Demystifying ICD 10 Beyond the Hype. What Therapists Should Know about ICD 10.
Welcome This session will be recorded Link to the recording and resources will be emailed to all registrants Jim Plymale President Clinicient Questions can be asked in the Question panel Webinar will be extended an additional 1/2 hour for Q & A
Welcome Jerry Henderson Physical Therapist, Co Founder of Clinicient Founder Physical Therapy Clinics, Inc. Co founder Integrated Rehabilitation Group Founder Physiocare Physical Therapy Jerry Henderson, PT VP of Clinical Community Clinicient Co founded PT Link, one of the first developers of physical therapy EMR software Avid Blogger on Industry Topics
Welcome David Stockman David Stockman Product Manager Clinicient Clinicient Product Manager Responsible for the ICD 10 Implementation at Clinicient Background in product and solution management for technology and education companies BA is History for University of Washington Masters degree in Education
Today s Agenda ICD 10: The Basics The Chatter Versus the Reality about ICD 10 Why Payer Readiness May be the Biggest Challenge The Impact on Therapists and Why ICD 10 is Good The Clinicient Advantage What You Can Do Now to Prepare
ICD 10: The Basics
Example: Back Pain ICD 9 Code = 724.2 Lumbago Used to report diagnoses and inpatient procedures Provide greater specificity than ICD 9 codes Used internationally US is just now getting up to speed Used in paperwork, electronic systems, and other processes, such as submitting reimbursement claims, identifying patient eligibility, getting prior authorization from a payer, reporting quality data ICD 10 CM not PCS
Example: Back Pain ICD 10 = M54.5 Low Back Pain Everyone covered by HIPAA must use the codes for claims with a Date of Service of October 1, 2014 No dual code transition timeline The new codes represent an increase from 13,600 diagnosis codes to over 69,000 PT/OT/SLP only use a small set of these
ICD 9 vs. ICD 10 Organization and Structure X X X. X X X X X. X X X X Category Etiology, Anatomic Site, Manifestation Category Etiology, Anatomic Site, Manifestation Extension ICD 9 Consists of three to five characters First character is numeric or alpha (0 or E) Second, third, fourth, and fifth characters are numeric Always at least three characters ICD 10 Consists of three to seven characters First character is alpha All letters are used except U Second and third characters are numeric Fourth, fifth, sixth, and seventh characters can be alpha or numeric
Top 10 Codes Used by PTs ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) 724.2 Lumbago M54.5 Low back pain 719.46 Pain in joint, lower leg M25.569 Pain in unspecified knee 719.41 Pain in joint, shoulder region M25.519 Pain in unspecified shoulder 723.1 Cervicalgia M54.2 Cervicalgia 728.87 Muscle weakness (generalized) 781.2 Abnormality of gait M62.81 Muscle weakness (generalized) R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility 719.7 Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified 719.45 Pain in joint, pelvic region and thigh 719.47 Pain in joint, ankle and foot M25.579 M25.559 Pain in unspecified hip Pain in unspecified ankle and joints of unspecified foot 729.5 Pain in limb M79.609 Pain in unspecified limb * Based on Clinicient Data
ICD 10 Transition Timeline
The Chatter Versus the Reality about ICD 10 4 Common Misconceptions
The Chatter: ICD 10 will be Hard for Therapists
The Reality: ICD 10 will be Hard for Therapists It will be Easier for Therapists than other specialties
The Reality: ICD 10 will be hard for therapists It will be Easier for Therapists than other specialties Choose a code based on what the payer needs Use tools to move back and forth between new and old codes Education and training will be part of the solution Early preparation will have you ready by the cut off date
The Chatter: ICD 10 is Complicated with so Many Codes
The Reality: ICD 10 is Complicated with so Many Codes It s not the Doomsday that some make it out to be
The Reality: ICD 10 is complicated with so many codes It s not the Doomsday that some make it out to be Therapists use a fraction or subset of the codes It is not as complex as for other disciplines 75% of new codes have a 1:1 mapping with an ICD 9 code Most of the silly codes used as examples are already in ICD 9
The Chatter: No worries Another Delay is Coming
The Reality: No worries Another Delay is Coming There will be No Change in the Deadline For ICD 10
The Reality: No worries Another Delay is Coming There will be No Change in the Deadline For ICD 10 We have already delayed the adoption standard, a standard the rest of the world has adopted many years ago, and we have delayed it several times, most recently last year. CMS Administrator Marilyn Tavenner At the HIMSS 2014 Annual Conference and Exhibition
The Reality: No worries Another Delay is Coming There will be No Change in the Deadline For ICD 10 We have already delayed the adoption? standard, a standard the rest of the world has adopted many years ago, and we have delayed it several times, most recently last year. CMS Administrator Marilyn Tavenner At the HIMSS 2014 Annual Conference and Exhibition
The Chatter: ICD 10 is Costly and Needs a lot of Training
The Reality: ICD 10 is Costly and Needs a lot of Training With the, With the right system, There is no Cost, and Little Training
The Reality: ICD 10 is Costly and Needs a lot of Training With the right system,, There is no Cost, and Little Training Understand where diagnosis codes are used and by whom Understand your top 10 ICD 9 codes and how they translate to the new ICD 10 code set Communicate to your team about the transition deadlines Determine whether your payers will be ready
Why Payer Readiness May be the Biggest Challenge
The Challenge for Therapy Practices: Payers May Not Be Ready History indicates that some payers may not be ready by October 1 Not all payers are required to use ICD 10 Challenge will be: Knowing who is ready and who is not Knowing who to send what *Source: ICD10watch.com
Examples of Different Payer Scenarios 1) All payers are ready to accept ICD 10 codes by October 1 2) Primary payer is ready by 10/1 but Secondary is not 3) Secondary is ready by 10/1 but Primary is not 4) Payer mix changes after 10/1 5) Primary is not ready by 10/1 but is ready on 10/15
Separate Systems May Increase Risk Old Way: Paper/ EMR Billing If you don t have a single system with payer rules, you won t know which codes to send to which payers Patient data lives in 2 separate systems New Way: EMR + Billing Payer Rules Documentation may not match the claim using separate systems All patient data lives in 1 system; Payer rules prompt staff on correct action to ensure payment
The Impact on Therapists and Why ICD 10 is Good
ICD 10 is Better for Our Profession More specific Better description of function
ICD 10 is Better for Our Profession More specific Better description of function. well, a little better anyway
Therapy Professions Playing in a Medical World CPT = procedures defined and designed by the AMA to explain medical procedures ICD 9 = international classification system for diseases ICD 10 = new version of ICD 9 Do therapists perform medical procedures? Do therapists treat diseases?
Source: ICD 10 Overview from CMS APTA? ASHA? AOTA?
Making Sense of ICD 10 for Therapists Concepts Most specific code available Describing what you are treating as the primary diagnosis Codes describing loss of function
Trivia How many ICD 9 CM codes are usable to describe ambulation problems?
Describing Functional Deficits with ICD 10 Pretty Specific ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) 781.2 Abnormality of gait R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility 719.7 Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified not so much
Case Study: Meet Mary 16 year old female basketball player with anterior knee pain following anterior blunt trauma during a game. Unable to play because of continued patello femoral irritation. Treatment consists of : soft tissue mobilization taping shoe orthotics strengthening to improve patellar tracking ice prn to decrease inflammation
Don t Get Stuck in a Crosswalk
Which Code? X X X. X X X X X. X X X X Category Etiology, Anatomic Site, Manifestation Category Etiology, Anatomic Site, Manifestation Extension ICD 9 717.89 Other internal derangement of knee M22.2X1 ICD 10 Patellofemoral disorder, right knee 719.46 Pain in joint, lower leg M25.561 Pain in right knee 781.2 Abnormality of gait R26.89 Other Abnormalities of gait and mobility 719.7 Difficulty in walking R26.2 Difficulty in walking, not otherwise classified 733.92 Chondromalacia M94.261 Chondromalacia, right knee
Which Code? X X X. X X X X X. X X X X Category Etiology, Anatomic Site, Manifestation Category Etiology, Anatomic Site, Manifestation Extension ICD 9 717.89 Other internal derangement of knee ICD 10 M22.2X1 Patellofemoral disorder, right knee 719.46 Pain in joint, lower leg 781.2 Abnormality of gait 719.7 Difficulty in walking 733.92 Chondromalacia M25.561 Pain in right knee? X R26.89 Other Abnormalities of gait and mobility R26.2 Difficulty in walking, not otherwise classified? M94.261 Chondromalacia, right knee X
Which Code? Treatment: soft tissue mobilization, taping, shoe orthotics, and strengthening M22.2X1 ICD 10 Patellofemoral disorder, right knee Ice prn to decrease inflammation M25.561 Pain in right knee soft tissue mobilization, taping, shoe orthotics, and strengthening R26.89 Other Abnormalities of gait and mobility
Describing Functional Deficits with ICD 10 ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) 781.2 Abnormality of gait R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility 719.7 Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified
Describing Functional Deficits with ICD 10 ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) 781.2 Abnormality of gait R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility 719.7 Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified
Describing Functional Deficits with ICD 10 ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) 781.2 Abnormality of gait R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility 719.7 Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified
Describing Functional Deficits with ICD 10 ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) 781.2 Abnormality of gait R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility 719.7 Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified
Describing Functional Deficits with ICD 10 ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) 781.2 Abnormality of gait R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility 719.7 Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified
Describing Functional Deficits with ICD 10 ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) 781.2 Abnormality of gait R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility 719.7 Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified
Unspecified Codes Source: CDC Website Example ICD 9 ICD 10 Specific ICD 10 Specific ICD 10 Specific 729.1 Myalgia and myositis, unspecified M60.9, Myositis, unspecified M79.1 Myalgia M79.7 Fibromyalgia
Let s talk about Specificity and Laterality Non specific ICD 10 codes cannot be used to indicate a medical diagnosis ICD 9 ICD 10 Non Specific ICD 10 Specific ICD 10 Specific ICD 10 Specific 719.46 Pain in joint, lower leg M25.56 Pain in knee M25.561 Pain in right knee M25.562 Pain in left knee M25.569 Pain in unspecified knee This is Non specific but this is Specific?
Let s talk about Specificity and Laterality Where is the ICD 10 for bilateral knee pain? ICD 9 ICD 10 Non Specific ICD 10 Specific ICD 10 Specific ICD 10 Specific 719.46 Pain in joint, lower leg M25.56 Pain in knee M25.561 Pain in right knee M25.562 Pain in left knee M25.569 Pain in unspecified knee
Specificity and Laterality Source: CDC Website If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.
Bilateral Problems ICD 9 Claim ICD 10 Claim 719.46 Pain in joint, lower leg M25.561 Pain in right knee M25.562 Pain in left knee ICD 9 Claim ICD 10 Claim 719.51 Stiffness of joint, NEC, shoulder region M25.611 Stiffness of right shoulder, NEC M25.612 Stiffness of left shoulder, NEC
Which Code Would You Use for an Antalgic Gait? ICD 9 Code ICD 9 Description ICD 10 Code(s) ICD 10 Description(s) 781.2 Abnormality of gait R26.0 R26.1 R26.89 R26.9 Ataxic gait Paralytic gait Other abnormalities of gait and mobility Unspecified abnormalities of gait and mobility 719.7 Difficulty in walking R26.2 Difficulty in walking, not elsewhere classified
Things to Remember Crosswalks are not enough Need more definition for accurate diagnosis
What You Can Do Now to Prepare
What You Can Do Now to Prepare Understand where diagnosis codes are being used and by whom Understand your top 10 ICD 9 codes being used today and how they translate to the new ICD 10 code set (Be sure to use our Cheat Sheet) Communicate to your team about the transition and deadlines Talk to your payers to see if they will be ready by Oct. 1, 2014
Questions to Ask Software Providers About ICD 10 What is their plan to support ICD 10? How do they manage payer data and settings? Do they have a simple way to add the new codes to the patient record and claims? Are they on track to hit the ICD 10 cut off date? Is there an additional cost for upgrading? Will the system work with both ICD 9 and ICD 10 codes? Will there be training and support for the new ICD 10 codes? Will there be an additional cost for ICD 10 training and support?
The Clinicient Advantage
Our Approach We are prepared and have a plan Front office and therapists will select the diagnosis code They can use either ICD 9 or ICD 10 or a word description of the diagnosis Testing will occur throughout Q2 and Q3 Therapists will be able to practice in the system before the transition date
The Single System Advantage Clinicient provides a single system for both EMR and Billing All patient information lives in one place We have the industry s largest payer database, with over a decade of payer data, constantly updated Payer requirements are built into workflows for all staff from front desk to therapist to billing, alerting what is needed and when Clinicient manages the change to help clinics be successful Will provide a tool to look up the appropriate code Dual ICD 9 and ICD 10 coding to support all payers System knows when to use which code set
Benefits of Clinicient s Single System System knows when to use ICD 9 and ICD 10 codes Fast and efficient for PTs Therapists just select a diagnosis, the system does the rest Coding easy and automatic No added resources and minimal business disruptions Clinicient does the heavy lifting not your staff Claims processing continues as usual No added costs for ICD 10 upgrades, testing or education
Our Experience We ve been planning and collecting data for ICD 10 for several years to make this an easy transition for our customers We have embedded workflows combined with a rules engine that simplifies these types of reforms for our customers: Functional Limitation Reporting, PQRS, MMR Our proven solution works for multiple disciplines PT/OT/SLP and many other specialties Free resources and education
Thank You! Questions? Please Ask in the Questions Pane.
Resources Clinicient Resources: ICD-10 Cheat Sheet ICD-10 Blog Posts ICD-10 FAQs Clinicient Overview on ICD-10 www.clinicient.com/icd-10/ Industry Resources: APTA Website: apta.org/payment/coding/icd10/ ICD-10 Watch Website: icd-10watch.com CMS Website: cms.gov/medicare/coding/icd10/index.html?redirect=/icd10
Contact Info EMR and Billing Solutions for Outpatient Rehabilitation Practices 1-877-312-6494 www.clinicient.com Visit our website to Learn More Schedule a Demo Get a Price Quote @clinicient @hendersonpdx @jimply http://www.linkedin.com/company/clinicient
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