ICD-10 Update
All Blue 2014 Workshops
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Agenda
Provider Readiness
Steps for Provider
Preparedness
BCBST Readiness Summary
BCBST ICD-10 Testing
Information
Questions & Next Steps
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ICD-10 Provider Readiness
WEDI survey showed roughly 80% of health care providers had not
completed business changes or begun testing before 2014. Twenty
percent of vendor respondents said they were halfway or less than
halfway complete with product development in support of ICD-10
Thirty-seven percent of today’s documentation is ready for the
transition, according to the American Association of Professional
Coders
Roadmaps are available at CMS.gov that include the following:
- Small and Rural clinical practices
- Small Hospitals
- Large Practices
- Communications Plan guidance
- Checklists
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Activities for Provider Preparedness
Assess Workflow and Systems
- Complete a gap analysis on the expected workflow and process changes
- Include IT systems
Assess System Vendor Readiness
- Upgrade or replace the practice’s IT systems
- Include forms and reports
Documentation Considerations
- Assess whether current clinical documentation will support the level of
specificity necessary
- Priority list of diagnoses requiring more detailed documentation
Revenue and Cash Flow Considerations
- Know which payers have fully transitioned to ICD-10-CM
- Professional services are paid based on the procedure code, but the
diagnosis code supports medical necessity
Train on New Processes and Systems
- Ensure staff can be trained prior to the compliance date on all changes
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BlueCross Preparedness
BCBST Systems Testing
- Quality Assurance Testing is complete for Core Systems
- System Integration Testing and End-to-End testing is in process
- UAT Testing is in process
Provider Testing
- Pilot Testing began October 2013
- Provider Testing Tools are being implemented
- Provider Testing is open for professional and institutional providers
Provider Communications
- Provider Administration Manual updates throughout the year
- BlueAlertSM articles for the remainder of the year will focus on ICD-10
updates
- Compliance statement on BCBST.com and FAQs
Training of BCBST Employees
- Training began in 2013 and will continue in 2014 and 2015
ICD-10 Delay Planning has concluded
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ICD-10 Provider Testing Tool
Professional Testing Tool – Web-Based Self Help
• Browser Requirements (Chrome, Safari, Internet Explorer, or FireFox)
• Give health care providers (physicians, etc.) pre-defined, clinically based
medical scenarios to review and determine the ICD-10 codes
• Enter the data in an easy, efficient manner
• Provide peer reports and/or notification of the correlation between input
and output codes
Provider Steps for tool registration and testing
•
•
•
•
Provider Registers on the website
Provider users access application
Provider completes scenarios
Provider reviews results
To express interest in testing, send email to ICD10_GM@BCBST.com
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ICD-10 Provider Testing Tools - Narratives
Each Specialty has a maximum of ten narratives available.
Each Narrative defines a specific healthcare encounter (Narratives include Chief
Complaint, Past Medical History and Office Visit Notes pertaining to a Patient)
Providers register via a website, and will receive an email inviting them to
participate with an embedded link to the testing tool
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ICD-10 Provider Testing Tools – Provider Report Sample
Chief
Complaint :
Pt presented to the E.R. with chest pain and shortness of breath
Past Medical
History:
Pt. takes Crestor 10 mg. daily and Zestril 30 mg daily for HTN. Pt is a 1 -2 pack/day smoker who has smoked for about
35 years.
Office Visit
Notes:
I was consulted to see this patient who was admitted to the hospital yesterday with chest pain that radiated down his
left arm and shortness of breath. Pt. was tachycardic, hypertensive and complaining of pain at an 8 on a scale of 1-10.
CBC was normal, pt. has a history of hyperlipidemia and poor diet. He smokes 1 - 2 packs/cig/day and doesn't exercise.
Pt was given Nitro yesterday and oxygen @ 2l/NC with minimal relief, so was placed in ICU on a continuous
Nitroglycerin drip. He has also been given 2mg Morphine Sulfate I.V. prn pain. A cardiac catheterization was
performed and found that the patient has atherosclerotic heart disease of one native coronary artery. His LAD
coronary artery is blocked over 80%, so after discussion with the patient and his wife, it was decided that the best
option will be to undergo a Coronary bypass in the am. Will continue to monitor vital signs and nursing staff is to call if
there is any change in patient's status.
Cardiology
Narrative 1
Total Providers:
3
Total Unique Answers:
3
Your Answer:
R0789
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ICD-10 Provider Testing Tool – Provider Specialties
Specialty
Allergy/Immunology
Total Narratives Specialty
9
Obstetrics & Gynecology
Total Narratives
10
Audiologist
6
Occupational Therapist in Private Practice
9
Cardiovascular disease
9
Ophthalmology
9
Certified Nurse Midwife
6
Optometry
9
Chiropractic
9
Orthopedic Surgery
9
Clinic or Group Practice
9
Otolaryngology
9
Dermatology
9
Pediatric Medicine
10
Emergency Medicine
9
Physical Medicine and Rehabilitation
9
Endocrinology
9
Physical Therapist in Private Practice
9
Family Practice
10
Plastic and Reconstructive Surgery
10
Gastroenterology
9
Podiatrist
10
General Practice
9
Psychiatry
9
General Surgery
10
Psychologist
9
Hematology
9
Psychologist, Clinical
9
Hematology-Oncology
9
Pulmonary Disease
9
Infectious Disease
9
Radiation Oncology
9
Internal Medicine
10
Rheumatology
9
Nephrology
9
Thoracic Surgery
9
Neurology
10
Urology
9
Nurse Practitioner
10
Vascular Surgery
9
Grand Count
363
MedTenn Conference 2014 > ICD-10
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ICD-10 Provider Testing Tool - Institutional
Facility Testing Tool – Web Based Self Service
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•
•
•
•
•
Browser Requirements (Chrome, Safari, Internet Explorer or FireFox)
Providers can test scenarios with DRG code being returned (Grouper 30)
Scenarios can be selected by the testing provider
Largely based upon DRGs of interest
Evaluation of results
To express interest in testing send e-mail to ICD10_GM@BCBST.com
Provider Steps for tool registration and testing
•
•
•
•
•
Provider contacts BCBST, BCBST loads claim scenarios
Provider Registers on the website
Provider users access application
Provider completes scenarios
Provider reviews results
Provider can express interest in testing by sending an email to
ICD10_GM@BCBST.com
ICD-10 Program
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Questions & Next Steps
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Appendix
Useful Links
Tennessee Hospital Association (THA)
www.THA.com
Tennessee Medical Association (TMA)
www.tnmed.org
BCBST ICD-10 Page (BCBST.COM)
www.bcbst.com/providers/icd-10.page
American Association of Professional Coders
(AAPC)
www.aapc.com/icd-10/index.aspx
American Health Information Management
Association (AHIMA)
www.ahima.org/icd10
Implementation Planning (CMS)
www.cms.gov/Medicare/Coding/ICD10/inde
x.html?redirect=/ICD10/02b_Latest_News.as
p
CMS “Road to ICD-10” Toolkit
http://www.roadto10.org/
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BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association