ICD-10 is Coming Ready or Not Dr. Thomas Ayoub Norwalk Hospital 2 ICD - International Classification of Diseases – Issued by World Health Organization (WHO) – Used world-wide as tool to classify diseases and other health problems USA is the only country to use ICD codes for billing purposes 3/4/2014 3 Change is long overdue • USA is the last country to implement ICD-10 • ICD-9 been in use in the USA since 1979 • HHS proposed change to ICD-10 in 2008 • Original start date 2011 – there will be no more delays 3/4/2014 IT Issues 4 Effects include: • Clinical documentation/EHR systems • Encounter forms/Superbills • Practice management systems • Contracts • Public health and quality reporting tools Much worse than Y2K 3/4/2014 How Can Physicians Prepare March 4, 2014 Most Common ICD-9 6 CMS recommends that offices start by: • listing their most commonly used ICD-9 codes • becoming familiar with corresponding ICD-10 codes 3/4/2014 Majority Rules 7 Start with highest volume codes The vast majority of practices use very few codes… 5% of codes account for about 70% of the volume 3/4/2014 Top Norwalk Hospital OB/GYN Diagnoses in ICD-9 Principal Diagnosis SCREEN MAMMOGRAM NEC ROUTINE GYN EXAMINATION SCREEN MAMMOGRAM HI RISK PREG STATE, INCIDENTAL ABN FINDING-BREAST NEC ICD-9 V76.12 V72.31 V76.11 V22.2 793.89 8 % 30% 12% 8% 4% 3% The top 5 codes account for 57% of the volume. 3/4/2014 Translate ICD-9 to ICD-10 9 Use free internet sites like http://www.icd10data.com or download free apps 3/4/2014 Example: OB/GYN Most Common Codes ICD-9 Description SCREEN MAMMOGRAM NEC ROUTINE GYN EXAMINATION ICD-9 Code V76.12 V72.31 SCREEN MAMMOGRAM HI RISK V76.11 PREG STATE, INCIDENTAL V22.2 ABN FINDING-BREAST NEC 793.89 ICD-10 Code 10 ICD-10 Description Encounter for screening mammogram 1:1 Match Z12.31 for malignant neoplasm of breast Encounter for gynecological examination Z01.411 (general) (routine) with abnormal findings Encounter for gynecological examination Z01.419 (general) (routine) without abnormal findings Encounter for screening mammogram for 1:1 Match Z12.31 malignant neoplasm of breast 1:1 Match Z33.1 Pregnant state, incidental Other abnormal and inconclusive findings on 1:1 Match R92.8 diagnostic imaging of breast 4 of top 5 codes have a direct, 1 to 1 Match 3/4/2014 Example: OB/GYN Most Common Codes ICD-9 Description SCREEN MAL NEOPCERVIX SUPERVIS OTH NORMAL PREG LUMP OR MASS IN BREAST INCONCLUSIVE MAMMOGRAM VAGINITIS NOS ICD-9 Code V76.2 V22.1 ICD-10 Code 11 ICD-10 Description Encounter for screening for malignant neoplasm Z12.4 of cervix Encounter for supervision of other normal Z34.80 pregnancy, unspecified trimester 611.72 N63Unspecified lump in breast 793.82 R92.2 Inconclusive mammogram 616.10 N76.0 Acute vaginitis N76.1 Subacute and chronic vaginitis N76.2 Acute vulvitis N76.3 Subacute and chronic vulvitis 3/4/2014 12 The good news Unspecified codes exist for many diagnoses The documentation may already include ICD-10 level specificity Most of the code volume relates to musculoskeletal anatomy I am available for on-site help but will need to start with your top volume codes via email susan.herson@norwalkhealth.org 3/4/2014 Colorectal Surgery Crosswalk 13 3/4/2014 Resources 14 Specialty Societies for guidance & billing forms Websites and apps www.cms.gov/icd10 www.roadto10.org precyse app stat ICD10 app On site physician training 3M handouts in 18 subspecialties 1-hour training sessions in April with HC-Pro 3/4/2014 www.roadtoicd10.org 15 3/4/2014 16 3/4/2014 ICD-10 – changes to Office Process 17 How does the office process change as a result of ICD-10 3/4/2014 Office Issues 18 Staffing: ½ of billers are expected to retire or change jobs Productivity: may drop as much as 50% Dual systems: required from several months prior to several months after…maybe longer Delayed Payments: the industry is expecting significant delays Cash Flow: CMS & Insurers will not accept bills after Oct 1, 2014 in ICD-9 format 3/4/2014 Be prepared for disrupted cash flow 19 • Even if your practice is fully prepared for ICD-10, be sure you prepare for cash flow disruption • The chances that every major payer will be able to handle new codes is slight • Make arrangement for potential cash flow disruptions starting in November 2014 which may last up to 6 months • Practical course of action – Secure line of credit for working capital to be drawn down if and when cash flow needs arise 3/4/2014 Practices based on paper superbill 20 • Remember only the ICD-9 diagnosis codes are changing not the CPT-4 procedure codes • If your practice has a superbill with pre listed ICD-9 codes – The superbill will have to redesigned with ICD-10 codes • If Superbill ICD-9 code field is free text – If you write a diagnosis narrative, how will your staff be able to convert the narrative to an ICD-10 code – Will your narrative contain enough specificity – If you write in a diagnosis ICD-9 code, how will you know what ICD-10 code to write in 3/4/2014 ICD-10 Implementation – Outpatient 21 Outpatient – script from the ordering physician is key (for example Lab, Rad or specialist referral ) Physician Office Physician Physician Script / Referral ICD-9 / ICD-10 Patient Norwalk Hospital Critical to both Physician Office and Hospital Hospital bills can confuse patients 3/4/2014 ICD-10 Scripts – the Patient Experience 22 Code is not clear Physician Script / Referral Patient Norwalk Hospital Physician Office • If the code is not clear, will result in phone calls to physician • Re-work for physician • Extends waiting time for patient 3/4/2014 ICD-10 Script Process 23 • ICD-10 requires new Specificity • Work in partnership with Physician offices on Process • Will result in best process by doing parallel • Goal for all – document most accurate Code • Best clarity – share same ICD-10 alphanumeric Code 3/4/2014 ICD-10 Summary 24 ICD-10 drives same results for Physician Office and Hospital: Bottom Line – if we don’t do ICD-10 correctly, we cannot bill!! 3/4/2014 How can we help 25 Tables today were set up to talk about: Getting Started Office Staff Training Physician Training Vendor Information NHP&S: Compare Notes with another practice 3/4/2014