DME MAC Collaborative ICD-10 Webinar: Are You Ready?
DME MAC CollaborativeICD-10 Webinar: Are YouReady?September 2015
Today’s PresentersJudie Roan, Jurisdiction A Terri Shoup, Jurisdiction B Angie Cooper, Jurisdiction C Michelle Wullstein, Jurisdiction D 2
Webinar Access All registrants received an email from:Medicare Webinar by National xonline.com] Click on the link within the email to join the webpresentation Using your telephone, dial into the conference callusing the number and access code provided inthe email3
Today’s PowerPoint Presentation Available via GoToWebinar Click on the handout on the right hand side ofyour screen Available on each of the DME MACs websitewithin the education and training section oftheir websites4
Audio Once you are connected tothe audio, the PIN displays Input the PIN on your screen intoyour telephone Dial in number and PIN areunique for each attendee5
DisclaimerThe Durable Medical Equipment Medicare Administrative Contractors(DME MACs) have produced this material as an informational referencefor providers furnishing services in our contract jurisdictions. DME MACemployees, agents, and staff make no representation, warranty, orguarantee that this compilation of Medicare information is error-free andwill bear no responsibility or liability for the results or consequences ofthe use of this material. Although every reasonable effort has been madeto assure the accuracy of the information within these pages at the timeof publication, the Medicare Program is constantly changing, and it is theresponsibility of each provider to remain abreast of the Medicare Programrequirements. Any regulations, policies and/or guidelines cited in thispublication are subject to change without further notice. CurrentMedicare regulations can be found on the Centers for Medicare &Medicaid Services (CMS) website at http://www.cms.gov.6
No Recording Attendees/providers are never permitted torecord (tape record or any other method)our educational events This applies to webinars, teleconferences, liveevents, and any other type of DME MACeducational event7
Objectives This webinar will review the basics ofICD-10 and discuss topics such as: whymove to ICD-10, billing changes that willoccur, frequently asked questions andresources to ease the transition.8
AgendaWhy move to ICD-10? What will change? What will not change? What are GEMs? When do I start billing ICD-10 codes? How do I remain educated? ICD-10 Summary Questions 9
Why Move to ICD-10?10
Why Move to ICD-10?Tenth Revision of the International StatisticalClassification of Diseases and Related HealthProblems (ICD-10) Codes reflect modern medicine and updatedmedical terminology Improved efficiencies More accurate reimbursement Degree of illness severity captured more easily11
Why Move to ICD-10? Mandatory for claims payment Required for both electronic and paper claims Claims returned as unprocessable12
ICD-10 Fun Fact Did you know that one-third of the codeexpansion that will occur with ICD-10 is dueto the addition of laterality, the specificationof left or right?13
What Will Change?14
What Will Change?ICD-10 CMICD-10 PCSCM: Clinical ModificationPCS: Procedure Coding SystemDiagnosis CodesInpatient ProceduresDMEPOS ClaimsInstitutional ClaimsExamples:Examples: Diabetes Total Knee Replacement Chest Pain Appendectomy Hemophilia Congestive Heart Failure15
What Will Change?ICD-9 Diagnosis CodesICD-10 Diagnosis Codes789.00E75.89E75.89A78.001BA78.001B3–5 characters in length3–7 characters in length16
What Will Change? Codes will increase from 17,000 toover 150,000 Billing departments must be trained on the newICD-10 code sets Claim billing software needs to be updated Ensure your billing software is updated Verify your billing service or clearinghouse will becompliant by the October 1 implementation date17
ICD-10 Fun Fact Did you know you can still conductAcknowledgement Testing any time priorto October 1?18
Testing Opportunities Two types of testing as outlined by CMS: Acknowledgement (front-end) End-to-End Acknowledgement Testing Registration is not required Test any time prior to October 1 No minimum or maximum number of claims required Ensure the claims are “clean” claimso Current dates of serviceo Valid ICD-10 codeso Include “T” in the ISA-15 field to identify it as a test claim19
ICD-10 Fun Fact ICD-10 will expand the code sets to over150,000 codes but did you know that mostpractices will only utilize a fraction of thecodes for a majority of their billing?20
What Will Change? Medical Policies updated to include theappropriate ICD-10 codes List of medical policies converted to ICD-10effective October 1 are available on CMS’ se21
What Will Change? CMN and DIF Form Revisions Minor changes “ICD-9 Diagnosis” removed and replaced with “DiagnosisCode” “HCPCS code” removed and replaced with “SupplyItem/Procedure Code” Required on or after October 1, 2015 For initial, recertification or revised CMNs and DIFs Not required when changing diagnosis from ICD-9to ICD-10 Available at -Forms-List.html22
What Will Not Change?23
What Will Not Change? CMNs and DIFs will not need to beupdated for claims submitted on or afterOctober 1, 2015 CMNs and DIFs created on or after October 1,2015 must use ICD-10 codes Ensure the diagnosis codes billed on the claim aresupported by documentation in the medical record Published on May 28, 201524
What Will Not Change? New medical record documentation is notneeded, as long as: Medical records and supporting documentationsubstantiate the ICD-10 code billed25
What are GEMs?26
What are GEMs? General Equivalence MappingsCreated by CMS and the CDCThe GEMS can be used to: Assist with conversion of ICD-9 to ICD-10 Assist with the conversion of ICD-10 to ICD-9 Ensure that consistence in national data is maintained To access the GEMs, visit the CMS D10/index.html Select the ICD-10 and GEMs link for the appropriate year27
Forward MappingICD-9 ICD-10 One ICD-9 DX is represented by multipleICD-10 more!28
Backward MappingICD-10 ICD-9 One ICD-10 DX is represented by multipleICD-9 ICD-9)29
No ICD-9 PredecessorICD-10DiagnosisT500x64Underdosing of mineralocorticoids and theirantagonists, initial encounterT501x6AUnderdosing of loop [high-ceiling] diuretics, initialencounterT502x6AUnderdosing of carbonic-anhydrase inhibitors,benzothiadiazides and other diuretics, initialencounterT503x6AUnderdosing of electrolytic, caloric and waterbalance agents, initial encounterT504x6AUnderdosing of drugs affecting uric acid metabolism,initial encounterand more!30
GEMs are Temporary GEMs are temporaryThe GEMs are not a substitute for learning howto use ICD-10 Coders expected to use medical record documentationwith ICD-10 coding books to select appropriate codes The GEMs are a tool to assist with the transition GEMs will be posted annually by CMS withupdates Will be maintained for three years f31
When Do I Start BillingICD-10 Codes?32
ICD-10 Fun Fact Did you know the Medicare claimsprocessing systems do not have thecapability to accept ICD-9 codes for datesof service after September 30, 2015; oraccept claims that contain both ICD-9 andICD-10 codes?33
When Do I Start BillingICD-10 Codes? Dates of service prior to October 1:ICD-9 codesDates of service on/after October 1:ICD-10 codesCMS will not allow for dual processing of ICD9 and ICD-10 codes after the October 1implementation date Do not report both ICD-9-CM and ICD-10-CMcodes on the same claim, submit separate claims34
When Do I Start BillingICD-10 Codes? Claims that require span dates Includes continuous passive motion device,diabetic testing supplies, parenteral and enteralnutrition Use the “From” date to determine which diagnosiscode set to bill DOS 9/25/2015–10/25/2015 ICD-9 codes DOS 10/1/2015–11/1/2015 ICD-10 codes You do not have to split claims35
When Do I Start BillingICD-10 Codes? CMS1500 Form and ICD-10 Revised 1500 form version 02/12 Indicators for differentiating between ICD-9-CM andICD-10-CM diagnosis codes The “ICD Indicator” identifies the ICD code setbeing reported. Enter the applicable ICD indicatoraccording to the following: 9 ICD-9-CM diagnosis 0 ICD-10-CM diagnosis Enter the indicator as a single digit between thevertical, dotted lines36
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When Do I Start BillingICD-10 Codes? PC-ACE Pro32 Free, ICD-10 compliant software program Bill claims and attachments electronically Including MSP claims Available on CEDI website Instruction guides and manualshttp//:www.ngscedi.com38
ICD-10 Fun Fact Did you know that Medicare will require theusage of ICD-10 codes on paper claims aswell as electronic claims as of the October 1,2015 implementation date?39
How Do I RemainEducated?40
How Do I Remain Educated? Jurisdiction A http://www.medicarenhic.com/dme/default.aspx Jurisdiction B http://www.NGSMedicare.com Jurisdiction C http://www.cgsmedicare.com/jc/index.html Jurisdiction D https://med.noridianmedicare.com/web/jddme41
How Do I Remain Educated? DME MACs ICD-10 Countdown clockFrequently asked questionsLatest NewsWebinarsWebsite articlesEmail UpdatesYouTube42
How Do I Remain Educated? CMS Implementation guidesWebcastsMLN Matters articles and fact sheetsVideosTraining and resource 10/index.html43
How Do I Remain Educated? CMS “Road to 10” Small Physician’s Practice Route to ICD-10 No-cost tool that will help you: Get an overview of ICD-10 Explore Specialty References Create your personal action planhttp://www.roadto10.org44
How Do I Remain Educated? CMS “Road to 10” Resources: ICD-10 Overview Webcasts FAQ Quick References Template Library Coding scenarioshttp://www.roadto10.org45
ICD-10 Summary46
ICD-10 Summary Why Move to ICD-10 Background Information Advantages of ICD-10 What Will Change ICD-10 CM versus ICD-10 PCS ICD-9 versus ICD-10 What Will Not Change CMNs and DIFs Medical Records47
ICD-10 Summary When Do I Start Billing ICD-10 Codes Implementation date is October 1, 2015 Span dates How Do I Remain Educated DME MAC resources CMS resources48
ICD-10 Fun Fact Did you know there are only 8 days left untilthe October 1 implementation date?49
Questions50
How to Participate Today51
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Thank You56
Why Move to ICD -10? Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) Codes reflect modern medicine and updated medical terminology Improved efficiencies More accurate reimbursement Degree of illness severity captured more easily . 11
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
Type of mold Height split cavity blocks BK 41 Type A BKS 41 Type A. www.dmeeu.com - 9 29/07/2010 Casting Resins & Chemical Products . 1 x BK 4011 DME 3 - 1.2312 Top bolster plate 2 x BK 4012 1.7131 Wear strips 2 x BK 4013 A DME 3 - 1.2312 Split cavity blocks DME 5 - 1.2344 DME 6 - 1.2767 DME 7 - 1.2311 DME 9 - Impax DME 10 .
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 .
DME . Coverage criteria apply; refer to the DME MAC : LCD for Pressure Reducing Support Surfaces-Group 1 (L33830). (Accessed August 16, 2021) Pressure Reducing Support Surfaces-Group 2 (Low Air Loss or Powered Flotation without Low Air Loss ) DME : Coverage criteria apply; refer to the DME M
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