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Table of Contents ICD 10 Overview Physician Practice Checklist Financial Planning for ICD 10 ICD 10 Education for Physicians ICD 10 Education for Staff ICD 10 Impacts on Processes System Readiness for ICD 10 Payer Readiness for ICD 10 Vendor Readiness for ICD 10 Resources to Assist with ICD 10 Readiness
ICD 10 Overview What is ICD 10? The ICD 9 CM (Clinical Modification) code sets used to report medical diagnoses and inpatient procedures will be replaced by the ICD 10 CM and ICD 10 PCS (Procedural Coding System) code sets on October 1, 2015. Physician practices will need to focus on the ICD 10 CM code set used for diagnosis coding in all U.S. healthcare settings. The transition to ICD 10 does not affect CPT or HCPCS coding (outpatient procedures). ICD 10 PCS codes are for hospital inpatient procedures only. Claims for services provided on or after the October 1, 2015 compliance date should be submitted with ICD 10 diagnosis codes. Claims for services provided prior to the October 1, 2015 compliance date should be submitted with ICD 9 diagnosis codes. What is Different from ICD 9 to ICD 10? The table below highlights a few of the key differences between ICD 9 and ICD 10: ICD 9 CM ICD 9 CM Volume I and II 3 5 digits, decimal after 3rd digit Numeric, except V and E codes Injury structure by wound type No laterality (left v. right) ICD 10 CM ICD 10 CM (Clinical Modification) 3 7 characters, decimal after 3rd digit Alphanumeric, alphabetic lead character Injury structure by body part (location) Laterality (left v. right) What are the Benefits Of Changing From ICD 9 To ICD 10? Precisely bill and receive reimbursement for services Generate detailed health care data and improve medical communication Assign codes that better describe the gravity of a patient s illness Position our physicians and facilities to receive proper payment for care provided
Physician Practice Checklist The transition to ICD 10 will take planning, preparation, and time. The following checklist consists of important tasks to address now to help you prepare your practice for ICD 10. Financial Planning for ICD 10 Assess the costs of any necessary software updates, reprinting of forms and reports, education, and any other ICD 10 related expenses. Save (or secure line of credit) 3 to 6 months cash reserve to off set the anticipated cash delay during the ICD 10 transition. Education for Physicians located in a Dignity Health Service Area i Watch Dignity Health Clinical Documentation Videos (each 5 8 minutes long), found at: http://icd10.dignityhealthmember.org/ Password: readiness Watch Recorded sessions of Clinical Documentation and ICD 10 Training (60 minutes in length), found at: http://icd10.dignityhealthmember.org/ Attend Dignity Health Physician In Person Training (Available July Sept 2015) at no charge. Please email ICD 10@dignityhealth.org for further information on educational offerings. ICD 10 Education for Staff Identify the staff in your office who work with ICD 9 codes. All staff who work with ICD 9 codes today will require ICD 10 education and training. Select education that best fits your practice s ICD 10 training needs and conduct staff training 3 9 months before the go live date. Listed below are several options for consideration: AHIMA Offers education for HIM coding professionals, physicians, and non coding healthcare professionals. See more at: http://www.ahima.org/education/onlineed/ Programs/ICD10. AAPC Offers education for: Coders, physicians and managers. See more at: https://www.aapc.com/icd 10/training.aspx. AMA Offers education for Coders, physicians and clinicians, administrators, and ancillary staff. See more at: http://www.ama assn.org CMS Offers free Implementation Guides, Checklists, Webcasts, Timelines and Other Resources for Providers. See more at: www.cms.gov/icd10. Medscape Education Modules Offers a free 30 minute video presentation offering practical guidance and covering some of the broader impacts on practices. See more at: http://www.medscape.org/viewarticle/766192. MGMA Offers education for Healthcare professionals in small and medium practices. See more at: http://www.mgma.com/icd 10 5010 implementation. Optum360 Offers education for HIM coding professionals, physicians, and non coding healthcare professionals. Optum360 elearning can be purchased for your office staff at a discounted rate at: https://www.optumcoding.com/nonprod/5684/?offer=dignity1 For the discounted rate, enter the code DIGNITY1 on the right side of the screen in the box labeled "Promo Code". For assistance, call the Optum ICD 10 Help Line: 866 223 4886 2
ICD 10 Impacts on Processes Determine how ICD 10 will affect your practice by reviewing how and where you use ICD 9 codes. Make sure to take into account the use of ICD 9 codes in authorizations/pre certifications, registration/scheduling, physician orders, superbills/encounter forms, history and physicals, care plans, policies and procedures, practice management and billing systems, and coding manuals. If you use ICD 9 codes on paper, they will need to be replaced with ICD 10 codes. Listed below are some tools that can assist you in converting ICD 9 to ICD 10 codes. Note: Validation of ICD 10 codes is highly recommended by a coder/subject matter expert, since mapping tools have varying degrees of accuracy. The American Academy of Professional Coders Provides a tool to convert codes from ICD 9 to ICD 10 and vice versa. See more at: https://www.aapc.com/icd 10/codes. Alkaline Software ICD 10 Tool Provides a tool to convert codes from ICD 9 to ICD 10 and vice versa. See more at: http://www.icd10data.com/convert. Common Codes from CMS Road to 10: The Small Physician Practice s Route to ICD 10 Provides common ICD 10 codes per specialty. To review common ICD 10 codes by specialty, select an option from the specialty references section. See more at: http://www.roadto10.org. System Readiness for ICD 10 If you use ICD 9 codes on a computer (system), contact your EHR or practice management IT representative to ask if they have plans to be ICD 10 ready. Once your systems have been updated for ICD 10, perform internal testing to ensure they process ICD 10 codes correctly. You can test by using your most commonly used functions within these systems. A few examples of common functions to test would be claims submission, eligibility verification, referrals, and charge capture. Payer Readiness for ICD 10 Contact your payers to confirm their plans to be ICD 10 ready. You may also want to access the payer s website to seek additional information. Vendor Readiness for ICD 10 (Third Party Services) If you are using vendors for any services, it is important to verify their ICD 10 readiness. Contact your vendors to communicate that your practice will be ready for ICD 10 and ask if they have plans to be ICD 10 ready. If there are any concerns regarding a vendors readiness, your practice should identify an alternate vendor. 3
Resources to Assist with ICD 10 Readiness The following list provides a few resources for physician practices and practice managers around the transition from ICD 9 to ICD 10. This list is not exhaustive and other resources may be available. CMS Road to 10 Online resource built for providers in small practices. This resource includes specialty references and gives providers the capability to build ICD 10 action plans tailored for their practice needs. See more at: http://www.roadto10.org. CMS Provider Resources CMS offers comprehensive checklists, helpful tips and webinars to guide providers in this transition. See more at http://www.cms.gov/medicare/coding/icd10. CMS ICD 10 Email Updates Visit www.cms.gov/icd10 and sign up for ICD 10 Email Updates to receive the latest news and resources on ICD 10. Questions If you have any questions regarding this checklist, please email ICD 10@DignityHealth.org No representation or warranty. By using this guide you acknowledge and agree that Dignity Health does not represent, warrant or guaranty that the Readiness Guide (a) will meet your requirements, be fit for any purpose, contain timely, complete, correct or accurate information, or be error-free; or (b) will not infringe on any copyright, trademark or patent of any person or entity. Dignity Health disclaims all other representations, warranties or guaranties of any nature or type not expressly granted herein, if any, to the fullest extent permitted by law. No other verbal or written information or documentation provided by Dignity Health will create any representation, warranty or guaranty and you agree not to rely on an verbal or written information or documentation as a representation, warranty or guaranty. i Videos and other educational materials provided by Dignity Health are provided as part of an organized compliance training program provided by Dignity Health to phycians who practice in the local community or service are served by Dignity Health and is intended to provide specific training regarding the requirements of federal and state health care programs, such as billing, coding and documentation. 4