Accessible version - Texas Department of Assistive and

How to Implement ICD-10 in TKIDS

1.1 Main Menu

Welcome to How to Implement ICD-10 in TKIDS. For a customized training experience, please select your role with ECI:

Data Entry

Direct Service

Program Directors & Other Administrators .

This training was created by DARS- ECI 2015 and describes the changes in TKIDS related to ICD-10 implementation on October 1,

2015. For basic TKIDS information, see the TKIDS manual on the

ECI Extranet.

1.2 ICD-10 Resources

Centers for Medicare and Medicaid Services (CMS) :

A website dedicated to the ICD-10 implementation that contains resources for providers and vendors with links to ICD-10 code tables, webinars and checklists to help prepare for the conversion.

Centers for Disease Control and Prevention (CDC):

A website containing background information regarding the ICD-10 implementation and ICD-10 code tables.

Texas Medicaid and Healthcare Partnership :

Provides information related to claims processing and other ICD-10 related concerns specific to Medicaid providers submitting claims directly to TMHP. Note: Providers who submit claims through either a third party vendor or a Managed Care organization should contact those entities directly for assistance or information with all claims

(including both Medicaid or other insurance).

How to Implement ICD-10 in TKIDS: Accessible (print) version, page 1

DARS Early Childhood Intervention :

A listing of ECI’s medically qualifying diagnoses. Effective October 1,

2015, it will contain only ICD-10 codes.

1.3 Professional Associations

Professional associations may provide additional information/training about the ICD-10 conversion, including overviews, topics, webinars related to discipline-specific billing, detailed information on the coding changes, and mapping documents for the codes most commonly used by these professionals.

American Occupational Therapy Association

American Speech-Language-Hearing Association (ASHA)

American Physical Therapy Association (APTA)

National Associations of Social Workers

1.4 For additional information:

Coding/mapping questions:

Call the ECI Main Line

(512) 424-6754

ECI.Policy@dars.state.tx.us

TKIDS issues:

Please email the TKIDS Mailbox:

T-Kids@dars.state.tx.us

Include “ICD-10” in the subject line.

Billing Issues:

TMHP/MCO or Third Party vendor as appropriate


1.5 Data Entry

As a result of this training, you will:



Know the fundamentals of the ICD-10 coding system



Understand the distinction between the Medical and the

Evaluation/Assessment pages within TKIDS



Be able to enter ICD-10 information into TKIDS



Be able to explain the use of the Medical Diagnoses web page

1.6 Data entry to-do list

Here is your to-do list. Work through each item to complete this training.

ICD-10 fundamentals

ICD-10 in TKIDS

Practice Scenarios

ICD-10 on the ECI web site

(Once all items complete) Congratulations! You’ve learned the basics of ICD-10 and how the conversion relates to your work. You completed all learning activities within the module and developed the necessary knowledge and skills to be prepared for the October 1,

2015, conversion. Take a moment to check out the additional resources available for ongoing support with ICD-10 implementation.

1.7 ICD-10 Fundamentals

Diagnosis codes are changing! The Centers for Medicare and

Medicaid Services (CMS) is implementing the International

Classification of Diseases -10 (or the ICD-10) for all Health Insurance

Portability Accountability Act (HIPAA) entities.


What is ICD-10?

The ICD-10 classification system includes specific detail in the code descriptions to provide better support for patient care. This results in an increased number of codes. For example, the diagnosis for Down syndrome is now represented by a total of four codes to allow the provider to accurately document the type of Down syndrome. Other diagnoses have expanded in number due to specificity in the location of a condition; e.g. right or left hand based on the location of a condition.

One other difference you will notice is that all ICD-10 codes begin with a letter rather than a number as is now the case in most ICD-9 diagnosis codes.

Why is this important for ECI?

For ECI, the changes will affect the diagnosis codes utilized in TKIDS.

Referring providers will use ICD-10 codes on referral forms and in medical records, and you'll use the same codes in TKIDS. Your billing system will also require the use of ICD-10. Note that the Current

Procedural Terminology (CPT) codes used to describe what treatment was provided are not affected by the ICD-10 implementation.

When will it happen?

HIPAA entities must begin using ICD-10 codes for dates of service on or after October 1, 2015. This date was mandated by Congress.

TKIDS will implement the use of ICD-10 codes on October 1, 2015 to align with these requirements.

1.8 Pages in TKIDS

The ICD-10 changes will only affect data entry in TKIDS for children with a qualifying medical diagnosis (that's on the

Evaluation/Assessment page), or when you are entering a medical


diagnosis (on the Medical page).

The Evaluation/Assessment page contains details of the evaluations or assessments conducted, as well as documentation of the chil d’s eligibility for comprehensive services.

For children who are eligible on the basis of a medical diagnosis, the

Evaluation /Assessment page will include at least one qualifying diagnosis; however, the system allows for multiple qualifying diagnoses to be added.

The Medical page details the chil d’s medical information. This page serves to document information regarding the chil d’s last physical exam, immunization status, medical diagnoses, therapy prescriptions, and the names of the physicians associated with the chil d’s case.

If you choose to record information on the Medical page, remember it will include qualifying diagnoses (in other words, those that automatically qualify a child for ECI services) as well as other nonqualifying medical diagnoses contained in the chil d’s medical record.

Diagnoses entered on the Evaluation/Assessment page will automatically populate on the Medical page. Note that when you select “new diagnosis,” in addition to entering a diagnosis code or description, you are required to enter a diagnosis date before the system will search for a match.

1.9 Case report in TKIDS

The enhancements to both the Evaluation/Assessment page and the

Medical page are reflected on the Case Report page.

U nder “Medical Information” the column now reads as ICD instead of

ICD-9 since both ICD-9 and ICD-10 codes may appear.

The diagnosis date column has been added, and the diagnoses are listed in order starting with most recent diagnosis. If a date is not entered for a diagnosis, the diagnosis defaults to the last listed diagnosis.


1.10 How to enter information in TKIDS

Learn how information is entered on both pages in TKIDS.

(Continues on next two slides)

1.11 To enter qualifying diagnosis

To enter a qualifying medical diagnosis: select

“Evaluation/Assessment.” Use the eligibility type drop down menu to select “Medical Diagnosis.” Enter the eligibility date found on the eligibility statement. Selec t “Add new” to add the diagnosis. Enter either the ICD code OR the ICD description. It is optional to enter the diagnosis date on this page. Then select “Search” to find the diagnosis.

1.12 To enter non qualifying diagnosis

To enter non-qualifying diagnoses or a qualifying diagnosis received after eligibility determination: select “Medical,” then select “New

Diagnosis.

” Enter either the ICD description OR the ICD code. You must enter a diagnosis date to generate a list, then select search to find the diagnosis.

1.13 Practice Scenarios

You receive documents for five children who need to be entered into

TKIDS. This will give you the opportunity to apply what you've learned about the new ICD-10 codes and test your understanding of how that impacts TKIDS. Users select from five photos of a child to access the scenarios.

1.14 TKIDS Practice Scenario 1: Billy

You receive two documents about Billy.

The Physician Referral form contains a diagnosis of “K91.2,

Postsurgical malabsorption, not elsewhere classified.”


The Eligibility Statement shows a diagnosis of “Postsurgical malabsorption, not elsewhere classified” with an ICD code of “K91.2.”

Where will you enter the medical diagnosis information about Billy into TKIDS?

Choices:

(a.)

(b.)

On the Medical page

On the Evaluation/Assessment page

Answer: (b.) On the Evaluation/Assessment page. Billy has a qualifying medical diagnosis, which is entered on the

Evaluation/Assessment page in TKIDS.


Which of Billy’s eligibility type will you select from the drop down menu in TKIDS?

Choices:

(a.)

(b.)

(c.)

(d.)

Developmental Delay - BDI-2

Developmental Delay – Qualitative

Hearing/Vision

Medical Diagnosis

Answer: (d.) Medical Diagnosis. Based on Billy's records, you should choose the eligibility type of medical diagnosis in TKIDS.


In the TKIDS “Eligibility” window you will see the following input fields:

Type, Eligibility Date, and Adjusted Age (Months)


What eligibility date from Billy’s documents will you enter in TKIDS?

Answer: 10/01/2015

1.17 Diagnosis search page

On the TKIDS Search Criteria page, you will see the Diagnosis Date input field with a drop-down menu next to it. NOTE: the diagnosis date is the date on the medical record you receive. The diagnosis date is an optional field here.

Below the Diagnosis Date is a field to enter the ICD Code. Here you can search for the qualifying medical diagnosis by ICD Code or

Description.

Note: you are able to search by partial code or description, and as you enter additional numbers to the ICD Code or letters to the

Description, your search narrows to the most accurate selection.


What diagnosis code will you enter in TKIDS?

Answer: K91.2. You would click to add it to the diagnosis list and then click to save.


The correct spelling of the diagnosis is: “Postsurgical Malabsorption”

But what if the medical record reads this: “Post Surgical

Malabsorption” (note the space between “Post” and “Surgical”)

You enter the following in TKIDS under Search Criteria:

Diagnosis Date: 10/01/2015

ICD Code: K91.2


Description contains: Post Surgical Malabsorption

And receive this error message: “No records found.”

(continues on next slide)


What would you do?

Choices:

(a.) page

Search for the name on the ECI Medical Diagnoses web

(b.) Determine this is not a qualifying diagnosis as it did not show up in TKIDS

(c.)

(d.)

Contact the Service Coordinator to discuss the error

Contact the referring physician

(e.) Only enter information into one search field

Answer: (a.) Search for the diagnosis on the ECI Medical Diagnoses webpage; only enter information into one search field; and/or consult with the team about the diagnosis.

1.21 TKIDS Practice Scenario 2: Frankie

You receive Frankie’s Eligibility Statement that needs to be entered into TKIDS on the Evaluation/Assessment page. It states Frankie’s

Eligibility date was 10/1/2015, has a diagnosis of “Trisomy 21,” and an ICD Cod e of “Q90.” Notice the diagnosis code (Q90) is an incomplete ICD-10 code.

When you type the description in TKIDS, multiple options appear:

Q90.0 Trisomy 21, nonmosaicism (meiotic nondisjunction)

Q90.1 Trisomy 21, mosaicism (mitotic nondisjunction)


Q90.2 Trisomy 21, translocation

(Continues on the next slide)


What would you do?

Choices:

(a.) Simply select the first option in the list - i.e., Q90.0

Trisomy 21, nonmosaicism (meiotic nondisjunction)?

(b.) Request specificity on the diagnosis description from the team (Service Coordinator)?

(c.) Don't search by description; search by the ICD code provided?

Answer: (b.) Request specificity on the diagnosis description from the team (Service Coordinator). It is best practice to discuss with the

Service Coordinator the accurate description for a diagnosis.


Now imagine Frankie’s referral form indicated a diagnosis of Down syndrome and the doctor had included the same incomplete ICD-10 code of Q90 ...

When you type in the code, the following options appear:




Q90.9 Down syndrome, unspecified

(Continues on next slide)



What would you do?

(a.) Simply select the first option in the list - i.e., Q90.0

Trisomy 21, nonmosaicism (meiotic nondisjunction)

(b.) Request specificity on the diagnosis description from the team (Service Coordinator)

(c.) Select "Down syndrome, unspecified"




Now imagine you receive a referral from the physician documenting

Down syndrome and the referral date is 9/15/2015.

The eligibility date on the eligibility form is 9/25/2015 and an ICD code is not provided on either record. You are entering the data in

TKIDS after 10/1/2015.

This will return an ICD-9 code. Can you use it?

Choices:

(a.)

(b.)

Yes

No

Answer: (a.) Yes. Late data entry does not affect your ability to enter

ICD-9 records into TKIDS. If records document eligibility was prior to

10/1/2015, you are able to enter data in the same manner you could previously. ICD-9 codes will be available for selection until

12/31/2015 if the eligibility date is prior to 10/1/2015.


1.26 TKIDS Practice Scenario 3: Adra

You receive records for Adra, who was referred and determined eligible after 10/1/2015. Her referral form states, “749.2, Cleft hard palate with unilateral cleft lip.”

On the Eligibility/Assessment page in TKIDS, you enter the ICD Code of 749.2 and receive this error message: “No records found.” What do you think is going on?

Answer: You searched for an ICD-9 code (749.2)


Next, you try searching by description in TKIDS and only one ICD-10 code is listed: Q37.1 (Cleft hard palate with unilateral cleft lip). Is it okay to select this as the qualifying medical diagnosis for Adra in

TKIDS?

Answer: Yes. While best practice is to verify the correct ICD-10 code with the team, an accurate ICD-10 description was provided and can be used in place of the code.

1.28 TKIDS Practice Scenario 4: Donald

You are entering the pre-enrollment paperwork for Donald.

He qualified with a developmental delay, but you notice on the referral form the doctor indicated Donald has a medical diagnosis of

Q68.0 ― Torticollis (intermittent) (spastic): congenital

(sternomastoid).

What should you do with this information?

Choices:

(a.) Document the diagnosis on the Medical page in TKIDS

(b.) Document the diagnosis on the Evaluation/Assessment page in TKIDS


Answer: (a.) Document the diagnosis on the Medical page in TKIDS.

Torticollis is not a qualifying medical diagnosis, so it may be entered on the Medical page.

1.29TKIDS Practice Scenario 5: Cindi

You receive medical records for Cindi who qualified a few weeks prior with a developmental delay.

The medical records show that Cindi has a qualifying medical diagnosis of F84.0 (Autistic Disorder).

What should you do with this new information?

Choices:

(a.) Document the new medical diagnosis on the Medical page in TKIDS

(b.) Change Cindi's TKIDS evaluation/ assessment record to

“eligibility type: medical diagnosis” along with a new eligibility date

Answer: (a.) Document the new medical diagnosis on the Medical page in TKIDS. According to TAC §108.825 (e) the eligibility statement is valid for one year, except for children who are eligible with a qualitative determination of developmental delay. The eligibility statement for children who are determined eligible with a qualitative determination of developmental delay is valid for six months.

Information about additional qualifying criteria is documented in the child's record. The eligibility statement does not need to be changed or updated until eligibility is re-determined.

1.30 Medical diagnoses page

You may be asked about the ECI Medical Diagnoses web page, or how to determine if a diagnosis automatically qualifies a child for ECI


services. The Medical Diagnoses web page is at http://www.dars.state.tx.us/ecis/resources/diagnoses.asp

.

As of October 1, 2015, the DARS ECI Medical Diagnoses web page will include new search capabilities and display ICD-10 codes and descriptions. The user will be able to search through the increased number of codes and more specific descriptions for qualifying medical diagnoses.

The update includes an auto-complete function: As you begin typing, diagnoses with the same combination of letters will display. The search narrows as you enter more specific descriptions. You can also complete a search by entering the ICD-10 code. If someone enters an incorrect code, incorrect description, a non-qualifying medical diagnosis, or an incorrect spelling of a word, the search will return an error message stating the diagnosis code is not found and directs the user to check for spelling or entry of the wrong code.

Additionally, the user is directed to contact the local ECI contractor if he/she needs assistance.

1.31 Direct Service







Be able to determine if a diagnosis is a qualifying medical diagnosis



Know the process for following-up with a provider for code clarification as needed

1.32 Direct service providers to-do list

Here is your to-do list. Work through each item to complete this training. Notice that the items related to TKIDS are optional. You may want to complete those if you are responsible for entering information into TKIDS.

ICD-10 fundamentals


Qualifying medical diagnoses

Clarifying ICD-10 codes

Optional: Changes in TKIDS

Optional: TKIDS Scenarios

(When all items complete) Congratulations! You’ve reviewed the basics of ICD-10 and how the conversion relates to your work. You're ready for the conversion on October 1, 2015! Take a moment to check out the additional resources available for ongoing support with

ICD-10 implementation.






What is ICD-10?











1.34 ECI Qualifying Medical Diagnoses page

The field of pediatrics presents many rare and unusual diagnoses.

I t’s impossible for us to be familiar with each and every one of them, but it’s important that as a service provider you have ready access to the ECI website to look up eligible diagnoses. The website is located at http://www.dars.state.tx.us/ecis/resources/diagnoses.asp

. Consider bookmarking the web page on your computer or smart phone web browser. When in doubt, take a minute to look it up.

As of October 1, 2015, the page will include new search capabilities and display ICD-10 codes and descriptions. You will be able to search through the increased number of codes and more specific descriptions for qualifying medical diagnoses.

The update includes an auto-complete function: As you begin typing, diagnoses with the same combination of letters will display. The search narrows as you enter more specific descriptions. You can also complete a search by entering the ICD-10 code. If someone enters an incorrect code, incorrect description, a non-qualifying medical diagnosis, or an incorrect spelling of a word, the search will return an error message stating the diagnosis code is not found and directs the user to check for spelling or entry of the wrong code.



1.35 The format of ICD-10 Codes

In addition to more specific code descriptions in ICD-10, the amount of alpha numeric characters in the diagnosis code typically increases in relation to the specificity of the description. Here are three examples, with increasing specificity, so as you'd expect, the codes have more digits as the descriptions get more specific. Here are some examples.

Example 1:

In chapter 17: Congenital malformations, deformations and chromosomal abnormalities, Q02: Microcephaly, a qualifying diagnosis, has only the one code of Q02 without describing the diagnosis in further detail.

Example 2:

Most of the ECI qualifying medical diagnosis codes will include a decimal followed by numbers, like with Q90: Down syndrome. This code cannot be used to indicate a medical diagnosis as there are 4 codes below Q90 that describe this diagnosis in greater detail.

One of the four codes for the Down syndrome category is an

“unspecified” or “not otherwise specified” code, which can be used if a general diagnosis is provided from the doctor and the medical record does not contain additional information. Best practice is to consult with the referring physician. In some categories, all of the diagnosis codes and descriptions are ECI qualifying medical diagnosis codes. If the ECI qualifying diagnosis is specific, then the use of the unspecified code is not allowed.

Example 3:

There are some diagnoses where the ECI qualifying medical diagnosis is a specific code within a section, such as P52.22:

Intraventricular hemorrhage grade IV. There is an unspecified code located within the same category as IVH grade IV, but in this case,


the unspecified code is a non-qualifying diagnosis and could not be used to determine eligibility.

Remember: You can verify a diagnosis is a qualifying diagnosis by searching the evaluation/assessment page in TKIDS or the ECI

Medical Diagnoses page.

1.36 Clarifying ICD-10 codes

As the new ICD-10 coding system is a more specific listing of diagnoses, some confusion may arise during the referral/evaluation process. Keep in mind that diagnosis code selection is the responsibility of the LPHA providing services, in coordination with the child's referring physician. The LPHA is also responsible for the accuracy of documentation in a child's record.

Let's take a look at the overall process for identifying the appropriate

ICD-10 code:

You receive a referral and review it for the ICD-10 diagnosis description or code.

If the referral document does not contain enough information to determine a code, then you look to the medical record for a diagnosis code or description.

For children eligible with a medical diagnosis, it's best practice to clearly define diagnosis codes or descriptions prior to reaching the point of data entry. So, depending on what you have gathered from the documents, you may have a decision to make:



If the referring provider did not indicate a specifier, you may use the code description "NOS" on the eligibility page if you are comfortable with the implied non-specified classification.



If you are not comfortable with the unspecified classification, the referring provider’s office should be contacted for the specific appropriate ICD-10 code. Each program has its own process for child intake and referral; therefore each program will need to decide the most appropriate staff person to intervene if code clarification is needed.

You may need to consider the accuracy of the diagnosis code needed for claims submission.


Finally, the most specific and accurate ICD-10 diagnosis code is entered in TKIDS.

1.37 Clarifying the ICD-10 Code: Example 1

In this example, the referral conta ins a diagnosis description of “Down syndrome ” and code of Q90.

Nothing further is noted in the medical records. If a more specific description or code is contained within the medical record, then the most specific information must be used.

But in this case, the referring provider did not indicate a specifier or

NOS in the diagnosis, so a decision has to be made. You can either use the implied nonspecified classification of “Q90.9-Down syndrome, unspecified” or contact the referring provider’s office for the particular appropriate ICD-10 code. That code is then used in the

Eligibility Statement and entered in TKIDS.

1.38 Clarifying the ICD-10 Code: Example 2

You receive a referral for Tameka with a medical diagnosis listed of

P52: Intracranial hemorrhage of newborn. You review Tameka’s medical records to gather more information. The birth record states

P52.2: Intraventricular hemorrhage, grade 3 and grade 4.

CMS lists several codes and it shows the code from the referral, P52, cannot be used to indicate a medical diagnosis as there are 8 codes below P52 that describe this diagnosis in greater detail. Additionally, the code f rom the child’s birth record, P52.2, also cannot be used to indicate a medical diagnosis as there are 2 codes below P52.2 that describe this diagnosis in greater detail.

Finally, within this section, the only qualifying medical diagnosis is

P52.22: Intraventricular hemorrhage grade 4.

Answer the question: What steps should you take to determine eligibility?


(a.) Based on the records, determine there is not enough information to select an ICD-10 code and proceed with administering the BDI-2.

(b.) Contact the provider for clarification.

(c.) Based on the records, determine it is appropriate to use P52.22:

Intraventricular hemorrhage grade 4 and enter the qualifying medical diagnosis.

Answer: Both (a.) or (b.) could be correct. At this point, you have a decision to make. You can choose to administer the BDI-2, as there is not enough information to determine a qualifying diagnosis. Best practice is to go through the process of contacting the physician for clarification. This communication could make a difference in how

Tameka qualifies for services and prevent you from taking unnecessary steps; however, it is in the family's best interest to take the steps to determine a developmental delay while you proceed in acquiring diagnosis clarification.



Evaluation/Assessment page), or when you are entering a medical diagnosis (on the Medical page).




The Medical page details the chil d’s medical information. This page serves to document information regarding the chil d’s last physical exam, immunization status, medical diagnoses, therapy prescriptions, and the names of the physicians associated with the chil d’s case.

If you choose to record information on the Medical page, remember it


will include qualifying diagnoses (in other words, those that automatically qualify a child for ECI services) as well as other nonqualifying medical diagnoses contained in the chil d’s medical record.

Diagnoses entered on the Evaluation/Assessment page will automatically populate on the Medical page. Note that when you select “new diagnosis,” you will need the date of the diagnosis before you can enter either a diagnosis code or description.












“Evaluation/Assessment.” Use the eligibility type drop down menu to select “Medical Diagnosis.” Enter the eligibility date found on the eligibility statement. Selec t “Add new” to add the diagnosis. Enter either the ICD code OR the ICD description. It is optional to enter the diagnosis date on this page. Then select “Search” to find the diagnosis.


1.43 To enter non-qualifying diagnosis


Diagnosis.









The Eligibility Stat ement shows a diagnosis of “Postsurgical malabsorption, not elsewhere classified” with an ICD code of “K91.2.”


Choices:

(a.) On the Medical page

(b.) On the Evaluation/Assessment page






Choices:

(a.) Developmental Delay - BDI-2

(b.) Developmental Delay – Qualitative

(c.) Hearing/Vision

(d.) Medical Diagnosis






Answer: 10/01/2015


On the TKIDS Search Criteria page, you will see the Diagnosis Date input field with a drop-down menu next to it. NOTE: the diagnosis date is the date on the medical record you receive. The diagnosis date is an optional field here.


Description.













ICD Code: K91.2





What would you do?

Choices:

(a.) Search for the name on the ECI Medical Diagnoses web page



(c.) Contact the Service Coordinator to discuss the error

(d.) Contact the referring physician




You receive Frankie ’s Eligibility Statement that needs to be entered into TKIDS on the Evaluation/Assessment page. It states Frankie’s

Eligibility date was 10/1/2015, has a diagnosis of “Trisomy 21,” and an ICD Code of “Q90.” Notice the diagnosis code (Q90) is an incomplete ICD-10 code.







What would you do?

Choices:

(a.) Simply select the first option in the list - i.e., Q90.0 Trisomy

21, nonmosaicism (meiotic nondisjunction)?







Now imagine Frankie’s referral form indicated a diagnosis of Down syndrome and the doctor had included the same incomplete ICD-10 code of Q90 ...








What would you do?


21, nonmosaicism (meiotic nondisjunction)












Choices:

(a.) Yes

(b.) No






You receive records for Adra, who was referred and determined eligible after 10/1/2015. H er referral form states, “749.2, Cleft hard palate with unilateral cleft lip.”




Next, you try searching by description in TKIDS and only one ICD-10 code is listed: Q37.1 (Cleft hard palate with unilateral cleft lip). Is it


okay to select this as the qualifying medical diagnosis for Adra in

TKIDS?






(sternomastoid).


Choices:





1.60 TKIDS Practice Scenario 5: Cindi





Choices:

(a.) Document the new medical diagnosis on the Medical page in

TKIDS

(b.) Chan ge Cindi’s TKIDS evaluation/ assessment record to




1.61 Program Directors & Other Administrators







Understand the distinction between the Medical and the

Evaluation/Assessment pages within TKIDS



Be able to enter ICD-10 information into TKIDS



Be able to explain the use of the medically qualifying diagnoses page



Be able to determine if a diagnosis is a qualifying medical diagnosis



Be able to develop a process for following-up with a provider for code clarification as needed



Know the resources available for the ICD-10 requirement of billing/claims submission


1.62 Program director to-do list

Here is your to-do list. Work through each item to complete this training.

ICD-10 Fundamentals

ICD-10 in TKIDS

Practice Scenarios

ICD-10 on the ECI web site

Comprehensive Plan

(When all items complete) Congratulations! You’ve reviewed the basics of ICD-10 and how the conversion relates to your work. You completed all learning activities within the module and developed the necessary knowledge and skills to be prepared for the October 1,

2015, conversion. Take a moment to check out the additional resources available for ongoing support with ICD-10 implementation.






What is ICD-10?













Evaluation/Assessment page), or when you are entering a medical diagnosis (on the Medical page).




The Medical page details the chil d’s medical information. This page


serves to document information regarding the chil d’s last physical exam, immunization status, medical diagnoses, therapy prescriptions, and the names of the physicians associated with the chil d’s case.

If you choose to record information on the Medical page, remember it will include qualifying diagnoses (in other words, those that automatically qualify a child for ECI services) as well as other nonqualifying medical diagnoses contained in the chil d’s medical record.

Diagnoses entered on the Evaluation/Assessment page will automatically populate on the Medical page. Note that when you select “new diagnosis,” in addition to entering a diagnosis code or description, you are required to enter a diagnosis date before the system will search for a match.












“Evaluation/Assessment.” Use the eligibility type drop down menu to select “Medical Diagnosis.” Enter the eligibility date found on the eligibility statement. Selec t “Add new” to add the diagnosis. Enter


either the ICD code OR the ICD description. It is optional to enter the diagnosis date on this page. Then select “Search” to find the diagnosis.

1.68 To enter non-qualifying diagnosis


Diagnosis.









The Eligibility Statement shows a diagnosis of “Postsurgical malabsorption, not elsewhere classified” with an ICD code of “K91.2.”


Choices:

(a.) On the Medical page

(b.) On the Evaluation/Assessment page






Choices:

(a.) Developmental Delay - BDI-2

(b.) Developmental Delay – Qualitative

(c.) Hearing/Vision

(d.) Medical Diagnosis






Answer: 10/01/2015


On the TKIDS Search Criteria page, you will see the Diagnosis Date input field with a drop-down menu next to it. NOTE: the diagnosis


date is the date on the medical record you receive. The diagnosis date is an optional field here.


Description.












ICD Code: K91.2






What would you do?

Choices:

(a.) Search for the name on the ECI Medical Diagnoses web page


(c.) Contact the Service Coordinator to discuss the error

(d.) Contact the referring physician




You receive Frankie’s Eligibility Statement that needs to be entered into TKIDS on the Evaluation/Assessment page. It states F rankie’s

Eligibility date was 10/1/2015, has a diagnosis of “Trisomy 21,” and an ICD Code of “Q90.” Notice the diagnosis code (Q90) is an incomplete ICD-10 code.







What would you do?


Choices:


21, nonmosaicism (meiotic nondisjunction)?






Now imagine Frankie’s referral form indicated a diagnosis of Down syndrome and the doctor had included the same incomplete ICD-10 code of Q90...








What would you do?


21, nonmosaicism (meiotic nondisjunction)












Choices:

(a.) Yes

(b.) No






You receive records for Adra, who was referred and determined eligible after 10/1/2015. Her referral form states, “749.2, Cleft hard palate with unilateral cleft lip.”





Next, you try searching by description in TKIDS and only one ICD-10 code is listed: Q37.1 (Cleft hard palate with unilateral cleft lip). Is it okay to select this as the qualifying medical diagnosis for Adra in

TKIDS?






(sternomastoid).


Choices:





1.85 TKIDS Practice Scenario 5: Cindi





Choices:

(a.) Document the new medical diagnosis on the Medical page in TKIDS

(b.) Change Cindi's TKIDS evaluation/ assessment record to




1.86 Medical diagnoses page

You may be asked about the ECI Medical Diagnoses web page, or how to determine if a diagnosis automatically qualifies a child for ECI services. The Medical Diagnoses web page is at http://www.dars.state.tx.us/ecis/resources/diagnoses.asp

.

As of October 1, 2015, the DARS ECI Medical Diagnoses web page will include new search capabilities and display ICD-10 codes and descriptions. The user will be able to search through the increased number of codes and more specific descriptions for qualifying medical diagnoses.

The update includes an auto-complete function: As you begin typing, diagnoses with the same combination of letters will display. The search narrows as you enter more specific descriptions. You can


also complete a search by entering the ICD-10 code. If someone enters an incorrect code, incorrect description, a non-qualifying medical diagnosis, or an incorrect spelling of a word, the search will return an error message stating the diagnosis code is not found and directs the user to check for spelling or entry of the wrong code.


1.87 Transition to ICD-10

Compliance with the ICD-10 means that all Health Insurance

Portability and Accountability Act (HIPAA) covered entities are able to successfully conduct health care transactions on or after October 1,

2015, using the ICD-10 diagnosis and current procedure codes. The transition to ICD-10 may require critical changes to billing system infrastructure and the documentation of diagnosis codes for services provided. In accordance with DARS rules, ECI contractors are required to establish billing systems and complete and submit reimbursement requests to corresponding third-party sources before billing DARS (Texas Administrative Code Title 40 Part 2 Chapter 108

Subchapter P Rule 108.1621).

Without proper systems and processes, accurate coding and proper payment will not be possible.

A successful transition to ICD-10 by the compliance date of October 1,

2015 requires a well-planned and well-managed implementation process. In your role as ECI program director or administrator, you should consider conducting an assessment of systems and processes that will be impacted by changes to updated diagnosis codes.

An assessment of your program’s systems and processes will help you:



Validate current processes and documentation



Identify documentation deficiencies



Identify your ICD-10 training needs



Avoid an increase in denied or unbillable claims




Prevent an interruption in revenue.

1.88 TKIDS and Beyond…Making a Comprehensive

Implementation Plan

Here is a general guide for creating a comprehensive implementation plan. Users select each topic to see items to consider during this transition. A printable checklist is available that you might find helpful to have on hand after this training.

Communication Plan



What is your plan for communicating with staff about documentation requirements, updates or changes to service delivery forms and billing forms?



What policies and procedures need to be developed or revised including procedures for communicating any issues after the implementation of ICD-10?



What is your plan for communicating to medical referral sources about the information your program needs when they refer a child with a qualifying medical diagnosis?

Develop a process for code clarification

As the new ICD-10 coding system is a more specific listing of diagnoses, some confusion may arise during the referral/evaluation process. Each program has its own process for child intake and referral; therefore each program will need to decide the most appropriate staff person to intervene if code clarification is needed.

Ultimately, it is the LPHA licensure that carries the responsibility of correct coding for documentation and billing, if the referring provider does not provide the ICD-10 code or a complete diagnosis description. (See discipline specific ethical practice acts.)

While it is required to obtain medical documentation to determine a child is eligible with a qualifying medical diagnosis, it is important to


emphasize the benefit of obtaining documented medical histories and information on all children prior to performing the evaluation. The correct diagnosis code will also assist in data entry and will provide accurate information for claims submission. You may need to consider the accuracy of the diagnosis code needed for claims submission.

A couple things to do:



Designate a liaison to contact referring providers, e.g. the LPHA, the Service Coordinator or other, when a diagnosis code or description needs to be obtained or clarified.



Assure that the family has given consent to contact or share information with the referring provider.

Regardless of your program’s process for obtaining medical information, the best practice is to clearly define diagnosis codes or descriptions for children eligible with a medical diagnosis prior to reaching the stage of data entry. Take a closer look at the process for code clarification...

A referral is received and reviewed for diagnosis description and/or code. If the referral document does not contain enough information to determine a code, then the medical record should be reviewed. The most specific information from these documents must be entered in

TKIDS.

What about the use of NOS or “not otherwise specified?” When can that be entered into TKIDS?

 Certainly if “NOS” was included in the diagnosis from the physician, it is appropriate to use the unspecified code or NOS in TKIDS.



Also, if the referring provider did not indicate a specifier, you may use the code description NOS in TKIDS.

Note: If the TKIDS system is integrated into the contractor’s claims system, then there may be a need to contact the referring provider’s office for the appropriate ICD-10 code.


Review documentation



How will you evaluate service documentation to make sure it accurately reflects what was done and supports the codes billed?

Perform an analysis of data



What are the most common diagnoses documented in services records and claim transactions? This information can be used to determine potential code conditions that may impact data reported in TKIDS during the transition to ICD-10. You should also perform this analysis with claims vendors and clearinghouses, and third party payers.



How will you evaluate data entered in TKIDS to make sure it accurately reflects service documentation?

 What will be your process for reconciling data from the child’s medical records, data reported in TKIDS and data used in claims?

What are your plans for providing oversight to ensure accuracy of this information?

Update technology



Do all of your technology systems, including electronic health records, data entry portals, billing systems and claims clearinghouse systems accommodate ICD-10?

Provide targeted education and training

What are your staff’s training needs related to ICD-10 implementation?



Provide training for staff that receive referrals, perform data entry, and provide services to ensure they are aware of code updates and changes to technology systems and procedures.



Take advantage of any training your claims vendor is offering on


ICD-10 system updates and ongoing support.

Test and monitor success



Are there any processes that need to be improved to ensure accurate data is reported in TKIDS and your billing systems? Before the implementation deadline, test your internal procedures to identify any potential issues.



What will happen if there are problems with your data collection or billing systems during the ICD-10 implementation? Develop a contingency plan for continuing operations and service documentation if critical systems issues occur when ICD-10 is implemented.


Accessible version - Texas Department of Assistive and

How to Implement ICD-10 in TKIDS

Related documents

Products

Support

Accessible version - Texas Department of Assistive and

How to Implement ICD-10 in TKIDS

Related documents

Add this document to collection(s)

Add this document to saved

Suggest us how to improve StudyLib