EHealth University: Introduction To ICD-10: A Guide For .
ICD-10» Introduction to ICD-10: A Guide for ProvidersCenters for Medicare& Medicaid Services
Compliance Date: October 1, 2015TABLE OF CONTENTSWhat is ICD-10?Why ICD-10 mattersWhy transition to ICD-10Getting ready for ICD-10CMS resourcesThis guide is intended to provide health care professionals with an overview of ICD-10. Hyperlinks to the CMSwebsite are included in the guide to direct you to more information and resources.WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES2
What is ICD-10?3WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
What is ICD-10?In 1990, the World Health Organization (WHO) approved the 10th Revision of the InternationalClassification of Diseases (ICD), known as ICD-10.WhatWhenWhy A method of coding:» The patient’s state ofhealth and» Institutional procedures In the U.S., ICD-10 includes:» ICD-10-CM : clinicalmodification of WHOstandard for diagnoses thatis maintained by NCHS andis for specific use in theU.S.» ICD-10-PCS: inpatientprocedures developed andmaintained by CMS ICD-10-CM and PCS arecomplete revisions of their U.S.developed ICD-9 counterparts,which were adopted in 1979» More information per code» Better support for caremanagement, qualitymeasurement, and analytics» Improved ability tounderstand risk and severity Compliance Date: 10/1/15» Outpatient services arebased on the Date ofService» Inpatient services arebased on the Date ofDischargeWho All HIPAA-covered entitiesmust use ICD-104WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Why ICD-10 Matters5WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Why ICD-10 MattersICD-10 replaces the ICD-9 code sets and includes updated medicalterminology and classification of diseasesICD-10 CM/PCS consists of two parts: ICD-10-CM for diagnosis coding in all health care settingsICD-10-PCS for inpatient procedure coding in hospital settingsCPT coding for outpatient and office procedures is notaffected by the ICD-10 transition6WHAT IS ICD-10?WHYWHY ICD-10ICD-10MATTERSMATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Why ICD-10 MattersICD-10-CM replaces ICD-9-CM fordiagnosis coding: ICD-9-CM diagnosis codes 3 to 5 digitsICD-10-CM codes 3 to 7 digitsOverall format of ICD-10 diagnosis codes similar to ICD-97WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Why ICD-10 MattersICD-10-PCS replaces ICD-9-CM for inpatientprocedure coding: ICD-9-CM procedure codes 3 to 4 numeric digitsICD-10-PCS codes 7 alphanumeric digitsICD-10-PCS code format substantially different from ICD-9Unlike ICD-9, ICD-10 expands details for many conditions8WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Why Transition to ICD-10WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Why Transition to ICD-10Better reflects current medical practiceCaptures more specific data from clinicaldocumentation than ICD-9 ICD-10-CM: For fractures, for example, captures left vs. right side ofbody, initial vs. subsequent encounter, routine vs. delayed healing, andnonunion vs. malunionICD-10-PCS: Provides detailed information on procedures anddistinct codes for all types of devices10WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Why Transition to ICD-10Detail captured by ICD-10 can: Facilitate patient care coordination across settingsImprove public health reporting and trackingICD-10 structure accommodates new codes ICD-9 is running out of capacity and cannot continue toaccommodate addition of codes to reflect new diagnosesand procedures11WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Compliance DateBy October 1, 2015, your practice must start usingICD-10 codes for services provided on or afterOctober 1, 201513WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Monitor Your ProgressMonitor your progress against your ICD-10project plan, which should identify: Each task to be completedWhen tasks should begin and endWho is responsible for each task14WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Check Your PlanCheck that your ICD-10 project plan: Ensures senior leadership understands breadth and significanceof ICD-10 changeAssigns overall responsibility and decision-making authority formanaging the transitionIncludes a comprehensive, realistic budgetEnsures involvement of all stakeholders, ranging from physiciansto clearinghouses and software vendors15WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Check Your PlanCheck that your ICD-10 project plan also covers: Software/hardware testingStaff training and sharing best practicesUpdating internal policies to support the transitionAdhering to a well-defined timeline16WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Key StepsEssential tasks to cover in project plan: Identify commonly used ICD-9 codes and explore related ICD-10codesIdentify paper and electronic forms to accommodate the ICD-10code structureSchedule ICD-10 training for clinicians, office managers, billers,coders, and other key staff17WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Analyze How You Use CodesIdentify how ICD-10 will affect your practice,specifically use of codes for: Billing and submitting claimsOther functions, like eligibility queries, registration, and referrals18WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Questions for Your AnalysisQuestions to inform your analysis: Will I be able to submit claims? You will need a billing system that is compliant withHIPAA Version 5010 transaction standards Verify that your existing billing system can submit and receiveICD-10 codesHow does ICD-10 work with my EHR systems? Verify whether your EHR captures ICD-10 codes as needed forbilling purposes19WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Questions for Your AnalysisHow do I become familiar with ICD-10 codes? Obtain ICD-10 code books if you use ICD-9 books for codelook-upCompare ICD-9 codes commonly used in your office tocorresponding ICD-10 codesCheck your software for an ICD-10 look up functionAcquire ICD-10 code trainingObtain new ICD-10 forms if you use ICD-9 forms today20WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Look for EfficienciesConsider opportunities to make codingmore efficient: List your most commonly used ICD-9 codes and look at theICD-10 codes you will use in their placeThen think about how front-office staff can help capture newinformation required under ICD-10 (e.g., trimester of pregnancyfor obstetric coding)21WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Changes to Your PracticeIdentify changes you might need to makeLook at: Business processesClinical documentationPractice management and clinical softwareReadiness of your vendors (e.g., practice management, billing, andclearinghouse products and services)22WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Business ProcessesBusiness processes to consider include: ReferralsAuthorization/precertificationPatient registration and schedulingPhysician ordersContracts with payers, clearinghouses, and other businesspartnersFinancial operationsPublic health reporting23WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:DocumentationClinical documentation of key medicalconcepts is essential to selecting specificICD-10 codes.As part of patient care, clinicians already document mostconcepts needed for ICD-10 coding.24WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:DocumentationDoes your practice’s documentation capturenecessary detail? Use documentation from recent patient encounters to tryselecting ICD-10 codesNote any changes needed to documentation for ICD-10 coding25WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:CommunicationConfirm ICD-10 plans and readiness of lling services26WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Talk with Payers Ask payers if they are revisingcontracts or policies based onICD-10; if so, negotiate newcontractsAsk about testing plans27WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Talk with Clearinghouses and Billing ServicesIf you work with a clearinghouse or billing service, check ontheir ICD-10 preparation and readinessFigure out how you can work together so yourclaims can be processed using ICD-10 Note: Clearinghouses cannot help identify which ICD-10 codesto use unless they offer coding services28WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Talk with Software/Systems VendorsTalk to your EHR and/or practicemanagement system vendors to seewhen they plan to upgrade your systemfor ICD-10Vendors will need to have productsready as soon as possible so you cantest them; if they don’t, you may needto find a new vendor who has ICD-10 ready products29WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Vendor Evaluation Identify your current vendorsContact vendors to confirm they areICD-10-ready and how they will helpyou get readyAssess whether you want or need todevelop new vendor relationshipsEvaluate your current vendor or newvendor by asking key questions30WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Key Vendor QuestionsAsk your vendors: Will you install products well before the October 1, 2015,compliance date, so I can begin testing?Will you support my products after October 1, 2015?Will you update my products and applications for ICD-10?Will you keep my products updated? Will there be a charge?Will I need new hardware to accommodate ICD-10-relatedsoftware changes?31WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Key Vendor QuestionsMore questions for your vendors: What costs are involved with maintaining new products?Will you offer product support for the transition? If so, forhow long?How do I report issues and how quickly will you respond?Will you provide training on your software?Will you offer support during internal ICD-10 testing?Will you help me test my system with payers and othertrading partners?32WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:TestingOnce your system is ICD-10-ready, test it Try systems that send and receive codes to ensure they processICD-10 codes correctly Test transactions that affect your practice most, such as: Claims submission Eligibility verification Quality reporting33WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:TestingLook at processes for collecting and reporting diagnosis codes(e.g., superbills and patient encounter forms)Try handling processes with ICD-10: If I had to select an ICD-10 code for the last patient, whatwould it be? If I had to prepare a claim with an ICD-10 code, how wouldI do that?34WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:TestingTest with payers and other business partners Work with your vendors and other business partners to developa testing plan and schedule for ICD-10 transactionsTest how well your systems work together to send and receivecodes—focus on transactions that affect your practice most35WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:ImplementationPrepare and monitor for ICD-10’spotential impact on: Coding productivityCoding accuracyReimbursementVendor responsiveness36WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:ImplementationSample steps to minimize ICD-10-relatedchallenges: Eliminate coding backlogs before ICD-10 transitionPrioritize medical records for codingProvide refresher training to address productivity andaccuracy issuesDevelop a process for managing errors and resolvingvendor issues37WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
CMS ICD-10 ResourcesWHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
ResourcesCMS website:www.cms.gov/icd10 Features fact sheets,FAQs, andimplementationguides, timelines, andchecklists39WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
ResourcesCMS ICD-10 EmailUpdates providetimely informationTo sign up for updates:1. Go to cms.gov/icd102. Select “CMS ICD-10 IndustryEmail Updates” from leftnavigation bar3. Click on “Sign up for updatemessages”40WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
ResourcesFact sheets on ICD-10for providers, payers,and vendors Available on the Provider,Payer, and VendorResources pages of theCMS ICD-10 website41WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
ResourcesICD-10 MedscapeModules Expert Column: Preparing forICD-10: Now Is the TimeVideo: ICD-10: Getting FromHere to ThereVideo: ICD-10 and ClinicalDocumentationFree continuing medical education (CME) and continuing education (CE)credits available to physicians and nurses who complete ta brief post-test.Accessible from CMS ICD-10 website: www.cms.gov/icd1042WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
ResourcesRoad to 10 Tool: on Provider Resources page, cms.gov/ICD-10The Road to10 can help you: Understand the basics ofICD-10 Build an ICD-10 actionplan to map out yourtransition Answer frequently askedquestions43WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
ResourcesFollow us on Twitter: @CMSgovJoin the conversation: Use #ICD10 to tweet about ICD-1044WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
ICD-10 replaces the ICD-9 code sets and includes updated medical terminology and classification of diseases . ICD-10 CM/PCS consists of two parts: ICD-10-CM for diagnosis coding in all health care settings ICD-10-PCS for inpatient procedure coding in hospital settings . CPT coding for outpatient and office procedures is not
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
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 .
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 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 .
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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-
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
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