CMS ICD-10 Resources Toolkit

September 2013

TABLE OF CONTENTS

Page NumberToolkit Introduction

Section 1: Introduction 2

Section 2: Available Materials 4

Section 3: ICD-10 Medscape Modules 18

Section 4: Member Outreach and Education 19

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Section 1: Introduction

This toolkit includes ICD-10 resources and materials from the Centers for Medicare & Medicaid Services (CMS) to help the health care industry with the transition to ICD-10.

Background on ICD-10The ICD-9 code sets that are currently used to report health care diagnoses and inpatient procedures must now be replaced with ICD-10 code sets. Mandated by law, this change will take place on October 1, 2014. The transition to ICD-10 affects diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA).

Key Messages Below are key messages that CMS would like to communicate to the health care industry about ICD-10. Messaging includes concrete steps on how to prepare and implement ICD-10 stage by stage to help the industry understand that the transition is doable in steps. Below are key messages and steps outlined by CMS for the ICD-10 transition:

The compliance deadline for the ICD-10 transition is October 1, 2014; this deadline is firm.

Claims for services provided on or after October 1, 2014 must use ICD-10 codes for medical diagnosis and hospital inpatient procedures. CPT codes for outpatient procedures are not affected by this change.

The transition from ICD-9 to ICD-10 will require many business and process changes throughout your organization. Now is the time to prepare.

All health care organizations that are covered entities under HIPAA must make the transition to ICD-10, not just those who file Medicare or Medicaid claims. Covered entities include providers, health plans, payers, clearinghouses, and third-party billers.

Non-HIPAA-covered entities that use ICD-9 coding are also advised to make the transition to ICD-10 to reduce risk of misinterpretation in the health care setting; ultimately ICD-9 codes will be obsolete.

CMS has resources to help organizations prepare for the transition to ICD-10. Visit www.CMS.gov/ICD10 to learn more.

Clearinghouses are not coders, and will not/cannot provide a safety net for providers for ICD-10. There is a perception that clearinghouses will take care of the ICD-10 transition as they did for Version 5010. That same process cannot happen with ICD-10.

How to Help with ICD-10 OutreachCMS is working to ensure that the health care industry is prepared to make the transition to ICD-10 by October 1, 2014. Organizations that represent health care providers, payers, and vendors can help by conducting outreach and education on ICD-10 to their constituents.

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This toolkit contains pertinent information, materials, tools, and tactics to assist you in communicating to your constituents about the ICD-10 transition. Many of these materials can be found on the CMS ICD-10 website.

The toolkit contains the following materials and resources: Fact sheets ICD-10 Implementation Guides ICD-10 Timelines and Checklists Drop-in articles Web button ICD-10 Email Updates Medscape Modules on ICD-10

CMS encourages you to take advantage of the materials in this toolkit, and we welcome your feedback and suggestions for additional items that would support you or your constituents’ transition to ICD-10.

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Section 2: Available Materials

The following is a list of materials contained in this toolkit. Several of the items include tailored versions that are geared toward a specific audience segment.

MATERIALS AVAILABLETYPE DESCRIPTION VERSIONS

Fact Sheets

These fact sheets provide an overview of the ICD-10 transition, tailored for specific audiences (providers, payers, vendors, and non-covered entities). The fact sheets can be used as handouts at conferences and other events, or sent to your constituents.

Fact Sheets ICD-10 Transition: An

Introduction ICD-10 Basics for Medical

Practices ICD-10 Basics for Small

and Rural Practices Talking to Your Vendors

About ICD-10: Tips for Medical Practices

Talking to Your Customers About ICD-10: Tips for Software Vendors

ICD-10 Basics for Payers The ICD-10 Transition:

Focus on Non-Covered Entities

Questions to Ask Your Systems Vendor About ICD-10

ICD-10 and CMS eHealth: What’s the Connection?

ICD-10 Resources List Pilot for End-to-End

Testing of Compliance with Administrative Simplification

ICD-10 Email Updates Messages

The ICD-10 Email Update messages contain updates, alerts, and general information on the ICD-10 transition. They are also used to inform subscribers of new CMS materials or events related ICD-10. Additionally, ICD-10 Email Updates are used to communicate the various steps of ICD-10 implementation.

A few sample messages are included in this toolkit,

Email Update Messages: The Role of

Clearinghouses in the ICD-10 Transition

How Will ICD-10 Affect Clinical Documentation?

Dates of Service: Is it ICD-9 or ICD-10?

Simple Steps to

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MATERIALS AVAILABLETYPE DESCRIPTION VERSIONS

which can be repurposed as web and newsletter content, handouts, or social media messages. Additional messages are hosted on the CMS website.

Subscription information to receive these email messages is available on the CMS website at http://cms.gov/Medicare/Coding/ICD10/CMS_ICD-10_Industry_Email_Updates.html

Improve Clinical Documentation

Assembling an ICD-10 Project Team

Communicating with Vendors

Web ButtonThe web button contains the official CMS ICD-10 logo and can be placed on your organization’s website to link to the CMS ICD-10 website.

Web button

Drop-in Articles

The drop-in articles focus on how organizations can prepare for the ICD-10 transition and what changes they should expect. These articles can be published in member newsletters and publications.

ICD-10 Tips for Small Provider Practices

ICD-10 Action Steps for Payers

Conducting an ICD-10 Impact Assessment

Testing Your Practice's ICD-10 Systems: First Steps

ICD-10 Timelines and Checklists

The CMS timelines and checklists are designed to provide a high-level understanding of what the ICD-10 transition requires.

The checklists include a list of ICD-10 tasks, including estimated timeframes for each task.This checklist is designed to provide a viable path forward for organizations just beginning to prepare for ICD-10. The timelines provide a visual guide to key transition activities by phase.

Large Practices Checklist and Timeline

Payers Checklist and Timeline

Small Practices Checklist and Timeline

Small Hospitals Checklist and Timeline

ICD-10 Implementation Guides

The ICD-10 Implementation Guides offer step-by-step guidance for planning and implementing ICD-10. The guides were developed for four audiences:

Large Practices Payers Small and Medium Practices Small Hospitals

ICD-10 Implementation Guide for Large Practices

ICD-10 Implementation Guide for Small and Medium Practices

ICD-10 Implementation Guide for Small Hospitals

ICD-10 Implementation Guide for Payers

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I. Fact Sheets

Fact sheets can be distributed to appropriate audiences at large gatherings such as conferences or on an individual, as-needed basis to allow for easy dissemination of important information about the ICD-10 transition. Fact sheets can also be post on organization websites.

ICD-10 Basics for Payers Description: Provides a payer-focused overview of ICD-10, a description of who will be affected by the transition, a short guide to preparing for the transition, and a list of resources available to payers.

The ICD-10 Transition: An Introduction Description: Provides a general overview of the ICD-10 transition, including who will be affected by the ICD-10 transition and steps to take to prepare for the transition.

ICD-10 Basics for Medical PracticesDescription: Provides a simple checklist for providers who are just beginning the ICD-10 transition.

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ICD-10 Basics for Small and Rural PracticesDescription: Provides a list of important questions small and rural practices should address to help prepare for the ICD-10 transition.

Talking to Your Vendors – Tips for Medical PracticesDescription: Provides tips for medical practices on how to start conversations with vendors about preparing for the ICD-10 transition.

Talking to Your Customers about ICD-10 – Tips for Software VendorsDescription: Provides a list of important dates and several important topics that vendors should discuss with customers..

Questions to Ask Your Systems Vendor About ICD-10Description: Offers a comprehensive list of questions that health care providers can ask their practice management and EHR systems vendors to ensure that the new system meets their practice’s health IT goals.

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ICD-10 and CMS eHealth: What’s the Connection?Description: Provides an overview of how CMS’ eHealth initiatives, including the transition to ICD-10 and the Meaningful Use of electronic health records, are connected.

ICD-10 Resources ListDescription: Provides a list of the ICD-10 resources available on the CMS ICD-10 website including fact sheets, email updates, continuing medical education modules, and PowerPoint presentations. The resources are categorized by topics like ICD-10 basics, communicating about ICD-10, and implementation planning.

Pilot for End-to-End Testing of Compliance with Administrative SimplificationDescription: Provides an overview of the CMS collaboration with National Government Services to develop a process and framework for end-to-end testing that can be used for all Administrative Simplification requirements, using ICD-10 as the test case.

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II. ICD-10 Email Update Messages

Email Update messages are sent from CMS to specific subscribers of the ICD-10 Email Updates list. The Email Update messages are used to distribute important ICD-10 updates, as well as practical tips for making the transition to ICD-10.

Below are sample ICD-10 Email Update messages. Note: New messages will be posted on the ICD-10 Email Update section of the CMS ICD-10 website.

SAMPLE MESSAGES:

The Role of Clearinghouses in the ICD-10 TransitionPractices preparing for the October 1, 2014, ICD-10 deadline are looking for resources and organizations that can help them make a smooth transition. It is important to know that while clearinghouses can help, they cannot provide the same level of support for the ICD-10 transition as they did for the Version 5010 upgrade. ICD-10 describes a medical diagnosis or hospital inpatient procedure and must be selected by the provider or a resource designated by the provider as their coder, and is based on clinical documentation.

During the change from Version 4010 to Version 5010, clearinghouses provided support to many providers by converting claims from Version 4010 to Version 5010 format. For ICD-10, clearinghouses can help by: Identifying problems that lead to claims being rejected Providing guidance about how to fix a rejected claim (e.g., the provider needs to include more or

different data)

Clearinghouses cannot, however, help you identify which ICD-10 codes to use unless they offer coding services. Because ICD-10 codes are more specific, and one ICD-9 code may have several corresponding ICD-10 codes, selecting the appropriate ICD-10 code requires medical knowledge and familiarity with the specific clinical event.

While some clearinghouses may offer third-party billing/coding services, many do not. And even third-party billers cannot translate ICD-9 to ICD-10 codes unless they also have the detailed clinical documentation required to select the correct ICD-10 code.

As you prepare for the October 1, 2014, ICD-10 deadline, clearinghouses are a good resource for testing that your ICD-10 claims can be processed—and for identifying and helping to remedy any problems with your test ICD-10 claims.

Keep Up to Date on ICD-10Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the

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October 1, 2014, deadline. Sign up for CMS ICD-10 Industry Email Updates and follow us on Twitter.

How Will ICD-10 Affect Clinical Documentation?As practices prepare for the October 1, 2014, transition to ICD-10, there's been a good deal of discussion about the many new codes ICD-10 offers and how clinical documentation will be affected. Just as with ICD-9, complete documentation is essential for patient care and accurate selection of ICD-10 codes.

ICD-10 Captures Familiar Clinical ConceptsConcepts that are new to ICD-10 are not new to clinicians, who are already documenting a patient's chart with more clinical information than an ICD-9 code can capture about: Initial Encounter, Subsequent Encounter, or Sequelae Acute or Chronic Right or Left Normal Healing, Delayed Healing, Nonunion, or Malunion

Many ICD-10 codes—more than one-third—are identical except for indicating laterality, or whether the right or left side of the body is affected. The advantage of ICD-10 codes is that they enable clinicians to capture laterality and other concepts in a standardized way that supports data exchange and interoperability for a more efficient health care system.

Verifying Your Documentation Is ICD-10-ReadyWhile ICD-10 should not require providers to change documentation practices, reviewing documentation will help you understand how ICD-10 will affect your practice. Understanding the scope of the ICD-10 transition will reduce the likelihood that you will overlook areas that need updates for ICD-10. Testing ICD10, from documentation all the way through communication with billing services, is vital to making sure you have worked out any snags in the process before the October 1, 2014, transition date.

Take a look at documentation for the most often-used ICD-9 codes in your practice and work with coding staff to select the appropriate corresponding ICD-10 codes.

Identifying these codes will help reinforce the information to highlight when documenting patient diagnoses for ICD-10.

Keep Up to Date on ICD-10 Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline.

Dates of Service: Is It ICD-9 or ICD-10?

With the October 1, 2014, ICD-10 deadline approaching, you may be wondering how you will code a claim that you are submitting in October 2014 for a service that your practice provided in September 2014.

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Even if you submit your claim on or after the ICD-10 deadline, if the date of service was before the October 1, 2014, deadline, you will use ICD-9 to code the diagnosis.

For dates of service on or after the October 1, 2014, deadline, you will use ICD10. You may not be able to use ICD-9 and ICD-10 codes on the same claim based on your payers' instructions. This may mean splitting services that would typically be captured on one claim into two claims: one claim with ICD-9 diagnosis codes for services provided before October 1, 2014, and another claim with ICD 10 diagnosis codes for services provided on or after October 1, 2014.

Some trading partners may request that ICD-9 and ICD-10 codes be submitted on the same claim when dates of service span the compliance date. Trading partner agreements will determine the need for split claims.

Here's an example of a split claim:A patient has an appointment on September 27, 2014, and is diagnosed with bronchitis. He returns for a follow-up appointment on October 3, 2014. In this case, a practice will submit a claim with an ICD-9 diagnosis code for the first visit and another claim with an ICD-10 diagnosis code for the follow-up visit.Make sure that your systems, third-party vendors, billing services, and clearinghouses can handle both ICD-9 and ICD-10 codes depending on the dates of service in the months following October 1, 2014.

Please note that future ICD-10 Email Updates will explore how Medicare will handle dates of service for inpatient settings (e.g., a hospital inpatient stay that begins before the transition date and ends after the transition date will be coded on a single claim with ICD-10). Stay tuned for details.

Keep Up to Date on ICD-10 Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline.

Simple Steps to Improve Clinical DocumentationOn October 1, 2014, your practice and the clearinghouses, payers, and billing companies that you work with will need to use ICD-10 codes. One way to help your practice prepare for ICD-10 is to work on improving how you document your clinical services. This will help you and your coding staff become more accustomed to the specific, detailed clinical documentation needed to assign ICD-10 codes.

Take a look at documentation for the most often used codes in your practice, and work with your coding staff to determine if the documentation would be specific and detailed enough to select the best ICD-10 codes. For example, laterality is expanded in ICD-10-CM. Therefore, clinical documentation for diagnoses should include information on which side of the body is affected (i.e., right, left, or bilateral).

Below are additional examples of the specific information needed to accurately code the following common diagnoses:

Diabetes Mellitus: Type of diabetes

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Body system affected Complication or manifestation If type 2 diabetes, long-term insulin use

Fractures: Site Laterality Type Location

Injuries: External cause – Provide the cause of the injury; when meeting with patients, ask and document

“how” the injury happened. Place of occurrence – Document where the patient was when the injury occurred; for example,

include if the patient was at home, at work, in the car, etc. Activity code – Describe what the patient was doing at the time of the injury; for example, was he

or she playing a sport or using a tool? External cause status –Indicate if the injury was related to military, work, or other.

Remember, ICD-10 will not affect the way you provide patient care. It will just be important to make your documentation as detailed as possible since ICD-10 gives more specific choices for coding diagnoses. This information is likely already being shared by the patient during your visit—it’s just a matter of recording it for your coding staff. Good documentation will also help reduce the need to follow-up on submitted claims—saving you time and money.

Assembling an ICD-10 Project TeamAssembling an ICD-10 Project Team to oversee your organization's shift to ICD-10 is instrumental to a successful transition. This team will be responsible for overseeing the ICD-10 planning and implementation process.

Select Your TeamSince ICD-10 will affect nearly all areas of your practice, project teams should consist of representatives from key areas of your organization, including:

Senior Management Health Information Management/Coding Billing/Finance Compliance Revenue Cycle Management Information Systems and Technology

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This multi-disciplinary team provides the cooperative environment necessary to address your organization's needs. If you run a small business or practice, several of these functional areas may rest with the same individuals, making your transition team smaller.

Appoint a Project ManagerOnce members of the project team have been selected, appoint one team member to serve as the project manager. As the manager, he or she will be responsible for establishing accountability across the ICD-10 implementation team and making business, policy, and technical decisions.

Your Team's Initial TasksWith an established project team and a designated project lead, you'll be ready to begin planning for ICD-10 implementation. Project teams should:

Establish regular check-in meetings to discuss progress and address any issues. Conduct an ICD-10 impact assessment to help you determine how the transition to ICD-10 will

affect your organization, and allow you to schedule and budget for all ICD-10 activities. Plan a comprehensive and realistic budget. This should include costs such as software upgrades

and training needs. Identify and ensure involvement and commitment of all internal and external stakeholders.

Contact vendors, physicians, affiliated hospitals, clearinghouses, and others to determine their plans for ICD-10 transition.

Develop and adhere to a well-defined implementation timeline that makes sense for your organization.

Communicate RegularlyRemember to communicate regularly with your entire ICD-10 project team! Keeping the lines of communication open will help make sure everyone is kept up to date on the implementation progress. It may be helpful to establish and circulate a calendar of internal tasks, milestones, and deadlines to help keep day-to-day activities running smoothly and on schedule.

Assessing Your Vendors Vendors are key partners who can help you prepare for ICD-10. When considering how your vendor can assist you in your transition to ICD-10, you should first assess your vendor’s capabilities:

Do your current vendor contracts cover your practice’s ICD-10-related needs? What is the vendor’s timeline for the ICD-10 transition? Will your vendor install products well before the October 1, 2014, deadline, so you can begin

testing them in 2013? Will all your vendor’s current products and applications be updated for ICD-10?

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Do products give you the ability to search for codes by the ICD-10 alphabetic and tabular indexes? By clinical concept?

Will the product allow for coding in both ICD-9 and ICD-10 to accommodate transactions with dates of service before October 1, 2014, and transactions with dates of service after October 1, 2014?

Communication During Your TransitionAfter assessing your vendor’s capabilities, continue to communicate with them throughout the ICD-10 transition:

Planning. Communicate your needs and goals to your vendor and ask for your vendor to provide assurance in writing that products and testing plans will fulfill your requirements.

Implementation and internal testing. Work with your vendors to update and test clinical, financial, actuarial, and reporting processes. Vendors should offer technical support and guidance during and after installation of new software.

Testing with payers. Find out how your vendor will provide support as you begin testing ICD-10 transactions with payers and other business trading partners. Allow up to a year in advance of the October 1, 2014, ICD-10 deadline for testing with trading partners.

For more information on working with vendors and other external business partners, consult the ICD-10 checklists, timelines, and implementation guides available on the CMS website.

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III. Implementation Guides

CMS has created four ICD-10 Implementation Guides that provide direction for payers, providers in small, medium, and large practices, and small hospitals on how to implement ICD-10. These handbooks are excellent resources and provide detailed information on best practices for ICD-10 implementation to their respective organizations.

Each guide is tailored to a specific organization type: Large Practices Small and Medium Practices Small Hospitals Payers

IV. Implementation Checklists and Timelines

In conjunction with the Implementation Guides, implementation timelines and checklists are available to provide organizations—small and medium practices, large practices, small hospitals, and payers—with a high-level understanding of what the ICD-10 transition requires and how their ICD-10 preparations compare with recommended timeframes.

The checklists include a list of ICD-10 tasks, including estimated timeframes for each task.This checklist is designed to provide a viable path forward for organizations just beginning to prepare for ICD-10. The timelines provide a visual guide to key transition activities by phase.

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Each timeline and checklist are tailored to a specific organization type: Large Practices: Checklist and Timeline Payers: Checklist and Timeline Small Practices: Checklist and Timeline Small Hospitals: Checklist and Timeline

V. Web Button

The Web Button can be used for your website alongside your ICD-10 related products or on your homepage. The button should be linked to the CMS ICD-10 information website: http://www.cms.gov/ICD10/.

Recommendations for Use: The Web Button provides a simple way to direct visitors to the CMS ICD-10 webpage for more information about the transition to ICD-10, as well upcoming ICD-10 educational opportunities.

VI. Drop-In Articles

Drop-in articles can be placed in publications and member newsletters to educate your constituents about ICD-10.

Drop-in articles have been created for provider and payer audiences on the following topics: Action Steps for Payers Impact Assessment Internal Testing of ICD-10 Small Provider Practices Information

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Section 3: ICD-10 Medscape Modules

ICD-10 Medscape Modules

CMS, through Medscape Education, has released two ICD-10 video lectures providing practical guidance for small practices transitioning to ICD-10. The video lectures are intended for all health care providers, particularly those in small community practices. Continuing medical education (CME) and continuing education (CE) credits are available to physicians and nurses who complete the learning modules, but anyone can take them and receive a certificate of completion.

The modules are free to use and the CME and CE credits are available until August 30, 2014. If the user is not a member of Medscape, they will first be prompted to fill out a brief registration form. Providers can use these modules to get a deeper understanding of ICD-10 than is provided by the CMS fact sheets and the website.

Video Lectures

The ICD-10: A Roadmap for Small Clinical Practices video lecture describes: The internal staff, functions, and processes within small independent clinical practices

that will be most directly affected by the conversion to ICD-10 How to plan and implement training, software, and procedural changes associated with

conversion to ICD-10 within a small clinical practice When and how to initiate testing of ICD-10 systems, both internally and externally, to

ensure a smooth transition by deadline

The ICD-10: Small Practice Guide to a Smooth Transition video lecture discusses: What the transition to ICD-10 will mean for small clinical practices Requirements, timelines, and framework for implementation of ICD-10 Resources that can guide and facilitate progress toward conversion by the October 1,

2014, deadline

Additional Medscape Education video lectures on ICD-10 tailored for small/medium practices or large practices are also available, but CME credits are no longer offered.

Video lecturesThe videos, ICD-10: A Guide for Small and Medium Practices and ICD-10: A Guide for Large Practices, feature Daniel J. Duvall, MD, MBA, medical officer with the Hospital and Ambulatory Policy Group at CMS, describe:

Global differences between ICD-9 and ICD-10 How ICD-10 will have different impacts on practices of different sizes Basic transition planning steps and resources

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Expert articleIn the article Transition to ICD-10: Getting Started, Joseph Nichols, MD, of Health Data Consulting covers documentation improvements, the coder-clinician relationship, training, working with vendors and payers, search tools, and resources.

For questions or technical assistance, please contact Medscape at CME@medscape.net.

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Section 4: Member Outreach and Education

Working with CMS on ICD-10 Outreach and Education

CMS is engaging national vendor, payer, and provider organizations to serve as intermediaries in reaching their memberships with messages about the ICD-10 transition and resources available from CMS.

You can coordinate with CMS on ICD-10 outreach and education by:

Posting CMS ICD-10 materials on your organization’s website and distributing materials at conferences or meetings

Linking to the CMS ICD-10 website from your organization’s website Coordinating with CMS to arrange opportunities for CMS ICD-10 spokespeople to present

at your conferences Sponsoring webinars and conference calls featuring CMS ICD-10 spokespeople Placing ICD-10-related drop-in articles in your publications Encouraging your members to subscribe to the CMS ICD-10 Email Update list

Stakeholder organizations that are interested in working with CMS can contact their CMS Regional Office.

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