Download - The ICD-10 Change-Over: Looking Ahead
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The ICD-10 Change-Over: Looking AheadAdele AllisonNational Director of Government Affairs, SuccessEHS
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ICD-10 Planning
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• HIPAA 5010 allows technology to accept ICD-10 electronically
• ICD-10 goes well beyond payer-provider transactions
• BCBS Association → Coding errors to increase 10-25% in first year
• CMS estimates for coder training needs: 179,267 PT / 50,000 FT
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• ICD-10 Impacts all components of the practice
• AMA estimates cost for 3-MD practice = $83,290
• Begin Impact AnalysisoWhat Systems / Workflows does ICD-
9 touch today?oWho needs Training → Coders, Biller,
Physicians for documentation
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• Begin Impact Analysiso EHR Adoption and MU have tentacles
into ICD-10 change-overoHow will EHR adoption impact
practice mgmt., billing, coding, reporting, etc.?
o SuccessEHS will support and continue to provide education
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Provider Documentation Training
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• “If it’s not documented, it didn’t happen” = Cannot bill
• More codes means more documentation
• Documentation Considerationso Linking relevant conditions o Initial Encounter → 7th Character
Extension “A” for Patient under Active Treatment
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• Documentation Considerationso Subsequent Encounter → 7th
Character Extension “D” for Routine Injury Care during Healing / Recovery
o Sequela → 7th Character Extension “S” for Complications / Conditions resulting from an injury (E.g., Scar resulting from a burn)
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• Impact Analysis:oClinical Documentation Assessments
→ Do random samples support ICD-10 coding?
o Implement Documentation Improvement Strategies → E.g., Train, Reassess, Train again
o ICD-10 Implementation/Documentation Champion
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Provider Documentation Training
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Provider Documentation Training
ICD-9-CM
555.2569.5
Patient: Betty Bea Goode DOB: 07/04/1955
Impression: 1.Patient has regional enteritis in the small and large intestine2.Patient has an intestinal abcess
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Provider Documentation Training
ICD-9-CM
555.2569.5
Patient: Betty Bea Goode DOB: 07/04/1955
Impression: 1.Patient has regional enteritis in the small and large intestine2.Patient has an intestinal abcess
ICD-10-CM
K50.814
Patient: Betty Bea Goode DOB: 07/04/1955
Impression: 1.Crohn’s disease of both the small and large intestine with abscess
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Provider Documentation Training
ICD-9-CM
555.2569.5
Patient: Betty Bea Goode DOB: 07/04/1955
Impression: 1.Patient has regional enteritis in the small and large intestine2.Patient has an intestinal abcess
ICD-10-CM
K50.814
Patient: Betty Bea Goode DOB: 07/04/1955
Impression: 1.Crohn’s disease of both the small and large intestine with abscess
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Area ICD-9 ICD-10 Comments / Examples
Diabetes Mellitus 59 Codes >200 Codes
Adds “poorly controlled” in addition to “Controlled” and “Not Controlled”
Adds multiple combination codes Example: E09.11 → Type 1 Diabetes
Mellitus with Ketoacidosis with Coma
InjuriesNo Expanded Categories for
Injury
Adds 7th Character Extension to Identify the
Encounter Type
A = Initial Encounter D = Subsequent Encounter for Fracture with
Routine Healing G = Subsequent Encounter for Fracture with
Delayed Healing S = Sequela Other: Must code the type, cause, size and
depth of injury
Drug Under-Dosing Absent
Codes for when the Patient takes
Less Rx than Prescribed
First code the Medical Condition Secondary Code of Under-dosing Tertiary Code of Reason Example: Documentation must include
“Patient could not afford their medication.”
Cerebral Infarctions
No differentiation between Type and
Late Effects of Stroke
Differentiation is made for Late
Effects of Stroke by Type
Combination codes exist for common etiologies or manifestations
Example: I63.012 → Cerebral Infarction due to Thrombosis of Left Vertebral Artery
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Area ICD-9 ICD-10 Comments / Examples
Acute Myocardial Infarction
Age definition is 8 weeks
Age definition is 4 weeks
New categories for subsequent AMI and for complications within 4 weeks (28 days) of event
Difference in terminology Laterality is included Example: I21.02 → ST Segment Elevation
Myocardial Infarction involving the Left Anterior Descending Coronary Artery
Musculoskeletal Limited Diagnosis
CodesExpanded
Diagnosis Codes Example: There are 8 codes for pathologic
fracture in ICD-9; 150 codes in ICD-10
PregnancyTrimester Not Required, uses
episodes of care
Documentation of Trimester Required
Counted from 1st day of last period Must document number of weeks Episodes of care deleted Obstructed Labor incorporates reason Code extensions use to ID baby (1-5) affected
by OB condition Example: (Trimester) O15.03 → Eclampsia in
Pregnancy in the 3rd Trimester Example: (Obstruction/Baby ID) O64.1xx2 →
Obstructed Labor due to Breech Presentation, Fetus 2
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What about dentists?
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• Fact: Dental Office Systems should be compatible with Medical Office Systems
• ADA Codes on Dental Procedures and Nomenclature used today
• All electronic dental claims MUST be 5010 compliant
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• No coding change for the ADA Codes due to ICD-10
• Exception → Dentists perform a medically warranted procedure billed on a medical claim
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How do you embrace change management?
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• Pragmatist–60% aim for minimum–Only core processes for
administration/revenue cycle management
–Aiming for Average = Potential Risk
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• Collaborator–20-25% aim for opportunity–Improve processes–Advanced analytics, internal
reporting–Aiming for Improvement =
Potential Value for Costs
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• Innovator–15-20% aim for transformation–Change agent–Contracting, training,
outcomes management–Aiming for Excellence =
Competitive Advantage & Strategic Positioning
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Structural differences in ICD-9 and ICD-10
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Structures• ICD-9
• ICD-10
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Structures• ICD-9
• ICD-10
Category Category, Anatomic Site,
Severity
Alpha/Numeric (E or V)Numeric
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Structures• ICD-9
• ICD-10
Category Category, Anatomic Site,
Severity
Alpha/Numeric (E or V)Numeric
Category Category, Anatomic Site,
Severity
Category
Numeric Alpha (Every Letter but U)Numeric or Alpha (Every Letter but U)
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Mapping differences in ICD-9 and ICD-10
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• One–to–One MappingICD-9-CM ICD-10-CM
733.6(Tietze’s Syndrome)
M94.0(Tietze’s Syndrome)
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• One–to–One Mapping
• One–to–Many Mapping
ICD-9-CM ICD-10-CM
733.6(Tietze’s Syndrome)
M94.0(Tietze’s Syndrome)
ICD-9-CM649.51
(Spotting during Pregnancy)
ICD-10-CMO26.851
(Spotting 1st Trimester)O26.852
(Spotting 2nd Trimester)
O26.853(Spotting 3rd
Trimester)
-OR-
962.9(Hormone Poisoning)
T38.801A T38.901AT38.802A T38.902AT28.803A T38.903AT38.804A T38.904AT38.891A T38.991AT38.892A T38.992AT38.893A T38.993AT38.894A T38.994A
733.82(Other Cartilage
Disorders)
T38.801AT38.901A T38.901AT38.901A38.901AT38.801AT38.901A T38.901AT38.901A T38.901AT38.802AT38.902A28.803AT38.903A T38.804AT38.904A T38.891A T38.991A 38.992A38.893AT38.993A T38.901T38.901AT38.892A T38.992A T38.893AT38.993A T38.90T38.90T38.901A T38.894A T38.992A T38.893AT38.993A T38.90T38.90T38.901AT38.994T38.901A38.901AT38.801AT38.901A T38.901AT38.901AT38.90102AT38.902AT28.803AT38.903A T38.804AT38.904A T38.891A T38.991A T38.901AT38.901A T38.892A T38.992A T38.893AT38.993A T38.901A T38.894A T38.901A T38.994A T38.901A38.901A T38.89 T38.801AT38.901A T38.901AT38.901A T38.901A 802AT38.902AT28.803AT38.903A T38.804AT38.904A T38.891A T38.991A T38.901AT38.901A T38.892A T38.992A T38.893AT38.993A T38.901A T38.894A T38.901A T38.994A T38.901A38.901A T38.89 T38.802AT38.902A T28.803AT38.903A T38.804A T38.992A T38.893AT38.993A T38.904A T38.891A T38.991A T38.901A T38.901A T38.90T38.892A T38.992A T38.893AT38.993A T38.901AT38.90T38.894A T38.901A T38.994A T38.901A38.901A T38.90 T38.90T38.801AT38.901A T38.901AT38.901A T38.901A 802AT38.902AT28.803AT38.903A T38.804AT38.904A T38.891A T
One-to-Sixteen One-to-2,530
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Which of the following statements apply to implementation of ICD-10?
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A. ICD-10 is effective October 1, 2013B. CMS and other payers cannot process
ICD-10 claims prior to Oct. 1, 2013C. ICD-10 applies to all providers and
payersD. Providers, clinics and vendors will
need to be prepared to support ICD-9 and ICD-10 based on the claim DOS
E. All of the above
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A. ICD-10 is effective October 1, 2013B. CMS and other payers cannot process
ICD-10 claims prior to Oct. 1, 2013C. ICD-10 applies to all providers and
payersD. Providers, clinics and vendors will
need to be prepared to support ICD-9 and ICD-10 based on the claim DOS
E. All of the above
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Provider documentation will be a significant factor in succeeding with ICD-10 because:
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A. More codes means more documentationB. Providers must link relevant conditions
in their documentationC. Providers must document whether the
visit is an initial encounter, subsequent encounter or sequela
D. Providers must capture expanded information on the visit
E. All of the above
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A. More codes means more documentationB. Providers must link relevant conditions
in their documentationC. Providers must document whether the
visit is an initial encounter, subsequent encounter or sequela
D. Providers must capture expanded information on the visit
E. All of the above
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