kareo - icd-10: don't freak out! webinar
DESCRIPTION
Watch recorded webinar: http://www.kareo.com/resources/webinars Are you clinically and financially ready for the implementation of ICD-10-CM with a current ‘go-live’ date of October 1, 2014? Get prepared for the changes in this coding system and for a possible dip in your business practice revenue and/or reduction in coding and billing productivity. This webinar offers pre- and post-assessments to check your readiness along with practical tips to ease the transition to ICD-10. You’ll learn: • What ICD-10 is and why the change is happening • What to ask your payers about ICD-10 and your claims • How to help prevent rejections after October 2014 • How to prepare for possible reduction in productivity and/or revenueTRANSCRIPT
PAGE 1 KAREO | CONFIDENTIAL @GoKareo; #KareoTip PAGE 1 KAREO | CONFIDENTIAL
ICD-10-CMDon’t Freak Out
Go Practice
PAGE 2 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Your Hosts Today…
Rochelle GlassmanPresident, United Physician Services, LLC
www.upshealthcare.com .
Lea ChathamContent Marketing Manager, Kareo
PAGE 3 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
How to Participate Today…
Follow us on Twitter @GoKareo We’ll be tweeting live using the hashtag #KareoTip
Join our other social media channels for constant updates!
PAGE 4 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Our Schedule for Today…
1 Introduction & Welcome Rochelle
2 ICD-10: Don’t Freak Out
3 Discover Kareo’s Role
4 Answer Questions
PAGE 5 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Rochelle Glassman
• Nationally-recognized healthcare consultant
• Former executive-level consultant for Cigna
• Healthcare business entrepreneur
• 30 years of healthcare business experience
• President/CEO United Physician Services, LLC
• Physician Advocate
• Trauma-trained RN [email protected]
602.685.9500
PAGE 6 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Our Schedule for Today…
1 Introduction & Welcome Rochelle
2 ICD-10: Don’t Freak Out
3 Discover Kareo’s Role
4 Answer Questions
PAGE 7 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
What We’ll Cover Today
1. Business practice solutions for ICD-10 2. Overview of ICD-10-CM3. Feedback for online ICD-10 coding test
PAGE 8 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Business Practice Solutions
How to prepare for loss of revenue and reduction in productivity when coding diagnoses in ICD-10.
What to ask your payers about processing your claims after ICD-10 is implemented?
Steps to help prevent insurance claim rejections.
PAGE 9 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Strategies to Manage Revenue Loss
Take steps to implement a line of credit as soon as possible.
Prepare a multi-year budget for the ICD-10 transition.
Ask insurance carriers if they guarantee timely payments once ICD-10 is in effect?
Develop a plan to transition into the updated coding system including optimizing from 5 - 7 ‘characters.’
Identify the impact ICD-10 will have with related business associates & IT systems.
Avoid loss of cash flow and the task of ‘fishing’ for those extra dollars.
PAGE 10 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
What to Ask Your Payers
Don’t chase after these funds… What is the action plan of your top eight to ten payers
for processing claims with ICD-10 diagnosis codes? Can each one adhere to contract guidelines to pay on
time once the claim is received? If a claim is rejected due to ICD-10 diagnosis codes
what is the protocol for resubmitting to get it paid? After resubmission when can you expect payment? Do your payers offer external testing for “Sample
patients” and when?
PAGE 11 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Prepare for Drop in Coding Productivity
1. ICD-10 training for the entire practice!
i. Billers & Codersii. Extra training for
anatomy/physiology and medical terminology
2. Understand key differences from ICD-9 to ICD-10.
3. Address any temporary staffing needs now and in the future.
4. How many ICD-10 trainers exist in your state (AHIMA, AAPC, etc.)?
“In times of drastic change, it is the
learners who inherit the future.”
E. Hoffer
PAGE 12 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Preventing Insurance Claim Rejections
Payers are ‘threatening’ to reject claims with unspecified diagnosis codes.
Determine documentation guidelines needed to assign codes to the highest level of specificity. Such as details to assign a code for closed fracture of the right carpal (wrist): initial encounter.
Run a report of commonly used diagnoses and physician notes and practice coding them in ICD-10.
Again, review and understand ICD-10 coding guidelines!
PAGE 13 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Example
In ICD-9, physician notes may state ‘other or ill-defined fracture of lower limb, NOS’ assign code; 827.0.
This may be rejected in ICD-10! To assign this code in ICD-10, the documentation would
need notes to include items such as the specific bone of the lower limb, is it with or without fibula, and record of the current encounter as a first visit or follow-up.
Thus: Subsequent encounter for fracture of left tibia shaft without fibula and the fracture is healing normally.
S82.202D
PAGE 14 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
ICD-10 Overview
PAGE 15 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
A little entertainment before the next subject… Do you feel like you are hitting something head on… ??Link: For ICD-10 Struck by… http://www.youtube.com/results?search_query=ICD-10+Code+W61.92+&oq=ICD-10+Code+W61.92+&gs_l=youtube.12...1916.1916.0.3252.1.1.0.0.0.0.74.74.1.1.0...0.0...1ac.2.11.youtube.9scNnGiw9XM
PAGE 16 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Overview of ICD-10
Be prepared! Are we behind other countries
implementing ICD-10? Why change? What’s the same? What is different? Discuss ‘Placeholders” What does GEMS mean? Excludes 1 & 2—what is that? Yes, there’s a code for that!
PAGE 17 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
We Are Lagging Behind
A number of other countries have already put ICD-10 in practice, including: United Kingdom (1995); France (1997); Australia (1998); Germany (2000); Canada (2001)
PAGE 18 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Why the change?
With our increased medical knowledge we ran out of room with ICD-9 to add updated diagnosis codes.
With ICD-9 some diseases and conditions were combined with other body systems.
For example: the sense organs (eyes and ears) are included with the nervous system diseases but will have their own chapters in ICD-10 CM.
To reflect current medical knowledge, certain diseases have been reclassified to a more appropriate chapter in ICD-10 CM.
For example, gout has been reclassified from the endocrine chapter in ICD-9 CM to the musculoskeletal chapter in ICD-10.
• In ICD-9 V and E codes are expanded in ICD-10. Thus, Chapters starting with ‘V, W, X, and Y’ are categorized as “External Causes of Morbidity, while Z is “Factors Influencing Health Status’
• Example: V00.131 is fall from skateboard and Z00.110 is health exam for newborn under 8 days old
PAGE 19 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
ICD-9-CM and ICD-10-CM Code Comparisons
ICD-9-CM Diagnosis Codes ICD-10-CM Diagnosis Codes
3-5 characters in length 3-7 characters in length
Approximately 13,000 codes More than 68,000 codes
First digit alpha (E or V) or numeric; Digits 2-5 numeric
•First digit is alpha; Digits 2-3 are numeric; Digits 4-7 are alpha or numeric [Example: digits 4-6 are numeric: H52.212 irregular astigmatism left eye]
Limited space for adding new codes Flexible for adding new codes
Lacks detail and laterality Very specific and has laterality
Example: Pregnant woman at 34 weeks, delivered
Example: O60.14X1, Pregnancy, woman, 34 weeks, 2 days gestation, delivered.
PAGE 20 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
What is the same? What is different?
ICD-10-CM Code format
Comparison ICD-10 (7 characters) to ICD- 9 CM (5 digits)
ICD-9 Code format
X X X X X X X X X X X X
category
Categoryetiology, extension
anatomic site
Example: S91.321A : 2cm laceration of the
right foot with foreign body
severity etiology, anatomic site,manifestations
Example: 892.1 is the same diagnosis,
without laterality
PAGE 21 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Guidelines – Seventh Character Definitions Initial encounter: Indicated by an ‘A’ as the 7th character
The letter ‘A’ is used while the patient is receiving active treatment for the injury.
Example: T22.111A: Burn of first degree of right forearm, First or Initial encounter
Subsequent encounter: Indicated by the letter ‘D’ The letter ‘D’ is used for encounter after the patient has received active
treatment of the injury and is receiving routine care for the injury during the healing or recovery phase.
Example: T22.111D: Burn of first degree of right forearm, Subsequent encounter
Sequela: Indicated by the letter ‘S’ as the 7th character The letter ‘S’ is used for complication or condition called the sequela. It is
defined as a “late effect or the residual effect after the acute phase of an illness or injury has ended that arise as a direct result of an injury.” Such as scar formation after a burn. The scars are a sequela of the burn
Example; T22.111S : Burn of first degree of right forearm, Sequela
PAGE 22 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
What Is GEMS?
The acronym GEMS means General Equivalence Mapping.
It was developed as a tool to assist with converting ICD-9 codes to ICD-10. or ICD-10 to ICD-9 codes.
These are designed as ‘code sets’ but never to be used to actually assign an ICD-10 diagnosis code and are not included in the Official Guidelines for Coding
The GEMS idea was developed by Center for Medicare and Medicaid Services (CMS ) and the Center for Disease Control (CDC).
PAGE 23 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Example of the specificity of ICD-10 codes
The ICD-10-CM Diagnosis Code of E11.341 is defined as “Type 2 Diabetes mellitus with severe non-proliferative diabetic retinopathy with macular edema.”
This one code in ICD-10 combines 3 ICD-9-CM codes needed to describe the same scenario:
Type 2 diabetes mellitus with severe non-proliferative (damage to blood vessels in the retina) diabetic retinopathy with macular edema:o 250.50 Diabetes with ophthalmic manifestations, type II or specified
type, not stated as uncontrolled;o 36206 Severe non-proliferative diabetic retinopathy;o 36207 Diabetic macular edema
PAGE 24 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Placeholders
ICD-10 CM utilizes a dummy placeholder, which is always the “x” and it has two uses.
When a code has less than six characters and a seventh character extension is required. The “x” is assigned for all characters less than six in order to meet the requirement of coding to the highest level of specificity.
W85.xxxA – Exposure to electric transmission lines, initial encounterS17.0xxA – Crushing injury of larynx and trachea, initial encounterS01.02xA – Laceration with foreign body of scalp, initial encounter
PAGE 25 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
ICD-9 has “Includes and Exclude” NotesICD-10 has Two Types of Excludes Notes
Excludes 1 – Indicates that the code excluded should never be used with the code where the note is located (do not report both codes).Example:•Q03– Congenital hydrocephalus.Excludes 1: Acquired hydrocephalus (G91.-).
Excludes 2 – Indicates that the condition excluded is not part of the condition represented by the code but a patient may have both conditions at the same time, in which case both codes may be assigned together (both codes can be reported to capture both conditions).Example:L27.2 – Dermatitis due to ingested food.Excludes 2: Dermatitis due to food in contact with skin (L23.6, L24.6, L25.4)
PAGE 26 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Additional changes for ICD-10
New concepts in ICD-10 There are 21 chapters in ICD-10 each one
beginning with a letter except for ‘U’ . Tabular Index is divided in chapters and
subdivided into blocks. The term “Sepsis” is being replaced with the
term “Septicemia” in Chapter 1 of ICD-10. In some cases multiple codes are still
needed. For example, a patient diagnosed with a malignant left ovarian tumor, major weight loss, and situational depression (C56.2, R63.4, F32.9).
PAGE 27 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Additional changes for ICD-10
Some diagnosis codes in ICD-10 are not difficult to find:
Examples: Acute cholecystitis is K81.0 and Acute appendicitis is K35.80. (As always, start with finding the main term in Index of Diseases and Injuries)
When coding for a diagnosis documented as bilateral two codes are assigned:o Idiopathic chronic gout, bilateral hips:
M1A051 (right hip) and M1A.052 (left hip)
PAGE 28 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
ICD-10 Let’s do something fun!
Yes, there’s a code for that!
Hint: Anaphylactic shock due to fruits and veggies (T78.04XA)
PAGE 29 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Thank you for attending this webinar!
If you have recently taken the online Entry level ICD-10 assessment please watch for an email response from the United Physician Services Team!
If you passed the test, congratulations and don’t freak out! You are on the path to be well prepared for ICD-10 implementation.
Next Step! accept the challenge of passing the Intermediate level test by visiting our online store:
www.upshealthcare.com/store
We are prepared to assist with your ICD-10 Coding needs! Contact us today to schedule a one on one session with an ICD-10 Trainer approved by AHIMA.
We can customize an ICD-10 specialty training course for your Best Business Practice. Contact us today for additional information!
Email us with any questions:[email protected] [email protected] or call 602.685.9500
PAGE 30 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Our Schedule for Today…
1 Introduction & Welcome Rochelle
2 ICD-10: Don’t Freak Out
3 Discover Kareo’s Role
4 Answer Questions
PAGE 31 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Discover Kareo’s Role
“…Make Your Practice a Best Practice!”
PAGE 32 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Discover Kareo’s Role
Cloud-basedMedical BillingPatient Payment ServicesInsurance Billing & RemittanceScheduling & Practice ManagementElectronic Health RecordsMedical Billing Services
20,000 Providers Nationwide
PAGE 33 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Discover Kareo’s Role
PAGE 34 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Discover Kareo’s ICD-10 Resources
PAGE 35 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Discover Kareo’s ICD-10 Resources
PAGE 36 KAREO | CONFIDENTIAL @GoKareo; #KareoTip
Questions? Contact:888-775-2736
[email protected]://www.kareo.com/chat