DME MAC Collaborative ICD-10 Webinar: Are You Ready?

September 2015

Today’s Presenters

Judie Roan, Jurisdiction A Terri Shoup, Jurisdiction B Angie Cooper, Jurisdiction C Michelle Wullstein, Jurisdiction D

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Webinar Access

All registrants received an email from: Medicare Webinar by National Government Services [GoToWebinar.Notifications@citrixonline.com] ◦ Click on the link within the email to join the web

presentation

◦ Using your telephone, dial into the conference call using the number and access code provided in the email

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Today’s PowerPoint Presentation

Available via GoToWebinar ◦ Click on the handout on the right hand side of

your screen

Available on each of the DME MACs website within the education and training section of their websites

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Audio

Once you are connected to the audio, the PIN displays ◦ Input the PIN on your screen into

your telephone ◦ Dial in number and PIN are

unique for each attendee

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Disclaimer

The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have produced this material as an informational reference for providers furnishing services in our contract jurisdictions. DME MAC employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this material. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of publication, the Medicare Program is constantly changing, and it is the responsibility of each provider to remain abreast of the Medicare Program requirements. Any regulations, policies and/or guidelines cited in this publication are subject to change without further notice. Current Medicare regulations can be found on the Centers for Medicare & Medicaid Services (CMS) website at http://www.cms.gov.

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No Recording

Attendees/providers are never permitted to record (tape record or any other method) our educational events ◦ This applies to webinars, teleconferences, live

events, and any other type of DME MAC educational event

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Objectives

This webinar will review the basics of ICD-10 and discuss topics such as: why move to ICD-10, billing changes that will occur, frequently asked questions and resources to ease the transition.

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Agenda

Why move to ICD-10? What will change? What will not change? What are GEMs? When do I start billing ICD-10 codes?

How do I remain educated? ICD-10 Summary Questions

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Why Move to ICD-10?

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Why Move to ICD-10?

Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) Codes reflect modern medicine and updated

medical terminology Improved efficiencies More accurate reimbursement ◦ Degree of illness severity captured more easily

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Why Move to ICD-10?

Mandatory for claims payment ◦ Required for both electronic and paper claims

◦ Claims returned as unprocessable

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ICD-10 Fun Fact

Did you know that one-third of the code expansion that will occur with ICD-10 is due to the addition of laterality, the specification of left or right?

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What Will Change?

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What Will Change?

ICD-10 CM ICD-10 PCS

CM: Clinical Modification PCS: Procedure Coding System

Diagnosis Codes Inpatient Procedures

DMEPOS Claims Institutional Claims

Examples:

• Diabetes

• Chest Pain

• Hemophilia

• Congestive Heart Failure

Examples:

• Total Knee Replacement

• Appendectomy

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What Will Change?

ICD-9 Diagnosis Codes ICD-10 Diagnosis Codes 789.00 E75.89 E75.89

A78.001B A78.001B

3–5 characters in length 3–7 characters in length

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What Will Change?

Codes will increase from 17,000 to over 150,000 ◦ Billing departments must be trained on the new

ICD-10 code sets Claim billing software needs to be updated ◦ Ensure your billing software is updated ◦ Verify your billing service or clearinghouse will be

compliant by the October 1 implementation date

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ICD-10 Fun Fact

Did you know you can still conduct Acknowledgement Testing any time prior to October 1?

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Testing Opportunities

Two types of testing as outlined by CMS: ◦ Acknowledgement (front-end) ◦ End-to-End Acknowledgement Testing ◦ Registration is not required ◦ Test any time prior to October 1 No minimum or maximum number of claims required Ensure the claims are “clean” claims o Current dates of service o Valid ICD-10 codes o Include “T” in the ISA-15 field to identify it as a test claim

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ICD-10 Fun Fact

ICD-10 will expand the code sets to over 150,000 codes but did you know that most practices will only utilize a fraction of the codes for a majority of their billing?

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What Will Change?

Medical Policies updated to include the appropriate ICD-10 codes ◦ List of medical policies converted to ICD-10

effective October 1 are available on CMS’ website

http://www.cms.gov/medicare-coverage-database

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What Will Change?

CMN and DIF Form Revisions ◦ Minor changes “ICD-9 Diagnosis” removed and replaced with “Diagnosis

Code” “HCPCS code” removed and replaced with “Supply

Item/Procedure Code” ◦ Required on or after October 1, 2015 For initial, recertification or revised CMNs and DIFs ◦ Not required when changing diagnosis from ICD-9

to ICD-10 ◦ Available at http://www.cms.gov/Medicare/CMS-

Forms/CMS-Forms/CMS-Forms-List.html

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What Will Not Change?

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What Will Not Change?

CMNs and DIFs will not need to be updated for claims submitted on or after October 1, 2015 ◦ CMNs and DIFs created on or after October 1,

2015 must use ICD-10 codes ◦ Ensure the diagnosis codes billed on the claim are

supported by documentation in the medical record ◦ Published on May 28, 2015

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What Will Not Change?

New medical record documentation is not needed, as long as: ◦ Medical records and supporting documentation

substantiate the ICD-10 code billed

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What are GEMs?

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What are GEMs?

General Equivalence Mappings Created by CMS and the CDC The GEMS can be used to: ◦ Assist with conversion of ICD-9 to ICD-10 ◦ Assist with the conversion of ICD-10 to ICD-9 ◦ Ensure that consistence in national data is maintained To access the GEMs, visit the CMS ICD-10

webpage http://www.cms.gov/Medicare/Coding/ICD10/index.html ◦ Select the ICD-10 and GEMs link for the appropriate year

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820.02

(ICD-9)

And more!

S72.032A

(ICD-10)

S72.031A

(ICD-10)

Forward MappingICD-9 ICD-10 One ICD-9 DX is represented by multiple

ICD-10 DX

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Backward Mapping ICD-10 ICD-9 One ICD-10 DX is represented by multiple

ICD-9 DX E11.341

(ICD-10)

362.07

(ICD-9)

362.06

(ICD-9)

250.50

(ICD-9)

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No ICD-9 Predecessor

ICD-10 Diagnosis T500x64 Underdosing of mineralocorticoids and their

antagonists, initial encounter T501x6A Underdosing of loop [high-ceiling] diuretics, initial

encounter T502x6A Underdosing of carbonic-anhydrase inhibitors,

benzothiadiazides and other diuretics, initial encounter

T503x6A Underdosing of electrolytic, caloric and water-balance agents, initial encounter

T504x6A Underdosing of drugs affecting uric acid metabolism,initial encounter

and more!

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GEMs are Temporary

GEMs are temporary The GEMs are not a substitute for learning how

to use ICD-10 ◦ Coders expected to use medical record documentation

with ICD-10 coding books to select appropriate codes ◦ The GEMs are a tool to assist with the transition GEMs will be posted annually by CMS with

updates ◦ Will be maintained for three years following

implementation

http://www.cms.gov/Medicare/Coding/ICD10/downloads/gems-crosswalksbasicfaq.pdf

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When Do I Start BillingICD-10 Codes?

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ICD-10 Fun Fact

Did you know the Medicare claims processing systems do not have the capability to accept ICD-9 codes for dates of service after September 30, 2015; or accept claims that contain both ICD-9 and ICD-10 codes?

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When Do I Start Billing ICD-10 Codes? Dates of service prior to October 1:

ICD-9 codes

Dates of service on/after October 1: ICD-10 codes

CMS will not allow for dual processing of ICD-9 and ICD-10 codes after the October 1 implementation date ◦ Do not report both ICD-9-CM and ICD-10-CM

codes on the same claim, submit separate claims

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When Do I Start Billing ICD-10 Codes? Claims that require span dates ◦ Includes continuous passive motion device,

diabetic testing supplies, parenteral and enteral nutrition ◦ Use the “From” date to determine which diagnosis

code set to bill DOS 9/25/2015–10/25/2015 = ICD-9 codes DOS 10/1/2015–11/1/2015 = ICD-10 codes ◦ You do not have to split claims

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When Do I Start Billing ICD-10 Codes? CMS1500 Form and ICD-10 ◦ Revised 1500 form version 02/12 Indicators for differentiating between ICD-9-CM and

ICD-10-CM diagnosis codes ◦ The “ICD Indicator” identifies the ICD code set

being reported. Enter the applicable ICD indicator according to the following: 9 ICD-9-CM diagnosis 0 ICD-10-CM diagnosis ◦ Enter the indicator as a single digit between the

vertical, dotted lines

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When Do I Start Billing ICD-10 Codes? PC-ACE Pro32 ◦ Free, ICD-10 compliant software program ◦ Bill claims and attachments electronically Including MSP claims ◦ Available on CEDI website Instruction guides and manuals

http//:www.ngscedi.com

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ICD-10 Fun Fact

Did you know that Medicare will require the usage of ICD-10 codes on paper claims as well as electronic claims as of the October 1, 2015 implementation date?

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How Do I Remain Educated?

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How Do I Remain Educated?

Jurisdiction A ◦ http://www.medicarenhic.com/dme/default.aspx

Jurisdiction B ◦ http://www.NGSMedicare.com Jurisdiction C ◦ http://www.cgsmedicare.com/jc/index.html Jurisdiction D ◦ https://med.noridianmedicare.com/web/jddme

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How Do I Remain Educated?

DME MACs ◦ ICD-10 Countdown clock

◦ Frequently asked questions

◦ Latest News ◦ Webinars ◦ Website articles ◦ Email Updates ◦ YouTube

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How Do I Remain Educated?

CMS ◦ Implementation guides ◦ Webcasts ◦ MLN Matters articles and fact sheets ◦ Videos ◦ Training and resource links ◦ Twitter

http://www.cms.gov/Medicare/Coding/ICD10/index.html

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How Do I Remain Educated?

CMS “Road to 10” ◦ Small Physician’s Practice Route to ICD-10

◦ No-cost tool that will help you: Get an overview of ICD-10 Explore Specialty References Create your personal action plan

http://www.roadto10.org

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How Do I Remain Educated?

CMS “Road to 10” ◦ Resources: ICD-10 Overview Webcasts FAQ Quick References Template Library Coding scenarios

http://www.roadto10.org

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ICD-10 Summary

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ICD-10 Summary

Why Move to ICD-10 ◦ Background Information ◦ Advantages of ICD-10

What Will Change ◦ ICD-10 CM versus ICD-10 PCS

◦ ICD-9 versus ICD-10

What Will Not Change ◦ CMNs and DIFs ◦ Medical Records

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ICD-10 Summary

When Do I Start Billing ICD-10 Codes ◦ Implementation date is October 1, 2015

◦ Span dates How Do I Remain Educated ◦ DME MAC resources ◦ CMS resources

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ICD-10 Fun Fact

Did you know there are only 8 days left until the October 1 implementation date?

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Questions

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How to Participate Today

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ForeSee Satisfaction Website Survey

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Say “yes” and complete the survey each time it is presented

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Thank You

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