Preparing for Radiology Coding Transition from ICD-9 to ICD-10: Understand the Changes and Develop Your Strategy

Transcription

1 Preparing fr Radilgy Cding Transitin frm ICD-9 t ICD-10: Understand the Changes and Develp Yur Strategy Presented by Dnna J. Richmnd, BA, RCC, CPC Senir Healthcare Cnsultant MedLearn, a Panacea Healthcare Slutins C. March 1, 2012 SLIDE 1 Slide 1

2 Disclaimer RAC Mnitr, LLC has prepared this seminar using fficial Centers fr Medicare and Medicaid Services (CMS) dcuments and ther pertinent regulatry and industry resurces. It is designed t prvide accurate and authritative infrmatin n the subject matter. Every reasnable effrt has been made t ensure its accuracy. Nevertheless, the ultimate respnsibility fr crrect use f the cding system and the publicatin lies with the user. RAC Mnitr, LLC, its emplyees, agents and staff make n representatin, warranty r guarantee that this infrmatin is errr-free r that the use f this material will prevent differences f pinin r disputes with payers. The cmpany will bear n respnsibility r liability fr the results r cnsequences f the use f this material. The publicatin is prvided as is withut warranty f any kind, either expressed r implied, including, but nt limited t, implied warranties r merchantability and fitness fr a particular purpse. The infrmatin presented is based n the experience and interpretatin f the publisher. Thugh all f the infrmatin has been carefully researched and checked fr accuracy and cmpleteness, the publisher des nt accept any respnsibility r liability with regard t errrs, missins, misuse r misinterpretatin. Current Prcedural Terminlgy (CPT ) is cpyright 2010 American Medical Assciatin. All Rights Reserved. N fee schedules, basic units, relative values, r related listings are included in CPT. The AMA assumes n liability fr the data cntained herein. Applicable FARS/DFARS restrictins apply t gvernment use. CPT is a trademark f the American Medical Assciatin. Cpyright 2012 by RAC Mnitr, LLC. All rights reserved. N part f this presentatin may be reprduced in any frm whatsever withut written permissin frm the publisher Published by RAC Mnitr, LLC, 595 Shrewsbury Avenue, Suite 201, Shrewsbury, NJ SLIDE 2 Slide 2

3 ICD-10-CM and ICD-10-PCS They re cming! They aren t ging away. (Prbably!) Yu re ging t have t use them. Outpatient, physician date f service Octber 1, 2013 Inpatient date f discharge Octber 1, 2013 That s mre than a year away why wrry nw? Especially if there is a delay? What s the difference in what we have nw and ICD-10? SLIDE 3 Slide 3

4 ICD-10-CM What and Why? Internatinal classificatin f diseases, 10th editin ICD-10 is used in mst f the rest f the wrld Since US uses ICD-9-CM instead f ICD-10, it s harder t cmpare and track disease prcesses internatinally US uses ICD-10 fr cding mrtality data fr death certificates which makes it difficult t cmpare death certificate inf with hspital inf Clinical Mdificatin (CM) used in US fr claims data ICD-9-CM is running ut f space ICD-9-CM can nt get t the detail needed in tday s healthcare climate SLIDE 4 Slide 4

5 ICD-10-PCS What and Why? Internatinal classificatin f diseases, 10th editin, Prcedure Cding System ICD-9-CM prcedure cdes d nt accurately reflect current technlgy and medical treatment. Since ICD-9-CM des nt accurately describe advancements in technlgies, significantly different prcedures are assigned t a single ICD- 9-CM prcedure cde. Limitatins in the cding system translate directly int limitatins in cverage and reimbursement. SLIDE 5 Slide 5

6 Benefits f ICD-10-CM ICD-10-CM incrprates much greater clinical detail and specificity than ICD-9-CM. Terminlgy and disease classificatin have been updated t be cnsistent with current clinical practice. The mdern classificatin system will prvide much better data needed fr: Measuring the quality, safety, and efficacy f care; Reducing the need fr attachments t explain the patient s cnditin; Designing payment systems and prcessing claims fr reimbursement; Cnducting research, epidemilgical studies, and clinical trials; Setting health plicy; Operatinal and strategic planning; Designing health care delivery systems; Mnitring resurce utilizatin; Imprving clinical, financial, and administrative perfrmance; Preventing and detecting health care fraud and abuse; and Tracking public health and risks. Surce: CMS Quick Reference Infrmatin SLIDE 6 Slide 6

7 ICD-10-CM Tabular lists cntains cause f mrbidity and diagnsis cdes Inclusin and exclusin terms Descriptin, guidelines and cding rules Alphabetical index t disease and nature f injury, external cause f injury, table f drugs and chemicals SLIDE 7 Slide 7

8 ICD-10-CM Myths Myth: N hard-cpy cde bks Fact: Bks are already available Myth: All cding will need t be electrnic Fact: Electrnic cding is nt required fr ICD-10-CM althugh it is anticipated that the imprved structure and specificity will facilitate the develpment f increasingly sphisticated electrnic cding tls Myth: Unnecessarily detailed medical recrd dcumentatin will be required Fact: There will still be unspecified diagnsis cdes, but better dcumentatin will result in higher-quality data Surce: CMS cnference call March 23, SLIDE 8 Slide 8

9 Finding Cdes in ICD-10-CM Identify the diagnsis r reasn fr visit in the dcumentatin Lcate the main term in the index Verify the cde in the tabular Read and be guided by instructinal ntes in bth the index and tabular It is imprtant t use bth the index and tabular in cde assignment Assign the cde Diagnsis cdes are t be used and reprted at their highest number f characters available SLIDE 9 Slide 9

10 ICD-10-CM Structure Alpha and numeric 1st character is always alpha All letters except U are used First 3 characters are the categry 4-6 are anatmic site, etilgy, severity, etc. 7 is extensin Perid after the first 3 characters (when there are 4 r mre characters) M1a.3120 M1a categry chrnic gut 3 etilgy renal impairment 1 lcatin shulder 2 laterality left 0 additinal inf withut tphs SLIDE 10 Slide 10

11 ICD-10-CM/PCS Details, Details Mre detail Apprximately 140,000 cdes vs. 17,000 nw 8,000 categries vs. 4,000 nw Laterality is included in the cde when apprpriate Cmbinatin cdes fr certain diseases and cmmn symptms and manifestatins Cmbinatin cdes fr pisnings and external cause Obstetric cdes identify trimester Clinical cncepts nt in ICD-9-CM Surgical cmplicatins distinguish between intraperative and pst-perative Change in cde definitins 2 kinds f excludes ntes SLIDE 11 Slide 11

12 Changes t ICD-10-CM Cmbinatin cdes fr certain diseases and cmmn symptms and manifestatins I athersclertic heart disease f native crnary artery with unstable angina pectris K71.51 Txic liver disease with chrnic active hepatitis with ascites I Varicse veins f unspecified lwer extremity with bth ulcer f calf and inflammatin Cmbinatin cdes fr pisnings and external cause T42.3X2S Pisning by barbiturates, intentinal selfharm, sequela SLIDE 12 Slide 12

13 Changes t ICD-10-CM Obstetric cdes identify trimester O26.02 Excessive weight gain in pregnancy, secnd trimester O Uterine size-date discrepancy, first trimester Clinical cncepts nt in ICD-9-CM Z67.40 Type 0 bld, Rh psitive Y90.6 Bld alchl level f mg/100 ml SLIDE 13 Slide 13

14 Changes t ICD-10-CM Surgical cmplicatins distinguish between intra-perative and pst-perative D78.01 Intra-perative hemrrhage and hematma f spleen cmplicating a prcedure n the spleen D78.21 Pst-prcedural hemrrhage and hematma f spleen fllwing a prcedure n the spleen SLIDE 14 Slide 14

15 Changes t ICD-10-CM Change in cde definitins Definitin f acute mycardial infarctin is nw 4 weeks instead f 8 I21 ST elevatin (STEMI) and nn-st elevatin (NSTEMI) mycardial infarctin Includes: cardiac infarctin crnary (artery) emblism crnary (artery) cclusin crnary (artery) rupture crnary (artery) thrmbsis infarctin f heart, mycardium, r ventricle mycardial infarctin specified as acute r with a stated duratin f 4 weeks (28 days) r less frm nset SLIDE 15 Slide 15

16 Changes t ICD-10-CM 2 kinds f excludes ntes Excludes 1 excluded cde shuld never be reprted with the cde where the nte is lcated (2 cnditins cannt ccur tgether) Excludes 2 excluded cde is nt part f the cnditin represented by the cde where the nte appears s bth cdes may be reprted tgether as apprpriate Q03 Cngenital hydrcephalus Excludes 1 Acquired hydrcephalus (G91.-) L27.2 Dermatitis due t ingested fd. Excludes 2 Dermatitis due t fd in cntact with skin (L23.6, L24.6, L25.4) SLIDE 16 Slide 16

17 Changes t ICD-10-CM Laterality and type f encunter are nw included within the cde S52.134D Nndisplaced fracture f neck f right radius, subsequent encunter fr clsed fracture with rutine healing SLIDE 17 Slide 17

18 Greater Specificity This is a ptential prblem fr radilgy, and smething practices shuld begin t wrk tward nw. Mst radilgy claims are cded nw with nn-specific diagnsis cdes because cmplete infrmatin is either nt prvided, r des nt make it thrugh the system t the final dictated reprt. While there will still be nn-specific cdes available fr use, the use f these nn-specific cdes n a regular basis will negate the benefits f ICD-10-CM. In additin, the advent f ICD-10- CM may bring mre specific medical plicies. It is pssible that claims will be denied if a nnspecific diagnsis is cded. SLIDE 18 Slide 18

19 Greater Specificity Payers are als ging t lk fr mre specificity regarding accident details. The cdes fr external causes have increased greatly. Place f ccurrence cdes (Y92.x) nw take up 4 + pages Y92.72 Chicken cp (r Hen huse) Hw the injury happened can nw be very specific W61.32 Struck by chicken W61.33 Pecked by chicken W61.39 Other cntact with chicken (expsure t chickens) SLIDE 19 Slide 19

20 ICD-9-CM t ICD-10-CM Mapping Smetimes 1 t 1 But ften 1 ICD-9-CM cde will map t multiple ICD-10-CM cdes Fr example (antepartum sptting cmplicatin f pregnancy) maps t 4 ICD-10-CM cdes (ne fr each trimester, ne fr unspecified trimester) Extreme example (nnunin f fracture) crrespnds t 2,530 ICD-10-CM cdes SLIDE 20 Slide 20

21 Fracture, Navicular Bne ICD-9-CM Clsed, navicular [scaphid] f wrist Open, navicular [scaphid] f wrist SLIDE 21 Slide 21

22 Fracture, Navicular Bne ICD-10-CM S62.00 Unspecified fracture f navicular [scaphid] bne f wrist S Unspecified fracture f navicular [scaphid] bne f right wrist S Unspecified fracture f navicular [scaphid] bne f left wrist S Unspecified fracture f navicular [scaphid] bne f unspecified wrist SLIDE 22 Slide 22

23 Fracture, Navicular Bne ICD-10-CM S62.01 Fracture f distal ple f navicular [scaphid] bne f wrist Fracture f vlar tubersity f navicular [scaphid] bne f wrist S Displaced fracture f distal ple f navicular [scaphid] bne f right wrist S Displaced fracture f distal ple f navicular [scaphid] bne f left wrist S Displaced fracture f distal ple f navicular [scaphid] bne f unspecified wrist S Nndisplaced fracture f distal ple f navicular [scaphid] bne f right wrist S Nndisplaced fracture f distal ple f navicular [scaphid] bne f left wrist S Nndisplaced fracture f distal ple f navicular [scaphid] bne f unspecified wrist SLIDE 23 Slide 23

24 S62.0 Fracture f Navicular [Scaphid] Bne f Wrist S62.02 Fracture f middle third f navicular [scaphid] bne f wrist S Displaced fracture f middle third f navicular [scaphid] bne f right wrist S Displaced fracture f middle third f navicular [scaphid] bne f left wrist S Displaced fracture f middle third f navicular [scaphid] bne f unspecified wrist S Nndisplaced fracture f middle third f navicular [scaphid] bne f right wrist S Nndisplaced fracture f middle third f navicular [scaphid] bne f left wrist S Nndisplaced fracture f middle third f navicular [scaphid] bne f unspecified wrist SLIDE 24 Slide 24

25 S62.0 Fracture f Navicular [Scaphid] Bne f Wrist WS62.03 Fracture f prximal third f navicular [scaphid] bne f wrist S Displaced fracture f prximal third f navicular [scaphid] bne f right wrist S Displaced fracture f prximal third f navicular [scaphid] bne f left wrist S Displaced fracture f prximal third f navicular [scaphid] bne f unspecified wrist S Nndisplaced fracture f prximal third f navicular [scaphid] bne f right wrist S Nndisplaced fracture f prximal third f navicular [scaphid] bne f left wrist S Nndisplaced fracture f prximal third f navicular [scaphid] bne f unspecified wrist SLIDE 25 Slide 25

26 S62.0 Fracture f Navicular [Scaphid] Bne f Wrist The apprpriate 7 th character is t be added t each cde frm categry S62 A fracture nt designated as pen r clsed shuld be cded t clsed A initial encunter fr clsed fracture B initial encunter fr pen fracture D subsequent encunter fr fracture with rutine healing G subsequent encunter fr fracture with delayed healing K subsequent encunter fr fracture with nnunin P subsequent encunter fr fracture with malunin S sequela Displaced fracture, middle third f navicular bne f right wrist, subsequent encunter fr fracture with rutine healing S62.021D SLIDE 26 Slide 26

27 Placehlder X Smetimes a categry requires a 6 th r 7 th character but the base cde desn t have that many. In that case, we will use X as a placehlder. Fr example, the injury cdes require a 7 th character t indicate initial encunter, subsequent encunter, etc. Yet, nt all injury cdes have 6 characters, s X is used in place f the missing character. This gives the cdes rm t grw in future years. SLIDE 27 Slide 27

28 Placehlder X Categry S43 The apprpriate 7 th character is t be added t each cde frm categry S43 A initial encunter D subsequent encunter S sequela S43.5 Sprain f acrmiclavicular jint Sprain f acrmiclavicular ligament S43.50 Sprain f acrmiclavicular jint, unspecified side S43.51 Sprain f right acrmiclavicular jint S43.52 Sprain f left acrmiclavicular jint Initial encunter fr sprain f the right AC jint S43.51xA SLIDE 28 Slide 28

29 ICD-10-PCS Cde Example SLIDE 29 Slide 29

30 ICD-10-PCS Cde Example SLIDE 30 Slide 30

31 Electrnic Transactins Standard % f Part A claims and 96% f Part B claims transactins are received electrnically Current versins f the transactin standards d nt have the functinality needed Allw fr the 7 characters f ICD-10-CM Adds a ne-digit versin indicatr t the ICD cde t indicate 9 vs. 10 Increases number f diagnsis cdes allwed Distinguishes between principal diagnsis, admitting diagnsis, external cause f injury, and patient reasn fr visit cdes Supprts mnitring f certain illness mrtality rates, utcmes fr specific treatment ptins, sme hspital length f stays, and clinical reasns fr care Addresses currently unmet business needs, such as an indicatr n institutinal claims fr cnditins that were present n admissin SLIDE 31 Slide 31

32 Electrnic Transactins Standard 5010 What Changes Must Occur with Versin 5010? Fr Medicare, these HIPAA-mandated frmats include the fllwing: Claims Remittance Advice Claim Status Inquiry/Respnse Eligibility Inquiry/Respnse Three additinal frmats, nt mandated by HIPAA, will als be adpted by Medicare Fee-fr-Service (FFS). These include: Transactin Acknwledgement Functinal Acknwledgement Claims Acknwledgement SLIDE 32 Slide 32

33 Electrnic Transactins Standard Implementatin Timeline Fr all cvered entities: Effective date f the regulatin: March 17, 2009 Level I cmpliance t begin by: December 31, 2010 Level II cmpliance by: December 31, 2011 Fully cmpliant n: January 1, 2012 Level I cmpliance means that a cvered entity can demnstrably create and receive cmpliant transactins, resulting frm the cmpliance f all design/build activities and internal testing. We expect cvered entities t be testing thrughut calendar year 2011, and t schedule testing as early as pssible, t ensure sufficient time fr crrective actins and re-testing. Level II cmpliance means that a cvered entity has cmpleted endt-end testing with each f its trading partners, and is able t perate in prductin mde with the new versins f the standards. SLIDE 33 Slide 33

34 What Can We D Nw? Chse an ICD-10 Prject Leader and team Schedule regular meetings fr fllw-up Mnitr regulatry infrmatin Staff invlvement Physicians Administratin Managers Nurses Cders Billers Registratin IT SLIDE 34 Slide 34

35 What Can We D Nw? Perfrm a practice impact analysis Identify all areas within the practice that ICD-10-CM will impact and create a plan Assign tasks Assign due dates Training needs Internal vs. external Type f training Training schedule Educatinal materials SLIDE 35 Slide 35

36 Practice Impact Analysis Clinical dcumentatin Frms Frnt desk are they getting cmplete diagnses nw? Physicians are they dictating the diagnses they are given? Cders are they cding specific diagnses dcumented are the nn-specific diagnses they remember? Order frms Charge tickets / superbills Systems RIS Encders Billing systems Registratin systems SLIDE 36 Slide 36

37 Practice Impact Analysis Payers Cntracts Claims submissin / acceptance Prvider s manuals Medical necessity plicy Preauthrizatin prcess Vendrs Get a detailed plan frm all yur vendrs (payers, clearinghuses) Upgrades and revisins t yur current system Release dates Testing schedules SLIDE 37 Slide 37

38 Practice Impact Analysis Create a timeline fr implementatin Estimate a budget (MGMA has estimated that a 3-physician practice will have an average ICD-10-CM implementatin cst f $84,000) Anticipate decrease in prductivity in transitin perid Anticipate a decrease in cash-flw if payers ther than Medicare aren t ready n time SLIDE 38 Slide 38

39 Dcumentatin Hspital radilgy departments, radilgy practices, and imaging centers shuld begin nw t train (r retrain) bth clerical and clinical staff t make sure that the mst cmplete and apprpriate clinical infrmatin and/r diagnsis cdes are btained and dcumented. Oftentimes, a cmplete diagnsis is given at the utset, but des nt make it thrugh frm frnt-desk t cder. Or, fr an inpatient, the hspital system nly allws the admitting diagnsis n the rdering frm. Practices shuld be lking at all the pints where diagnsis cding can be impacted and begin nw t wrk t imprve the prcess. SLIDE 39 Slide 39

40 Dcumentatin Scheduling r ther in-take persnnel shuld ask fr additinal infrmatin if a nn-specific indicatin is given. If an uncertain diagnsis such as rule-ut pneumnia is given as the clinical indicatin, radilgy persnnel shuld ask what symptms the patient has that is leading tward that pssible diagnsis. Technlgists may ask the patient fr additinal infrmatin. As lng as this is dcumented int the medical recrd, it can be used fr cding. Radilgist shuld be respnsible fr dictating the clinical indicatin in his reprt. SLIDE 40 Slide 40

41 Cding The final step in this prcess is the cder. Many cders have a cheat sheet with cmmn (and usually nn-specific) cdes that they use and rarely pen a diagnsis cde bk. This will nt be pssible with ICD-10-CM and cders shuld begin nw t get used t lking up the mre specific cdes that are available even nw with ICD-9-CM. All cders shuld be familiar with the Official Guidelines that are revised and published each year n the NCHS website. ( htm) If pssible, cders shuld als have access t AHA Cding Clinic Fr ICD-9-CM and when the time cmes the ICD-10-CM publicatin. Cding Clinic is the fficial publicatin fr guidelines and advice cncerning diagnsis cding. SLIDE 41 Slide 41

42 Dcumentatin The facility r physician wh is billing fr the service is ultimately respnsible fr the medical necessity f that service. Wrk nw with referring physicians and radilgy staff t make sure yu are getting apprpriate infrmatin. SLIDE 42 Slide 42

43 Training fr Cders Dn t start memrizing yet! Per CMS intensive cder training shuld nt be prvided until 6-9 mnths prir t implementatin althugh certificatin requirements may require earlier training Additinal training may be needed t refresh r expand knwledge in anatmy, physilgy, terminlgy, and disease prcesses Cders can start nw learning abut the structure, rganizatin, and new features f ICD-10-CM Review / test n anatmy, physilgy, terminlgy, disease prcesses SLIDE 43 Slide 43

44 What Abut Our Cding Credentials? AAPC Special nline timed test 75 questins $60 fr 2 attempts (can pay $60 again if needed fr mre than 2 tries) Octber 1, 2012 September 30, 2014 AHIMA Specific CEU requirements January 1, 2011 December 31, 2013 (Academy fr ICD-10 can be used even if taken befre 1/1/2011) CHPS 1/30, CHDA 6/30, RHIT 6/30, RHIA 6/30 CCS-P 12/20, CCS 18/20, CCA 18/20 RCC Specific CEU requirements SLIDE 44 Slide 44

45 Resurces CMS AAPC AHIMA AHA Central Office view.shtml Natinal Center fr Health Statistics SLIDE 45 Slide 45

46 Thank yu fr yur participatin! SLIDE 46 Slide 46