ICD-10 For Practice Managers - NAMAS
12/1/2013ICD-10 for PracticeManagers:How to Make the TransitionPresented by Evan M. Gwilliam, DC CPCCCPC NCICS CCCPC CPC-I MCS-P CPMA1Introduction Education Bachelor’s of Science, Accounting - Brigham Young University Master’s of Business Administration - Broadview University Doctor of Chiropractic, Valedictorian - Palmer College of ChiropracticCertifications Certified Professional Coder (CPC) - AAPC Nationally Certified Insurance Coding Specialist (NCICS) - NCCT Certified Chiropractic Professional Coder (CCPC) - AAPC ChiroCode Certified Chiropractic Professional Coder (CCCPC) - ChiroCode Certified Professional Coder – Instructor (CPC-I) - AAPC Medical Compliance Specialist – Physician (MCS-P) - MCS Certified Professional Medical Auditor (CPMA) – AAPC, NAMAS Certified ICD-10 Trainer - AAPC21
12/1/2013Introduction Affiliations / Experience Chiropractic Practice – in Washington and UtahExecutive Director of Education and Consulting – FindACodeCoding Instructor - Broadview UniversityEditorial Board Member - ICD10Monitor.comSpeaker/Instructor – Cross Country Education, ChiroCode, TargetCoding, AAPC, multiple state professional associationsContributor – Chiropractic Economics, ACANews, AAPC CuttingEdge, The American Chiropractor3DisclaimerEvery attempt has been made to make this presentation ascurrent as possible, but things changeBe sure to check with your local carriers and Medicare forupdates as the ICD-10 implementation date gets closer42
12/1/2013ICD-10 Readiness Survey1. What do you already know about ICD-10?2. Why are we changing?3. How much do you think ICD-10 will affectyour clinic?4. Does anything concern you about ICD-10implementation?5. Where do you plan to go for moreinformation?How much of a headachewill ICD-10 really be?Government Encephalitis – G04.90Health Insurance Plans 2 star headacheSinus – R51Providers 3 star headacheCluster – G44.009Billing agencies 4 star headacheMigraine – G43.909Hospitals 5 star headache1 star headacheTension – G44.2093
12/1/20137Which parts of a practice willbe affected?4
12/1/2013Which parts of a practice willbe affected?Front Desk System updates, trainingProvidersManagement Documentation with more Vendor and payer contracts specificity Budgeting New code specific training Training plan Compliance plan, codingguidelinesWhich parts of a practice willbe affected?Clinical areas New patient coverage policies New super bills New ABNs based on new LCDsBilling Code set training Reimbursement policies (more denials?)5
12/1/2013Why do we have diagnosis codes? HIPAA requirementEstablish medical necessityProcess claimsTranslate written terminology intocommon languageProvide data for statistical analysisIdentify fraud, set healthcare policy,measure quality11Where did they come from? ICD-9 was developed by the World HealthOrganization for public health and statisticalanalysis First revision 1893, ninth revision 1979o Shifted focus from mortality to morbidity “ICD-9-CM” means Clinical Modification - for usewith health care claims in the U.S. ICD-9-CM was mandated by CMS in 1988 under theMedicare Catastrophic Coverage Act126
12/1/2013Why can’t we keep using ICD-9? Too old Many sections are full andcannot be expanded Not descriptive enough Not able to accurately reflectadvances in medicalknowledge or technology Will not meet healthcareneeds of the future13Why can’t we keep using ICD-9? Requires excessive reliance on supportingpaper documentation Hampers the ability to compare costs andoutcomes147
12/1/2013Why can’t we keep using ICD-9?ICD-1068,000codesICD-914,000codes15What does ICD-10bring to the table? Appropriate payment via stratification of morbidityo “My patients are sicker” Specificity needed for episodes of care, AffordableCare Organizations, quality monitoring Better quality in research and trials Identification of consistent cohorts Improved outcomes from population analysis Targeting resources to diseaseso Specialty, county, environment168
12/1/2013Where did ICD-10 come from? ICD-10 was introduced by the WHOo Used since 1999 to report mortality data on death certificates ICD-10-CM was developed by the NationalCenter for Health StatisticsooooooReady in 1994Public comments 1997-1998Tested in 2003 by AHA and AHIMAFinal rule for implementation published 2009Postponed in 2012Implementation October 1, 2014 (for sure, maybe)17Won’t they just postpose it again?189
12/1/2013Won’t they just postpone it again? Jan. 2013, the AMA asked CMS to abandonICD-10 Feb. 6, 2013, CMS Acting Administrator,Marilyn Tavenner said noooooToo much work has already been done to turn back nowThe old system won’t work with new technologiesThat would penalize innovatorsIt is necessary for health care reform19Will Oct. 1, 2014 be the end of the world?2010
12/1/2013How do I implement ICD-10in my practice?ICD-10 Myths October 1, 2014 will be the end of the world The date will be delayed Worker’s Comp and Auto insurance will still useICD-9 The number of codes make ICD-10 impossible to use Documentation requirements will make ICD-10impossible to use ICD-10 is already out of date ICD-10 will replace ads/ICD-10MythsandFacts.pdfHow are ICD-9 and ICD-10 similar? Still a tabular list divided into chaptersbased on body system or condition Similar hierarchy Still an index with main terms and subterms Conventions are mostly the sameo Exception: Excludes1 and Excludes2 Must code to the highest level of specificity ICD-10 is mandated under HIPAA2211
12/1/2013How are ICD-9 and ICD-10 similar?I. Official Guidelines (about 30 pages)II. IndexesI. Diseases and Injuries (300 pages)I. Includes Neoplasms (20 pages)II. Drugs and Chemicals (30 pages)III.External Causes (20 pages)23How are ICD-9 and ICD-10 similar?I. Official Guidelines (about 30 pages)II. IndexesI. Diseases and Injuries (340 pages)II. Neoplasms (20 pages)III.Drugs and Chemicals (50 pages)IV.External Causes (35 pages)2412
12/1/2013How are ICD-9 and ICD-10 similar?III. Tabular list (340 pages)I. Infectious DiseasesII. NeoplasmsIII. EndocrineIV. BloodV. MentalVI. NervousVII. CirculatoryVIII.RespiratoryIX. DigestiveX. GenitourinaryXI. PregnancyXII. SkinXIII.MusculoskeletalXIV.Congenital malformationsXV. PerinatalXVI.Signs and SymptomsXVII.Injuries and PoisoningE-codes. External CausesV-codes. Health Status25How are ICD-9 and ICD-10 similar?III. Tabular list (600 pages)I. Infectious DiseasesII. NeoplasmsIII. BloodIV. EndocrineV. MentalVI. NervousVII. EyeVIII.EarIX. CirculatoryX. RespiratoryXI. DigestiveXII. SkinXIII.MusculoskeletalXIV.GenitourinaryXV. PregnancyXVI.PerinatalXVII.Congenital malformationsXVIII.Signs and SymptomsXIX.Injuries and PoisoningXX. External CausesXXI.Health Status2613
12/1/2013How are ICD-9 and ICD-10 different? ICD-10’s alphanumeric structure provides more specificinformation, which creates a more descriptive clinicalpicture of the patient Increased codes and categories allow for more accuraterepresentation of diagnoses27How are ICD-9 and ICD-10 different?FeatureICD-9-CMICD-10-CMNumber of CodesAbout 14,000About 68,000Number of characters 3-5 characters inlength Characters are allnumeric (or E or V) Decimal is used after3 charactersNumber of Chapters17 plus E and Vchapters 3-7 characters inlength Character 1 is alpha Character 2 isnumeric Characters 3-7 arealpha or numeric Decimal is used after3 characters Some codes use “x”for characters 4-6 Character 7 used incertain chapters21 chapters2814
12/1/2013How are ICD-9 and ICD-10 different?FeatureICD-9-CMICD-10-CMStart Date1975, 1979 in US1994, 2014 in USExpansionVery limitedHas significant abilityto expand without astructural changeDetailLacks detailVery specificLateralityLacks lateralityIncludes lateralitywhen appropriateEncountersInitial and subsequentencounters are notdefinedInitial and subsequentencounters are definedCombination CodesCombination codesare limitedCombination codesare frequent29How are ICD-9 and ICD-10 different?ICD-9ICD-103015
12/1/2013What are some ICD-10 examples?ICD-10-CM code for chronic gout due to renalimpairment, left shoulder, without tophus.31What are some ICD-10 examples?E844.8 Sucked into a jet without damage to airplane;ground crew3216
12/1/2013What are some ICD-10 examples?V97.29XA2G Sucked into a jet without damage toairplane; luggage cart driver; male; under 5’5” inheight; slightly bald; wearing a tank top33What are some ICD-10 examples? V95.42XA: Spacecraft crash injuring occupant, initialencounter. W59.22XA: Struck by a turtle, initial encounter G44.82: headache associated with sexual activity V91.07XA: Burn due to water-skis on fire, initialencounter (search for this one on YouTube) T75.01XD: shock due to being struckby lightning, subsequent encounter Y34: Unspecified event,undetermined intent R45.2: unhappiness3417
12/1/2013What are some ICD-10 examples?Look up:o Kissing SpineIn ICD-10In Kissing SpineOccipito-atlanto regionCervical regionCervicothoracic regionThoracic regionThoracolumbar regionLumbar regionLumbosacral 8.2735How do I find theICD-10 code?GEMs mapping:724.3 Sciatica M54.30 Sciatica, unspecified side18
12/1/2013How do I find theICD-10 code?GEMs mapping:724.3 Sciatica M54.30 Sciatica, unspecified side(M54.31 and M54.32 right or left)ORM54.40 Sciatica with lumbago, unspecified(M54.41 and M54.42 right or left)How do I find theICD-10 code?Look up 724.3 using GEMs-M54.30Look up “sciatica” in the ICD-10 index-M54.3Now find it in the tabular list-unspecified codes need to be investigated-at least five characters required to code tothe highest level of specificity3819
12/1/2013What does the documentationlook like?S: Mrs. Finley presents today after having a new cabinet fall on her last week,suffering a concussion, as well as some cervicalgia. She was cooking dinner atthe home she shares with her husband. She did not seek treatment at thattime. She states that the people that put in the cabinet in her kitchen missedthe stud by about two inches. Her husband, who was home with her at thetime told her she was “out cold” for about two minutes. The patient continuesto have cephalgias since it happened, primarily occipital, extending up intothe bilateral occipital and parietal regions. The headaches come on suddenly,last for long periods of time, and occur every day. They are not relieved byAdvil. She denies any vision changes, any taste changes, any smell changes.The patient has a marked amount of tenderness across the superior trapezius.O: Her weight is 188 which is up 5 pounds from last time, blood pressure 144/82,pulse rate 70, respirations are 18. She has full strength in her upper extremities.DTRs in the biceps and triceps are adequate. Grip strength is adequate. Heartrate is regular and lungs are clear.A: Status post concussion with acute persistent headachesCervicalgiaCervical somatic dysfunctionP: The plan at this time is to send her for physical therapy, three times a weekfor four weeks for cervical soft tissue muscle massage, as well as upper dorsal.We’ll recheck her in one month, sooner if needed.39What does the documentationlook like?S06.0x1AConcussion with loss of consciousness of 30 minutes or less, initialencounterG44.311Acute post traumatic headache, intractableM54.2CervicalgiaM99.01Segmental and somatic dysfunction of cervical regionW20.8xxA Struck by falling object (accidentally), initial encounterY93.g3Activity, cooking and bakingY92.010Place of occurrence, house, single family, tion-example.aspx4020
12/1/2013How do I implement ICD-10in my practice?41How do I implement ICD-10in my practice?21
12/1/2013What should I asksoftware vendors? What implementation plans do you have inplace? What software changes will be needed (if any)? What products and services will be available? When will you be ready to test your program? What guidance and assistance will you provideduring the rollout? Is your clearinghouse ready?What are thebudgeting considerations?Budgeting for ICD-10 falls into four categories:1. Information systems upgrades2. Auditing and monitoring documentation forICD-103. Education and training4. Staffing and overtime costsAccording to a RAND corporation study, itcould cost as much as 40,000 on average,but small clinics may be closer to just 4,000.22
12/1/2013What about claim denials?Denial rates couldincrease 200%A/R days couldincrease 40 percentSolution:Open a line of credit45Where else do I need toupdate to ICD-10? EHR/EMR Software – allow time for updates andtraining. Forms – charting forms, internal forms, etc. Documents – ex. ABN form Website Contracts Policy & Procedure Manuals Inter-departmental documents23
12/1/2013What other resourcesare out there?Medicare: free information Sign up for the ICD-10 email updates Search ICD-10 Provider Resources Watch Medscape presentations:ICD-10: A Roadmap for Small Clinical PracticesICD-10: Small Practice Guide to a SmoothTransitionFindACode.com: Crosswalks andother toolsICD10Monitor.com: free articlesAAPC.com and AHIMA.orgHow do I implement ICD-10in my practice?1. Learn the basics-review these notes again with yourwhole office2. Buy a copy of the code set and get access to GEMs3. Run a report with the list of most common ICD-9 codesand do your own crosswalk4. Dedicate a few minutes of each office meeting to ICD-101. Find articles in specialty trade journals and blogs, thenshare them at each meeting.2. Take a completed case and crosswalk it to ICD-10,then rework the documentation. (include everyone)24
12/1/2013How do I implement ICD-10in my practice?5. Administrative checklist:1. Plan a budget for implementation expenses2. Update all your forms3. Contact all your vendors4. Conduct internal testing6. Use consulting services if you need help.7. Have a good time!Is ICD-10 good .or bad? It will compel providers to improve the way theydocument, which may be hard for some It will compel coders to learn anatomy/pathologybetter It may compel billers to deal with denials It may create revenue challenges for practicemanagers It will improve data collection for studies5025
724.3 Sciatica M54.30 Sciatica, unspecified side (M54.31 and M54.32 right or left) OR M54.40 Sciatica with lumbago, unspecified (M54.41 and M54.42 right or left) How do I find the ICD-10 code? Look up 724.3 using GEMs-M54.30 Look up “sciatica” in the ICD-10 index -M54.3 Now find it in the tabular list -
ICD-9 724.02 ICD-10 M48.06 Spinal stenosis, lumbar region ICD-9 720.2 ICD-10 M46.1 Sacroiliitis, not elsewhere classified ICD-9 724.8 ICD-10 R29.898 Other symptoms and signs involving the ** musculoskeletal system ICD-9 721.42 ICD-10 M47.16 Other spondylosis with myelopathy, lumbar region ICD-9 723.1 ICD-10 M54.2 Cervicalgia ICD
More on ICD-10. ICD-10-PCS replaces ICD-9-CM inpatient procedure coding: ICD-9-CM procedure codes 3 to 4 numeric digits ICD-10-CM codes 7 alphanumeric digits ICD-10-PCS code format substantially different from ICD -9 Unlike ICD-9, ICD-10
ICD-10 Tips from PHCS The Road to ICD-10 Flyer AMA ICD-10 Project Plan Template Educational Tools Folder Precyse University ICD-10 Physician Office Solution Brochure Precyse Catalog of ICD-10 Courses ICD-10 Precyse Apps for Physicians Resources Folder Free Resources ICD-9 to ICD-10 Crosswalk of Most Common ICD-9 .
Dec 14, 2010 · ICD-9. ICD-10. ICD-9. ICD-10. Inactive. Active. Combined Code Set. Core Technologies. ICD-9 and ICD-10 code values are unique. Generally, the industry is taking one of two approaches as it relates to the ICD-10 transition: Remediation: Modify/expand all systems and processes to accommodate ICD-
ICD-10 to ICD-10-CM Based on FY2017 ICD-10-CM codes Category and subcategory codes are shaded in grey and marked with an Cells shaded in pink and marked with an *indicate the preferred code when a single code maps to multiple codes (see Introduction) Reportable Neoplasms . Type of Code ICD-10 Category Chapter II (Neoplasms) ICD-10 Term . ICD .
7/13/2015 1 Tonya Mitchell, RHIT July 17, 2015 Objectives Review the History of ICD‐10 Discuss the Myths and Facts of ICD‐10 Discuss GlGeneral DttiDocumentation CtConcepts Review ICD‐10 Documentation Concepts Analyze Documentation for Top Diagnosis in ICD‐10 WHY CHANGE FROM ICD‐9 TO ICD‐10? ICD‐9 was developed in the 1970s and cannot support current
of the previous ICD-9 coding system. The volume of ICD-10 codes as compared to ICD-9 codes is significant because in ICD-10, the code size has been expanded, code values and interpretations have been redefined and specificity has been further improved. Global ICD-10 adoption The current version of ICD is ICD-10, which was adopted by the World .
According to CMS, GEMs are “a tool to assist with the conversion of ICD-9-CM codes to ICD-10 and the conversion of ICD-10 codes back to ICD-9-CM. The GEMs are forward and backward mappings between the ICD-9-CM and ICD-10 coding systems.” Watch out: Although you’ll see the term “cr
