preparing for ICD-10 Who is effected by ICD-10-CM implementation? On October 1, 2015 medical coding in U.S. health care settings will change from ICD-9-CM to ICD-10- CM. The transition requires businesses and systems to change throughout the health care industry. Everyone who is covered by the Health Insurance Portability and Accountability Act (HIPAA) must make the transition, not just those who submit Medicare or Medicaid claims. Preparing for ICD-10 The compliance dates are firm? Prepare now and avoid potential reimbursement issues for services received 10/1/2015 and later. There is no impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. 2

3 Preparing for ICD-10 Partial code freeze October 1, 2011 The last regular, annual updates were made to both code sets. October 1, 2012 through October 1, 2014 Only limited code updates for new technologies and new diseases were made to both code sets (Section 503(a) of Public Law ). October 1, 2015 Only limited code updates for new technologies and new diseases will be made to the ICD-10 code set. No further updates will be made to ICD-9-CM on or after October 1, 2015, as it will no longer be used for reporting. October 1, 2016 Regular updates to ICD-10 will start. Differences between ICD-9-CM and ICD-10-CM ICD-9-CM has approximately 14,000 diagnosis codes and ICD-10-CM will have approximately 70,000 diagnosis codes ICD-10-CM codes are longer and use more alpha character to provide greater clinical detail and specificity when describing the diagnosis Terminology and disease classification have been updated to be consistent with current clinical practice. Differences between ICD-9-CM and ICD-10-CM Benefits of ICD-10-CM coding will provide better data to: Measure the quality and efficiency of care Support operational and strategic planning Monitor resource utilization Improve clinical, financial, and administrative performance 3

4 Differences between ICD-9-CM and ICD-10-CM Project Planning ICD-10-CM Project Planning Administration needs to be involved in planning this transition. Determine who currently utilize ICD-9-CM codes. Who should be involved in training for ICD-10-CM? C Suite Management Health Information Management staff Nursing Unit Secretaries MDS Coordinators/RNACs Admissions Billing Rehabilitation Department, Medical Directors, Vendors, etc., etc. 4

5 ICD-10-CM Project Planning The project planning will be different at each facility If you have not already, start now There is no crosswalk Step 1 Task Force Step 2 Budget Step 3 Educate Step 4 Implement and Test Step 5 - Transition ICD-10-CM Project Planning Considerations EHR Paper chart Vendors Billing Physicians The Task Force may have subcommittees to ensure all areas are covered and on track Budget for education, re-education, orientation, materials costs (i.e., manuals, new forms), and potential delays in claims processing ICD-10-CM Project Planning Determine education needed by determining those who assign or are involved currently with ICD-9-CM codes Consider basic versus in-depth training Develop a timeline to ensure adequate preparation Contact your software vendor to determine: When their upgrades will be completed Determine when dual coding will be a possibility 5

6 ICD-10-CM Project Planning Project any possible MDS and/or billing backlogs in advance and work to gain compliance prior to October 1, 2015 Determine additional staff that will be required to maintain a current status through the 10/1/2015 implementation date Implementation 6

7 Possible consequences of delays Decreased accuracy and productivity of staff related to ICD-10-CM coding Increased risk of claims rejection and lack of payments Decreased time with patients and impact on patient care Decline in staff morale Assess current coders strength and weaknesses to determine training requirements; Consider need for refresher courses in anatomy and physiology, medical terminology and pharmacology before starting the ICD-10-CM training due to level of specificity of ICD-10-CM codes. AHIMA recommends from hours of ICD-10-CM training depending on the experience and credentialing of the person completing the coding. Testing November 17-21, 2014 This testing week will give trading partners access to the Medicare Administrative Contractor s (MACs) and Common Electronic Data Interchange (CEDI) for testing with real-time help desk support. The event will be conducted virtually. What you can expect during testing: Test claims with ICD-10 codes must be submitted with current dates of service (i.e. October 1, 2014 through November 17, 2014), since testing does not support future dated claims. 7

8 Testing November 17-21, 2014 (cont d) What you can expect during testing: Test claims will be subject to all existing EDI frontend edits including Submitter authentication and NPI validation. Test claims will receive the 277CA or 999 acknowledgement as appropriate, to confirm that the claim was accepted or rejected in the system. Testing will not confirm claim payment or produce remittance advice. MACs and CEDI will be staffed to handle increased call volume during this week. ICD-10 Limited End-to-End Testing with Submitters for 2015 On January 26-30, 2015, CMS will offer end-to-end testing to a small sample group of providers. End-toend testing includes the submission of test claims to CMS with ICD-10 codes and the provider's receipt of a Remittance Advice (RA) that explains the adjudication of the claims. The goal of this testing is to demonstrate that: Providers or submitters are able to successfully submit claims containing ICD-10 codes to the Medicare FFS claims systems; ICD-10 Limited End-to-End Testing with Submitters for 2015 CMS software changes made to support ICD-10 result in appropriately adjudicated claims (based on the pricing data used for testing purposes); and Accurate RAs are produced. The sample will be selected from providers, suppliers, and other submitters who volunteered to participate. Registration for the January week of end to end testing is now closed. Providers will still be able to send test cases through traditional testing even if not chosen for end to end testing. More information will be sent out if you are selected once the registration forms are reviewed. 8

9 Training: January through March 2015 (cont d) Assess quality of current clinical documentation by physicians and staff to identify improvement opportunities; Complete review of random sample of charts; Focus on high volume diagnoses; and Identify diagnoses known to cause documentation problems. Determine best solution to improve documentation; Modify any forms or templates utilized for documentation both manual and EHR; and Provide educational opportunities addressing documentation requirements. Training: January through June 2015 (cont d) Provide training for all staff that utilize the ICD-10-CM codes. ICD-10-CM training is available from professional associations, commercial vendors, and independent consultants ICD-10-CM training can be accomplished with online self-paced or instructor-led courses and/or onsite or off-site face to face training Training: January through June 2015 (cont d) Follow training with hands on practice Determine if those individuals who code utilize a list of frequently seen ICD-9-CM codes and convert the codes on the list to have corresponding ICD-10-CM codes, when possible. Transitioning from ICD-9-CM to ICD-10-CM: January through June 2015 Improved documentation will now allow for more in depth ICD-9-CM coding similar to what will be utilized in ICD-10- CM, allowing both practice for the person coding and ease of transition in the future. 9

10 Transitioning from ICD-9-CM to ICD-10-CM: January through June 2015 (cont d) Print or copy current long term residents diagnosis lists and add the ICD-10-CM diagnoses to this sheet. Divide the long term population by the 13 weeks in this time period and practice coding that number of diagnosis sheets each week; Save the residents diagnosis lists with ICD-10-CM codes to utilize when dual coding is available by your software provider. Transitioning from ICD-9-CM to ICD-10-CM: January through June 2015 (cont d) Contact your software provider to determine a date when (or if) dual coding capability will be available to begin data entry. The key to this time period is to continue practicing and becoming familiar with looking up and identifying the correct ICD-10-CM code to utilize Transitioning from ICD-9-CM to ICD-10-CM: January through June 2015 (cont d) General Equivalence Mappings (GEMs) are designed to help with mapping links concepts in two code sets without consideration of resident clinical record information only and will not take place of individually coding each resident appropriately with ICD-10-CM codes ICD-10-CM books are available from existing ICD-9-CM code book publishers. ICD-10-CM is available free of charge in PDF and XML formats from: 10

11 Transitioning from ICD-9-CM to ICD-10-CM: July through September 2015 Verify that dual coding capacity is working and ready to use. Continue dual coding of both ICD-9-CM and ICD-10-CM for: New Admissions; Hospital Returns; Long term residents - follow the MDS ARD schedule to code ICD-10-CM codes as assessments are due, utilizing the diagnosis lists that were saved from practice coding last quarter until all diagnosis lists are updated. Transitioning from ICD-9-CM to ICD-10-CM: October 1, 2015 and Beyond Utilize ICD-10-CM codes only for all diagnoses for dates of service/admissions starting October 1, 2015 and utilize in medical record documentation and billing. Maintain the ICD-9-CM Diagnosis list for verification if any claim denials occur. Transitioning from ICD-9-CM to ICD-10-CM: Billing Claims All claims submitted for services on or before 9/30/2015 will use ICD-9-CM; All claims submitted for services on or after 10/1/2015 will use ICD-10-CM; Claims cannot contain both ICD-9-CM and ICD-10- CM codes Claims for services 10/1/2015 and after with ICD-9- CM codes will be REJECTED. 11

12 Physician education is very important Documentation is crucial for accurate coding Other Areas ICD-10-CM Other Areas Additional areas impacted by ICD-10-CM coding: Survey Minimum Data Set, version 3 MDS 3.0 Section I Active Diagnoses Quality Measures Pressure ulcers Falls UTI 12

13 Code Features ICD-10-CM Code Features ICD-10-CM diagnosis codes are three to seven characters; The first character is always alpha (all letters except U are used); The second character is numeric; Characters 3-7 are either alpha or numeric A decimal is placed after the third character. Example: A69.21 Meningitis due to Lyme disease ICD-10-CM Code Features ICD-10-CM codes have laterality (left, right, bilateral) Example: L L89.xxx Pressure ulcer xxx.02x - Left elbow xxx.xx2 - Stage II ICD-10-CM codes have combinations codes certain conditions with common associated symptoms and manifestations Example: I Atherosclerotic heart disease of native coronary artery with unstable angina pectoris 13

14 ICD-10-CM Code Features ICD-10-CM codes may have a character x used as a 5 th character placeholder in certain 6 character codes allowing for future expansion of the code and to fill in other empty characters when a code is less than 6 characters in length requires a 7 th character. Example: T46.1x5A Adverse effect of calciumchannel blockers, initial encounter ICD-10-CM Code Features ICD-10-CM coding may utilize Excludes notes: Excludes 1 indicates a code that should never be used with the code where the note is located (do not report both codes). Example: Q03 Congenital hydrocephalus (Excludes 1:acquired hydrocephalus (G91.-) Excludes 2 indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time, in which case both codes can be reported to capture both conditions. Example: L27.2 Dermatitis due to ingested food (Excludes 2: Dermatitis due to food in contact with skin (L23.6, L24.6, L25.4) ICD-10-CM Code Features ICD -10-CM coding includes clinical concepts (did not exist in ICD-9-CM.) Example: T45.526D Under-dosing of antithrombotic drugs, subsequent encounter ICD-10-CM significantly expands a number of codes. Example: E Type 1 diabetes mellitus with diabetic neuropathic arthropathy ICD -10-CM makes distinction between intra-operative complications and post-procedural disorders. Example: D78.21 Post-procedural hemorrhage and hematoma of spleen following a procedure on the spleen vs. D78.01 Intra-operative hemorrhage and hematoma of spleen complicating a procedure of the spleen. 14

15 ICD-10-CM Code Features ICD-10-CM coding includes a 7th character in certain situations. Post acute care providers will most frequently utilize this when coding: injury, musculoskeletal and external cause codes. The seventh character describes encounters: initial, subsequent, and sequela (previously late effect in ICD-9-CM). ICD-10-CM Code Features ICD-9-CM Codes Closed fracture of unspecified part of neck of femur V54.13 Aftercare for healing traumatic fracture of hip ICD-10-CM Codes S72.114A Nondisplaced fracture of greater trochanter of right femur, initial encounter for closed fracture S72.114D Nondisplaced fracture of greater trochanter of right femur, subsequent encounter for closed fracture with routine healing ICD-10-CM Code Features Additional changes in ICD-10-CM coding: Injuries are grouped by anatomical site not type of injury; Some new code definitions to reflect current medical knowledge; Restructuring and reorganization of disease classification reflecting current medical knowledge; and V codes or E codes, as in ICD-9-CM, are incorporated into main classifications. 15

16 ICD-10-CM Code Features Nonspecific codes ( unspecified or not otherwise specified ) are available to use when detailed documentation to support more specific coding is not available. A few other coding features are encompassed in ICD-10- CM coding that post acute care settings will most likely not encounter. ICD-10-CM coding book continues with an alphabetic index and a tabular index as ICD-9-CM was divided. ICD-10-CM codes should be looked up in the alphabetic index and then verified in the tabular index. ICD-10-CM Code Features ICD-10-CM Code Features An Introduction to ICD-10 fact sheet is available on the CMS website at 16

17 Take Away Task Force + Needs Assessment + Education + Implementation + Execution = Smooth Transition Resources include:

18 RKL ICD-10-CM Education SAVE THE DATE March 10-11, 2015 York, PA Contacts Stephanie Kessler Partner Reinsel Kuntz Lesher LLP Karin Sherman Senior Consultant Reinsel Kuntz Lesher LLP 18