ICD-10 CM: Focus on documentation Psychiatry, clinical psychology & psychology 1
WebEx Pass code: meet Audio dial in: 866.394.1551 Should you have technical difficulties during the webinar: Email: PayersCollaboration@Humana.com 2
Who we are & why we re here The Payers Collaboration is a group of payers working together to provide a resource for physicians in their ICD-10 readiness activity We are working as one voice to provide valuable information to the provider community about transitioning to ICD-10 and to show that the transition doesn t have to be overly costly or burdensome 3
Contact us with questions Please email us at: PayersCollaboration@Humana.com Q&A from todays webinar will be posted on: https://www.unitedhealthcareonline.com/b2c/cmaaction.do?c hannelid=6fa2600ae29fb210vgnvcm1000002f10b10a http://www.priorityhealth.com/provider/news-andeducation/icd-10 Humana.com/providerwebinars https://www.hap.org/providers/icd10.php bcbsm.com/icd10 4
Agenda Part 1 Introduction to ICD-10 ICD-10 timeline & billing dates of service Part 2 Specialty specific documentation examples Part 3 Next steps and wrap up 5
Objectives Identify the What, Why and When of ICD- 10 implementation Recognize the format of ICD-10 codes Apply documentation tips for the most common diagnoses in a given specialty Value the benefits of ICD-10 documentation 6
Part 1 Introduction to ICD-10 ICD-10 Timeline & billing dates of service 7
What is ICD-10-CM? International Classification of Diseases- 10 th Revision-Clinical Modification Listed by the World Health Organization (WHO) and the National Center for Health Statistics (NCHS) 8
Why are we implementing ICD-10? The Centers for Medicare and Medicaid Services (CMS) announced on July 31, 2014 that the new deadline for ICD-10 Implementation will be October 1, 2015 ICD-9 codes provide limited data about patients medical conditions and hospital inpatient procedures ICD-10 codes allow for greater specificity and accuracy in describing a patient s diagnosis and in classifying inpatient procedures 9
ICD-10 world adoption 10
How will ICD-10 impact me? The required specificity of ICD-10 documentation will have a positive provider impact in the areas listed to the right. 11
Implementation Delays ICD-10 implementation has been delayed several times but the current implementation date is October 1, 2015 Why so many delays? The most common reason cited for delaying ICD-10 is the complexity and cost involved on the health care provider side Another reason is the possibility of rejected claims due to noncompliance and the impact on health care providers and cash flow 12
Provider & Payer Concerns Everyone agrees that disruption to the claims processing system is the greatest danger of ICD-10 implementation It could lead to cash flow problems and disruptions It could also increase inquiries and resources straining health plans resources (i.e., longer hold times, response times, etc.) We need to work together to ensure that all stakeholders are ready to minimize disruption 13
Fact or Fiction? It can cost (a provider office) $80k to transition from ICD-9 to ICD-10 We too have heard facts like this, but believe that this figure assumes implementation, planning, and costs that will not be seen by the majority of health care providers. For most specialties, cost are much lower. -United HC findings http://www.medscape.com/viewarticle/839670 14
What provider documentation will be impacted by ICD-10? Impacted Diagnosis documentation for inpatients Diagnosis documentation for outpatients Not Impacted Procedure documentation for outpatient services Procedure documentation for certain professional services and medical supplies 15
What are some key differences between ICD-9 and ICD-10? ICD-9 Diagnosis codes ICD-10 Diagnosis codes 3-5 characters in length 3-7 characters in length Approximately 14,000 codes First digit may be alpha (E or V) or numeric; Digits 2-5 are numeric Limited space for expansion Lacks detail and laterality Difficult to analyze data due to non specific codes Approximately 69,000 codes Character 1 is alpha; character 2 is numeric; characters 3-7 are alphanumeric Room for expansion Very specific and added laterality Specificity improved coding accuracy/richness for data analysis/medical research 16
Is ICD-10 required on calendar date or date of service Oct. 1, 2015? Date of service Prior to October 1, 2015 Code set billed ICD-9-CM October 1, 2015 and later ICD-10-CM Provider outpatient AND inpatient claims are based on date of service. (DOS) Note: Overlapping dates require separate claims. 17
Part 2 Specialty specific documentation examples 18
ICD-9 Depressive disorder: Codes at a glance ICD-10 311 Depressive disorder, not elsewhere classified 296.21 Major depressive disorder, single episode 296.31 Major depressive disorder, recurrent episode F32.0 Major depressive disorder, single episode, mild F32.1 Major depressive disorder, single episode, moderate F32.2 Major depressive disorder, single episode, severe without psychotic features F32.9 Major depressive disorder, single episode, unspecified 19
Documentation: ICD-10 major depressive episodes In typical depressive episodes of all three varieties described on the slide mild (F32.0), moderate (F32.1), and severe (F32.2 and F32.3), the individual usually suffers from depressed mood, loss of interest and enjoyment, and reduced energy leading to increased fatiguability and diminished activity. Marked tiredness after only slight effort is common. Other common symptoms are: a) Reduced concentration and attention b) Reduced self-esteem and self-confidence c) Ideas of guilt and unworthiness (even in a mild type of episode) d) Bleak and pessimistic views of the future e) Ideas or acts of self-harm or suicide f) Disturbed sleep g) Diminished appetite 20
Documentation: ICD-10 major depressive disorder Mild Depressive Episode Diagnostic guidelines include a depressed mood, loss of interest and enjoyment, and increased fatigability are usually regarded as the most typical symptoms of depression, and at least two of these, plus as least two of the other symptoms described on the previous slide should usually be present for a definite diagnosis. None of the symptoms should be present to an intense degree. Minimum duration of the whole episode is about 2 weeks. An individual with a mild depressive episode is usually distressed by the symptoms and has some difficulty in continuing with ordinary work and social activities, but will probably not cease to function completely. Moderate Depressive Episode Diagnostic guidelines include at least two of the three most typical symptoms noted for mild depressive episode (F32.0) should be present, plus at least three (and preferably four) of the other symptoms. Several symptoms are likely to be present to a marked degree, but this is not essential if a particular wide variety of symptoms is present overall. Minimum duration of the whole episode is about 2 weeks. 21
Documentation: Depressive disorder The patient is seen today with complaints of feeling quite sad, unhappy, withdrawn, apathetic. He is bursting into tears without provocation. He s not sleeping well. His appetite is not good and he often feels miserable. The diagnosis is documented as depression F32.9 Major depressive disorder, single episode, unspecified NOT ICD-10 SPECIFIC The patient is seen today with complaints of feeling quite depressed, sad, unhappy, withdrawn, apathetic and lacking energy or ambition to do much over the last 2 weeks. He is bursting into tears without provocation. He s not sleeping well. His appetite is not good and he often feels miserable. The diagnosis is documented as moderate major depression, single episode F32.0 Major depressive disorder, single episode, mild ICD-10 SPECIFIC 22
Bipolar disorder, current episode: ICD-9 296.80 Bipolar disorder, unspecified Codes at a glance ICD-10 F31.10 Bipolar disorder, current episode manic without psychotic features, unspecified F31.11 Bipolar disorder, current episode manic without psychotic features, mild F31.12 Bipolar disorder, current episode manic without psychotic features, moderate F31.13 Bipolar disorder, current episode manic without psychotic features, severe 23
Documentation: Bipolar disorder, current episode Patient with history of severe depression presented to the office complaining of inability to sleep, impulsive behavior, and being argumentative at work. She said that she feels much better now and is enjoying the fact that she is feeling better. Impression is bipolar disorder. The diagnosis is documented as bipolar disorder Patient with history of severe depression presented to the office complaining of inability to sleep, impulsive behavior, and being argumentative at work, she is full of energy, volunteering for overtime and recently her boss suggested that she take a break. She feels much better now and is just enjoying the fact that she is feeling better. Impression is bipolar disorder. The diagnosis is documented as bipolar disorder, current episode manic without psychotic features, moderate F31.9 Bipolar disorder, unspecified NOT ICD-10 SPECIFIC F31.12 Bipolar disorder, current episode manic without psychotic feature, moderate ICD-10 SPECIFIC 24
Bipolar disorder, remission: ICD-9 296.80 Bipolar disorder, unspecified Codes at a glance ICD-10 F31.71 Bipolar disorder, in partial remission, most recent episode hypomanic F31.72 Bipolar disorder, in full remission, most recent episode hypomanic F31.73 Bipolar disorder, in partial remission, most recent episode manic F31.74 Bipolar disorder, in full remission, most recent episode manic 25
Documentation: Bipolar disorder, partial remission Patient is in remission at this time for his bipolar disorder. He recently stopped taking his medication. His mother convinced him to restart his medication. He is to continue his Lithium with a dosage increase to 900 mg. daily. Ordered labs to test for diabetes insipidus as well as renal function. Patient is in partial remission at this time for his bipolar disorder. He recently had a hypomanic episode and stopped taking his medication. His mother convinced him to restart his medication. He is to continue his Lithium with a dosage increase to 900 mg. daily. Ordered labs to test for diabetes insipidus as well as renal function. The diagnosis is documented as bipolar disorder, in remission F31.70 Bipolar disorder, currently in remission, most recent episode unspecified NOT ICD-10 SPECIFIC The diagnosis is documented as bipolar disorder, in partial remission, most recent episode hypomanic F31.71 Bipolar disorder, in partial remission, most recent episode hypomanic ICD-10 SPECIFIC 26
Opioid dependence: Codes at a glance ICD-9 ICD-10 304.00 Opioid type dependence, unspecified 304.01 Opioid type dependence, continuous 304.02 Opioid type dependence, episodic 304.03 Opioid type dependence, in remission F11.21 Opioid dependence, in remission F11.23 Opioid dependence with withdrawal F11.24 Opioid dependence with opioid-induced mood disorder F11.9 Opioid use, unspecified 27
Documentation: Opioid dependence Patient has been using oxycodone for 6 months for pain relief following an auto accident. She realizes she is dependent on the oxycodone and stopped taking the drug. Her last dose was yesterday. Prescription was written for Buprenorphine as a replacement and to wean her off the oxycodone. The diagnosis is documented as opioid dependence F11.20 Opioid dependence, uncomplicated NOT ICD-10 SPECIFIC Patient has been using oxycodone for 6 months for pain relief following an auto accident. She realizes she is dependent on the oxycodone and stopped taking the drug. Her last dose was yesterday. She is experiencing chills, tachycardia, restless leg syndrome, weakness and generalized restlessness. Prescription was written for Buprenorphine as a replacement and to wean her off the oxycodone. The diagnosis is documented as opioid dependence with withdrawal F11.23 Opioid dependence with withdrawal ICD-10 SPECIFIC 28
Generalized anxiety disorder: Codes at a glance ICD-9 ICD-10 300.00 Anxiety state, unspecified 300.02 Generalized anxiety disorder 300.09 Other 300.9 Unspecified nonpsychotic mental disorder F41.1 Generalized Anxiety disorder F41.3 Other mixed anxiety disorders F41.8 Other specified anxiety disorders F41.9 Anxiety disorder, unspecified 29
Documentation: Generalized anxiety disorder A 35-year-old female is seen with complaints of feeling anxious, with headaches and irritability. The patient thinks she may also be depressed. The patient has a history of panic attacks. Diagnosis is documented as anxiety with possible depression F41.9 Anxiety disorder unspecified NOT ICD-10 SPECIFIC A 35-year-old female is seen with complaints of trembling, headaches, irritability, lightheadedness, sweating, tachycardia, and dizziness. The patient has a history of panic attacks. Diagnosis is documented as generalized anxiety F41.1 Generalized anxiety disorder ICD-10 SPECIFIC 30
Schizoaffective disorder: Codes at a glance ICD-9 ICD-10 295.70 Schizoaffective disorder, unspecified 295.71 Schizoaffective disorder, subchronic 295.72 Schizoaffective disorder, chronic 295.73 Schizoaffective disorder, subchronic with acute exacerbation 295.74 Schizoaffective disorder, chronic with acute exacerbation 295.75 Schizoaffective disorder, in remission F25.0 Schizoaffective disorder, bipolar type F25.1 Schizoaffective disorder, depressive type F25.8 Other schizoaffective disorders F25.9 Schizoaffective disorder, unspecified 31
Documentation: Schizoaffective disorder Patient is 38 year old female diagnosed with schizoaffective disorder. One year ago, she lost her job and insurance, and couldn't afford her medications. She resorted to living on the street. Her family located her 2 months ago, had her committed and put back on her medicine. She made a complete turnaround. She realizes that she can never go off her medications again. The diagnosis is documented as schizoaffective disorder Patient is 38 year old female diagnosed with schizoaffective disorder. One year ago, she lost her job and insurance, and couldn't afford her medications. She had sleep disturbances, hallucinations, lack of personal hygiene and lost her home. She resorted to living on the street. Her family located her 2 months ago, had her committed and put back on her medicine. She made a complete turnaround. She realizes that she can never go off her medications again. She denies delusional thinking or hallucinations and her paranoid behavior has lessened substantially. F25.9 Schizoaffective disorder, unspecified NOT ICD-10 SPECIFIC The diagnosis is documented as schizoaffective disorder, bipolar type F25.0 Schizoaffective disorder, bipolar type ICD-10 SPECIFIC 32
Attention deficit disorder: ICD-9 314.00 Attention deficit disorder, without mention of hyperactivity 314.01 Attention deficit disorder, with hyperactivity Codes at a glance ICD-10 F90.0 Attention-deficit hyperactivity disorder, predominantly inattentive type F90.1 Attention-deficit hyperactivity disorder, predominantly hyperactive type F90.2 Attention-deficit hyperactivity disorder, combined type F90.8 Attention-deficit hyperactivity, other type F90.9 Attention-deficit hyperactivity disorder, unspecified type 33
Documentation: Attention deficit disorder Patient is seen for an assessment for ADD. He has difficulty concentrating, unable to study and waits till the last minute to get things done. He is disorganized, and frequently misses the bus. When asked questions to screen for hyperactivity, patient doesn't seem to fit the criteria. Based upon observation, impression is ADD without hyperactivity. Patient education materials were given. They will follow-up with PCP. The diagnosis is documented as attention deficit disorder F90.9 Attention-deficit hyperactivity disorder, unspecified type NOT ICD-10 SPECIFIC Patient is seen for an assessment for ADD. He has difficulty concentrating, unable to study and waits till the last minute to get things done. He is disorganized, and frequently misses the bus. When his mother tells him to do something he would rather not do, he gets distracted and starts playing video games. When asked questions to screen for hyperactivity, patient doesn't seem to fit the criteria. Based upon observation, impression is ADD without hyperactivity. Patient education materials were given. They will follow-up with PCP. The diagnosis is documented as attention deficit disorder, predominantly inattentive type F90.0 Attention-deficit hyperactivity disorder, predominantly inattentive type ICD-10 SPECIFIC 34
ICD-9 309.0 Adjustment disorder with depressed mood 309.3 Adjustment disorder with disturbance of conduct 309.4 Adjustment disorder with mixed disturbance of emotions and conduct Adjustment disorder: Codes at a glance ICD-10 F43.20 Adjustment disorder, unspecified F43.21 Adjustment disorder with depressed mood F43.22 Adjustment disorder with anxiety F43.23 Adjustment disorder with mixed anxiety and depressed mood F43.24 Adjustment disorder with disturbance of conduct F43.25 Adjustment disorder with mixed disturbance of emotions and conduct F43.29 Adjustment disorder with other symptoms 35
Patient was seen due to problems sleeping. His wife of 30 years left him 10 days ago, after his last child left home for college. He is suffering severe anxiety every time he thinks of the future. He denies having a plan for his death, he just has random thoughts. He hasn't been paying his bills and has been calling in sick frequently. He doesn't feel like being with friends and family. The diagnosis is documented as adjustment disorder, unspecified Documentation: Adjustment disorder Patient was seen due to problems sleeping, severe anxiety and feelings of hopelessness. His wife of 30 years left him 10 days ago, after his last child left home for college. He is suffering severe anxiety every time he thinks of the future. He denies having a plan for his death, he just has random thoughts. He hasn't been paying his bills and has been calling in sick frequently. He doesn't feel like being with friends and family. Patient exhibits adjustment disorder with mixed anxiety and depressed mood. F43.20 Adjustment disorder, unspecified NOT ICD-10 SPECIFIC The diagnosis is documented as adjustment disorder with mixed anxiety and depressed mood F43.23 Adjustment Disorder with mixed anxiety and depressed mood ICD-10 SPECIFIC 36
Part 3 Part 3 Next steps and wrap up 37
In summary Physician claims for outpatient and inpatient services will transition to ICD-10 Clinical Modification (ICD-10-CM) for reporting diagnoses on October 1, 2015 Also, please note that ICD-10-PCS will NOT replace the CPT procedure codes Remember, insurers making payment decisions, rating severity of illness or trying to predict recovery time, all need physician documentation that is at the highest level of specificity 38
Start with a checklist Obtain a list of your most commonly used ICD-9 codes Use existing tools to develop a list of viable ICD-10 codes http://www.aapc.com/icd-10/crosswalks/pdf-documents.aspx Become familiar with the level of detail needed in the medical record Make sure that medical record documentation supports ICD-10 codes Use existing content-based testing environments and practice ICD-10 coding of those scenarios 39
Content-based testing objectives Give healthcare professionals (physicians, etc.) pre-defined, clinically-based medical scenarios to review and have them determine the ICD-10 codes they would use on the claim Allow providers to enter the data in an easy, efficient manner Share the effects of their selection in the form of Peer Reports and/or notification of the correlation of their inputs against expected codes 40
Content-based testing organization Each Specialty has a maximum of nine Narratives available. Each Narrative defines a specific healthcare encounter Narratives are grouped into Scenarios (3 narratives per Scenario) Providers register via a website, and will receive an email inviting them to participate with an embedded link to the testing tool 41
Content-based testing specialties Allergy/Immunology Audiologist Cardiovascular Disease Certified Nurse Midwife Chiropractic Clinical Psychologist Dermatology Emergency Medicine Endocrinology Family Practice Gastroenterology General Practice General Surgeon Group Practice Hematology Hematology-Oncology Infectious Disease Internal Medicine Nephrology Neurology Nurse Practitioner Obstetrics & Gynecology Occupational Therapist Ophthalmology Optometry Orthopedic Surgery Otolaryngology Pediatric Medicine Physical Medicine and Rehabilitation Physical Therapist Plastic and Reconstructive Surgery Podiatry Psychiatry Psychologist Pulmonary Disease Radiation Oncology Rheumatology Thoracic Surgery Urology Vascular Surgery 42
Humana Content-based testing links http://hureg.providercodingimpact.com/registration.aspx BCBSM http://bcbsmicd10providerregistry.highpoint-solutions.com/registration.aspx?test=y Michigan Dept of Community Health http://www.michigan.gov/mdch/0,1607,7-132-2945_42542_42543_42546_42552_42696-256928--,00.html#testing 43
Additional ICD-10 coding resources Crosswalks for the Top 50 codes by specialty http://www.aapc.com/icd-10/crosswalks/pdf-documents.aspx ICD-10 CM/PCS documentation tips http://bok.ahima.org/pdfview?oid=300621 100 Tips for ICD-10-PCS coding http://icd10monitor.com/enews/item/615-100-tips-for-icd-10-pcs-codingtips-1-10 Free code conversion tool http://www.icd10data.com/convert FAQs: ICD-10 transition basics http://www.cms.gov/medicare/coding/icd10/downloads/icd10faqs.pdf 44
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Disclaimer This presentation is intended only for information use accompanying a live teleconference by the Payer Collaboration (Collaboration). No copy or use of this presentation should occur without expressed permission from the Collaboration. While our best efforts are to provide accurate and useful information, the Collaboration makes no claim, promise, or guarantee of any kind about the accuracy, completeness, or adequacy of the content of the presentation and expressly disclaims liability for errors and omissions in such content. As diagnostic codes changes annually, you should reference the current version of coding guidelines for the most detailed and up-to-date information. The information contained in this presentation is intended for informational purposes only. The Collaboration has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this seminar, including but not limited to any loss of revenue, interruption of service, loss of business or indirect damages resulting from the use of this program. The Collaboration makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service. The material is designed and provided to communicate information about coding and documentation in an educational format and manner. The presenter(s) are not providing or offering legal advice, but rather, practical and useful information and tools in the area of clinical documentation, data quality and coding. Every reasonable effort has been taken to ensure that the educational information provided is accurate and useful. 47