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Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some state laws. This should not be used as legal advice. Itentive recognizes that there is not a “one size fits all” solution for the ideas expressed in this webinar; we invite you to follow up directly with us for more personalized information as it pertains to your specific practice and issues. Thank you, and enjoy the webinar.

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ICD-10: It’s Back!

Are you Ready?

ITENTIVE WEBINAR SERIES

Agenda

• Do I really have to?
• What Is It?
• Who Does This Affect?
• Why Is This Important?
• What Do I Have To Do?
• When Is It In Effect?

I keep hearing to get ready, but it keeps being delayed – do I really have to worry about it this year? I don’t want to waste my time preparing for nothing…

All Health Insurance Portability and Accountability Act (HIPAA)-covered entities must implement the new code sets with dates of service, or date of discharge for inpatients, that occur on or after October 1,

• 2015. HHS has no plans to extend the

compliance date for implementation of ICD- 10-CM/PCS; therefore, covered entities should plan to complete the steps required to implement ICD-10-CM/PCS on October 1, 2015.

ICN 902143 August 2014 MLN

What is ICD-10?

• International Classification of Diseases,

Revision 10 - is a code set that was developed by the World Health Organization in the 1970’s

• ICD-10 is in use in almost every country

in the world

• The U.S. is the only major country in the

world that is not already using ICD-10

In Fact…

• The unchanged version of ICD-10 is used in

about 110 countries for cause of death reporting and statistics

• Only 25 countries use ICD-10 for

reimbursement and resource allocation, but the U.S. is the only country that is on a fee for service payment system

• Some countries have made modifications to

the ICD-10 codes

• The U.S. has permission to modify the ICD-10

codes to better accommodate their use

How does ICD-10 differ from ICD-9?

• ICD-9 CM – 17,500 codes consisting of
• 3-5 Numeric Characters
• Digits 0-9 Letters E or V
• ICD-10 CM – 70,000 codes consisting of
• 3-7 Alpha or Numeric Characters
• Digits 0-9

Letters A-T, V-Z There is no one to one match of codes from ICD-9 to ICD-10 for 80% of the codes

• ICD-9 doesn’t reflect new services

and technologies that CMS has to acknowledge

• ICD-9 is limited to a maximum of

10,000 codes, of which most are assigned

• ICD was designed to be updated

every 10 years

ICD-10

• Reflects current knowledge of disease

processes

• Will encompass more precise

documentation of clinical care

• Will allow more accuracy when

determining medical necessity for services rendered

• Will help identify fraudulent activity

ICD-10 Structure

• The basic structure of an ICD-10 code
• The first 1-3 characters – the category
• f disease
• 4th character – etiology of disease
• 5th character – body part affected
• 6th character – severity of illness
• 7th character – placeholder for

extension of the code to increase specificity

ICD-10 Structure

Who Does ICD-10 Affect?

A better question would be – Who isn’t and what isn’t affected in your

• rganization?

Who Does ICD-10 Affect?

• Clinicians - physicians, mid level

practitioners, PT, OT, ST, nutritionists, nurses, MA’s – all need to know the correct code to choose when documenting their notes

• New concepts are captured that did not

exist in ICD-9 and must be included in the documentation

• i.e alcohol level, Glasgow coma scale,

dosing and blood type

• Coders - need to know which code

fits the documentation. If they are working your RAC audits, they will need to know ICD-10

• There are specific post operative

codes – using a pre-operative diagnosis code post operatively would be inaccurate

• Office Staff will need to understand

ICD-10

• Management and reimbursement

staff will need to understand ICD-10 when reviewing set up of charges/ codes and analyzing utilization reports

• Contracting staff will need to

understand ICD-10 when preparing and reviewing contracts with insurance companies

• Many , if not all insurance companies

will use specificity to determine reimbursement amounts

Authorization, referral staff and billing staff will need to understand ICD- 10 to insure patient coverage benefits and accurate payments

You will need to understand not

• nly how to

choose the correct code but, most importantly how documentation must change to support the code chosen

For Example…

Obstetric Care

• ICD-9 codes are organized by episode
• f care
• ICD-10 codes are organized by stage
• f pregnancy

This will impact documentation and could impact billing and reimbursement

Coma

• Coma is coded 780.01 in ICD-9
• ICD-10 requires coma be coded based
• n a coma scale. Also must code (7th

character extension) how the patient arrived (in the field, at arrival in ED etc.) The documentation must support the code

Important Steps to Take when Preparing

Evaluate Contracts

• Be especially thorough when

examining new contracts

• Watch for payment adjustments for

broader ranges of diagnosis codes

• Contracts which include pay for

performance based on ICD-9 need to be modified for ICD-10

Analyze System Needs

• Is your EHR and PM software up to date?
• Can it support dual coding?
• Is there a crosswalk from ICD-9 to

ICD-10?

• What build needs to occur in EHR?
• What build needs to occur in PM?
• Who will do the build and when?

Contact Vendors

Contact vendors to determine their readiness:

• Clearinghouses and Insurance Carriers
• Labs
• Eligibility vendor
• Practice Management and EHR

Vendors

Internal Testing

• Test your own systems
• Test your own people
• Perform dry runs to make sure

everyone knows exactly what they need to do

• Check accuracy and specificity

External Testing

• Test your clearinghouse
• Test your direct payers
• Test your eligibility company
• Test any vendor to whom you send

a diagnosis

And Of Course…. Training… Training…. And More Training!!!

Are NextGen and Itentive Ready? Yes! And we can help….

NextGen has a large number of white papers and utility guides to help with implementing ICD-10

White Paper: Importing and Mapping ICD Codes, Version 5.8 (Download from Knowledge Exchange)

Includes information and instructions for the steps involved in setting up ICD-10 codes and General Equivalency Mappings (GEMs) in File Maintenance in version 5.8.

The ICD-9/ICD-10 comparison Utility is a testing and educational tool to familiarize us with the mapping of ICD-10 codes for commonly used ICD-9 codes

• NextGen Healthcare ICD-9/ICD-10 Comparison

Utility automatically or manually modifies the 837 claim file containing the ICD-9 codes and generates an 837 claim file containing ICD-10 codes independent of the EHR or Practice Management system.

• This will allow a method by which financial

impact of ICD-10 can be analyzed in a controlled “sandbox” environment for testing and code education.

Clinical Data Loader Utility Guide, Version 5.8 (Download from Knowledge Exchange) Clinical Data Loader Utility (Download from Knowledge Exchange)

NextGen Steps To Implementation

• System requirement: Version 5.8

and KBM 8.3 minimum

• Prerequisite: ICD-9 Decimalization
• Prerequisite: Run the Clinical Data

Loader Utility (CDL)

NextGen Steps To Implementation

• Step 1: Import ICD-9 and 10 codes into the

ICDCM Codes Master File

• Step 2: Import ICD-9 and 10 codes from the

ICDCM Codes Master File into the Diagnosis Codes Library

• Step 3: Import GEMs into the Diagnosis Codes

Library

• Step 4: Setup Payers (HIPAA Non-Covered

Entities) to use GEMs

• Step 5: Modify templates– templates with hard

coded diagnoses need to be modified with ICD-10 code

Finally, Go Live with ICD-10

And your Providers will be asking…

Questions

• Mercedes Moers
• Managing Consultant
• mmoers@Itentive.com
• 224-220-5589
• Cynthia Kincade
• Vice President, Client Solutions
• ckincade@Itentive.com
• 224-220-5575
• Llyod Taylor
• Strategic Account Manager
• ltaylor@Itentive.com
• 224-220-5616

Thank you