Transitioning to ICD-10-CM
Deena Wojtkowski, CPC, CEMC, CCP-P
Speaker
April 3, 2014
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Good Afternoon everyone,
I would like to take this time to thank everyone for joining us for this lunch
time learning webinar today. This webinar is provided to you by
Independent Physician Advisors . I am Deena Wojtkowski and I will be your
presenter for today's seminar. I have over 25 years of billing expertise. I
have my credentials as a Certified Professional Coder (CPC), an Evaluation
and Management Specialist (CEMC) and a Certified Compliance
Professional (CCP-P). I am currently the Assoc. VP of Client Services for
ebix, Incorporated. At ebix, we work in partnership with you to ensure that
your practices revenue cycle is being managed effectively. We currently
provide revenue cycle management services to many clients through out
the midwestern united states.
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Disclaimer
The information contained in this webinar is for general information purposes only. The
information is provided by Independent Physician Advisory Group and while we endeavor to
keep the information up to date and correct, we make no representations or warranties of
any kind, express or implied, about the completeness, accuracy, reliability, suitability or
availability with respect to the information contained in this webinar for any purpose.
In no event will we be liable for any loss or damage including without limitation, indirect or
consequential loss or damage, or any loss or damage whatsoever arising from the use of
this information.
Every effort is made to keep the information we share with you as accurate and complete as
the time it was released.
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As you know, today's seminar was
created to assist you with
understanding and implementing ICD10-CM to your practice.
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ICD-10 Delayed
On Monday, the U.S. Senate voted to pass the
Protecting Access to Medicare Act of 2014, which both
pushes back the compliance deadline for ICD-10 and
perseveres the pay rate for doctors treating Medicare
patients. Before this officially could take hold, President
Barack Obama needed to sign the bill into law.
President Obama formally approved the bill on April 1,
2014.
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ICD-10 Delayed
•The measure states, “The Secretary of Health
and Human Service may not, prior to October 1,
2015, adopt ICD-10 code sets as the standard for
code sets.”
•CMS estimates that a one-year delay of ICD-10
could cost between $1 billion and $6.6 billion
(according to AHIMA, which strongly opposes the
bill) [iHealthBeat 3/28]
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ICD-10 Delayed
•There are other groups that are also deeply
disappointed. College of Healthcare Information
Management (CHIME) and the American
Medical Association among others.
•However, other health care providers welcome
the ICD-10 delay.
•Medical Group Management Association policy
advisor Robert Tennant said that the proposed
delay is “recognition that the industry is simply
not ready for the transition.” [iHealthBeat, 3/28]
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ICD-10 Delayed
•In January MGMA released survey results that showed
less than 10% of 570 responding practices reported
making significant progress in overall ICD-10 transition
readiness.
•So we all know that the transition to ICD-10 is delayed.
Without addressing the reason for the delay, we may
very well be back in the same place next year.
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ICD-10 Delayed
•This delay means that you will have more time to
make the transition more smoothly.
•Implementation will not be easy unless you are
prepared.
•It does not matter where you see patients, what
specialty you are in, or whether you bill Medicare or
not. In order to get paid, you are going to need to
know how to use ICD-10 correctly, whether it is
October 2014 or October 2015.
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ICD-10 Delayed
•So what does this mean to you and your practice?
•Prior to the senate vote we at Independent Physician
Advisors had prepared this ICD-10 training webinar in
order to provide you with information you will need to
successfully implement the proper use of ICD-10 in your
practice.
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ICD-10 Delayed
•We suggest you take full advantage of this delay by
dual coding now in order to maintain coder productivity.
•Wherever possible you should do IT Testing with
insurance companies and your clearing houses. One of
the downfalls of this years implementation delay is
CMS lack of response to requests that providers and
clearinghouses had related to claims submission
testing.
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It is recommended that during your preparation that you
follow one claim per payer, from start to finish, or end to
end testing, to see how many areas it touches, and who
will need to be educated on their particular process
related to ICD-10 transitioning
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How To Prepare
•Create a ICD-10 Committee
•Choose a representative from each area of your
practice to participate
•Create an impact analysis based on your results
•Develop a set of clear, consistent, and concise
messages concerning the ICD-10 implementation
project to ensure that everyone is speaking with “one
voice”
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ICD-10 Delayed
•Is this an opportunity or a diversion?
•Regardless of where you were in the implementation
process, the delay must be viewed as an opportunity.
•Successful implementation of ICD-10, at either the
hospital or physician practice level, is a test of
foundational revenue cycle functionality.
•What is your current revenue cycle state?
•Be honest. Are you having problems now?
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ICD-10 Delayed
Lets look at what the foundational revenue cycle
components are:
•Chargemaster
•Revenue Capture
•Compliance Protocols
•Coding
•Business office
•Each of these areas impact financial viability,
growth and compensation.
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ICD-10 Delayed
•How do we focus on these components to facilitate
increased gross, maximum net, compliance mitigation and
successful ICD-10 implementation?
•You must go back to the basics
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ICD-10 Delayed
Chargemaster Functionality
•
Why is the chargemaster important?
•
Identification of steps to ensure best practices
The chargemaster is the electronic brain of your practice
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ICD-10 Delayed
•The chargemaster relates all services that are
performed in a language that facilitates payment.
•The chargemaster is a living breathing entity.
Changing all of the time. It needs the right people
to take care of it and update it as needed.
•The chargemaster requires ongoing attention
especially when this form leads to provider
revenue.
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ICD-10 Delayed
•If your chargemaster is done properly, it facilitates clean,
compliant claims that ensure proper, timely reimbursement.
•If your chargmaster is done improperly, it increases
compliance risk, increased the cost per claim and slows
reimbursement.
•It also increases customer satisfaction. Patients are more
savvy now and when they receive their EOB they review and
will question the EOB vs. what services were actually
provided to them and included on the chargemaster from
their visit.
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ICD-10 Delayed
•In the majority of hospitals and physician
practices, the chargemaster is:
•Treated as an afterthought
•Not treated as a active, living, vibrant living
entity.
•Treated as a static mechanism that has
minimal impact on financial viability
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ICD-10 Delayed
•Your chargemaster review should focus on:
•Review of newly added codes
•Deletion of codes where necessary
•Descriptions
•Alternate code assignment
•Some CPT/HCPCS codes overlap and
payers determine which code is required for
processing
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ICD-10 Delayed
•The chargemaster must maintain all CPT and HCPCS
used within your organization, and provide accurate
differentation between codes for proper identification.
•Example: 22 CPT codes representing upper GI
endoscopy from esophagus to jejunum. As numbers
change in CPT, they get more specific and detailed. If
you do not maintain and review your chargemaster you
could be loosing money.
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ICD-10 Delayed
Certified Coders and/or someone who is knowledgeable
in Anatomy and Physiology should be reviewing the CPT
Codes.
For example:
43250 Upper GI Endoscopy
•Description fits over 40 CPT codes
What are you doing from a revenue standpoint to be certain
you are billing out the correct CPT codes in order to
maximize your revenue?
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Next Steps for ICD-10 – GAP Analysis
•Why should you perform a gap analysis?
•Tells you where you are, what you need to do and
creates the timetable for successful implementation.
•Use the delay as a opportunity
•If you were on course, allows for better preparation
•If you were behind, allows you to catch up
•ICD-10 will happen so take action!
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The Transition to ICD-10-CM
•There are two code sets for ICD-10
•ICD-10-CM – Fee for service code set
•ICD-10-PCS – Facility Code sets
•Workers Compensation, auto and personal liability
insurance are currently exempt from ICD-10
ICD-10 is already in use in the United States but only
for mortality coding done for the CDC
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Who is impacted by this transition?
Consider who is your target audience?
•Management
•Coding Staff
•Billing Staff
•Information Technology
•Providers
•Business Associates
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How To Prepare – Develop your ICD-10 Strategy
•Identify actions, persons responsible, and deadlines for
the tasks required to complete the transition.
•Assess needed training and education
•Schedule Training
•Budget Resources
•Develop a communication plan
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How To Prepare
•Conduct regularly scheduled standing meetings of
the committee to ensure communication between key
individuals
•Establish ongoing communication with all affected
personnel
•Appoint and recognize external communication
liaisons to manage communication with business
associates and other external entities.
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Analysis and Education
•Coder Training: Recommendations for coder training
range anywhere from 15-100 hours or more with a
refresher in anatomy and physiology.
•Provider feedback: provide regular, real time feedback
to your providers. Code in ICD-9 and also in ICD-10 so
you can share things such as specificity, laterality and
other requirements related to ICD-10. Documentation is
the key.
•Decide if you will need to hire temporary staffing or if
you will choose to offer overtime.
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Education: GEM Crosswalk
ICD-9 Bridge to ICD-10-CM Crosswalk Codes
ICD-9:
357.2 Polyneuropathy in diabetes (one to five)
ICD-10-CM-GEM Crosswalk:
E08.42 Diabetes mellitus due to underlying condition with
diabetic polyneuropathy
E09.42 Drug or chemical induced diabetes mellitus with
neurological complications with diabetic polyneuropathy
E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy
E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy
E13.42 other specified diabetes mellitus with diabetic
polyneuropathy
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What do you code first?
Code First
•Poisoning due to drug or toxin, if applicable (T36-T65 with
fifth or sixth character 1-4 or 6)
•Use additional code for adverse effect, if applicable, to
identify drug (T36-T50 with fifth or sixth character 5)
•Use additional code to identify any insulin use (Z79.4)
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Scenario
Today lets look at the female 26-year-old patient who
presents to her physicians office with ankle sprain. No
other information is offered about the injury or how it
happened. In ICD-9CM we code this Medical Record
statement as:
845.00 sprains and strains of ankle, unspecified site
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Scenario crosswalk ICD-10
ICD-10CM: S93.4- Sprain of ankle
This block instructs us to use a fifth, sixth, and seventh digit:
S93.4- Sprain of ankle
S93.401- Sprain of unspecified ligament of right ankle
S93.402- Sprain of unspecified ligament of left ankle
S93.409- Sprain of unspecified ligament of unspecified ankle
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Scenario Crosswalk ICD-10
In ICD–10 you are Required to use a 7th digit to
identify the encounter:
A- Initial
D- Subsequent
S- Sequela
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Scenario Crosswalk ICD-10
This documented statement in the medical record of ankle
sprain will require a written inquiry to the physician for
additional information:
•Which ankle, right or left?
•Is this the initial, subsequent or sequela encounter?
•How did this injury happen?
•Where did this injury happen?
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Scenario Crosswalk ICD-10
The following week we receive the inquiry back from the
physician with the information that is needed to select an
ICD-10CM code for the encounter.
The physician indicates that this is the first encounter for this
right ankle sprain, leading us to use:
S93.401A.
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Scenario Crosswalk ICD-10
The physician also tells us that the patient slipped in the
driveway on the ice while going to the mailbox.
This is additionally coded in ICD-10CM as W00.0xxA - fall on
same level due to ice and snow, initial encounter.
The seventh character A indicates that this is the initial
encounter. You may notice that code W00.0xxA describes how
the injury happened and that this code includes two xx
placeholders.
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Lets Discuss the Placeholders and what they mean.
•Not every ICD-10 code with a seventh character, has
a sixth character, or even a fifth or fourth character for
that matter.
•This frequently occurs with poisonings and injuries.
•The letter “x” serves as a placeholder when a code
contains fewer than six characters and a seventh
character applies. The “x” also allows for future
expansion of the codes.
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Placeholder for ICD-10
•When reporting ICD-10 codes, coders must add a
placeholder so the seventh character is in the
correct position. Without this placeholder to ensure
characters appear in the correct positions, the
codes are invalid.
•For example:
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Placeholder for ICD-10
A patient presents with an accidental poisoning by an
anti-allergic drug. For the initial encounter, coders
should report:
ICD-10 - T45.0x1A
In this case, the x in the fifth position serves as a
placeholder so that the sixth and seventh characters
are in the correct position. If a coder inadvertently
omits the placeholder, the resulting code would be
T45.01A, which is invalid
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Placeholder for ICD-10
Please note that the location of the x within a
code matters. When x is in the fourth, fifth and/or
sixth character, it appears lowercase and is a
placeholder. When X is at the beginning of the
code, it is uppercase and indicates the chapter
(i.e., codes X00-X99 Chapter 20: External
Causes of Morbidity)
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Something else to think about when we talk about
crosswalking ICD-9-CM to ICD-10-CM. I will use Gout
as an example:
•In ICD-9 a physician/coder will choose
category 274 and choose one of 15 Gout
codes to describe the encounter.
•In ICD-10 a physician/coder will choose
from category M10 and select a code from
162 choices. In order to select the
appropriate code, your documentation will
need to reflect all of the following elements
that most accurately describe the encounter:
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•anatomical area affected
•laterality
•idiopathic
•lead-induced (also identify the toxic effects of lead and its
compounds)
•drug induced (also identify the drug)
•renal impairment (also code the associated renal disease)
•other secondary (coding first the associated condition)
•an additional code to identify certain diseases and/or disorders
classified elsewhere
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The days of memorizing codes could be drawing to a
close, the use of unspecified codes very likely may be
restricted by payers. Take advantage of this delay in
implementation to jump start your smooth transition
to ICD-10.
“At the end of the day, it all boils down to the
documentation”
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QUESTIONS?
dwojtkowski@ebixinc.com
Keep Calm and Code on . . . .
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