facilitators: kit cairns, wiitts karen navarro, university of wi hospital & clinics claudia...
TRANSCRIPT
Facilitators:Facilitators:
Kit Cairns, WIITTSKit Cairns, WIITTSKaren Navarro, University of WI Hospital & ClinicsKaren Navarro, University of WI Hospital & ClinicsClaudia Yoakum-Watson, WEA Trust and CCRSClaudia Yoakum-Watson, WEA Trust and CCRS
Overview of 5010 and ICD-10: Definitions, Planning and Readiness
Introductions
Review of this afternoon’s sessions:
• Overview of 5010 and ICD-10• 5010 Working Session• ICD-10 Working Session
Welcome!Welcome!
Agenda for Overview SessionAgenda for Overview Session
50105010
ICD-10ICD-10
Implementation Implementation
ResourcesResources
QuestionsQuestions
5010 Questions5010 Questions
What is 5010 and why do we have to do this?
Who uses 5010?
EDI 5010 Overview
When does 5010 happen?
Where is 5010 used?
What is 5010?What is 5010?
• Started with requirement that the Secretary of the Department of Started with requirement that the Secretary of the Department of Health and Human Services (HHS) adopt standards for covered Health and Human Services (HHS) adopt standards for covered entities to use when they electronically conduct certain health care entities to use when they electronically conduct certain health care administrative transactions.administrative transactions.
• The Transactions and Code Sets final rule published on Aug. 17, The Transactions and Code Sets final rule published on Aug. 17, 2000, adopted standards for the statutorily identified transactions, 2000, adopted standards for the statutorily identified transactions, some of which were modified in a subsequent final rule published some of which were modified in a subsequent final rule published on Feb. 20, 2003.on Feb. 20, 2003.
• On January 16, 2009, HHS announced a final rule that replaces the On January 16, 2009, HHS announced a final rule that replaces the current Version 4010/4010A and NCPDP Version 5.1 with Version current Version 4010/4010A and NCPDP Version 5.1 with Version 5010 and Version D.0, respectively.5010 and Version D.0, respectively.
EDI 5010 Overview
What is 5010?What is 5010?
• Improvements in structural, front matter, technical, and data Improvements in structural, front matter, technical, and data content.content.
• More specific in requiring the data that is needed, collected, and More specific in requiring the data that is needed, collected, and transmitted in a transaction.transmitted in a transaction.
• Significant improvements for the reporting of clinical data, enabling Significant improvements for the reporting of clinical data, enabling the reporting of ICD–10–CM diagnosis codes and ICD–10–PCS the reporting of ICD–10–CM diagnosis codes and ICD–10–PCS procedure codes, and distinguishes between principal diagnosis, procedure codes, and distinguishes between principal diagnosis, admitting diagnosis, external cause of injury and patient reason for admitting diagnosis, external cause of injury and patient reason for visit codes. visit codes.
EDI 5010 Overview
Because of the Final Rule publishedBecause of the Final Rule published
by the US Department of Health andby the US Department of Health and
Human Services on 1/16/2009:Human Services on 1/16/2009:
http://edocket.access.gpo.gov/2009/pdf/E9-740.pdfhttp://edocket.access.gpo.gov/2009/pdf/E9-740.pdf
EDI 5010 Overview
Why do we have to do this?Why do we have to do this?
December, 2010December, 2010
Complete internal testing – able to send & Complete internal testing – able to send & receive compliant transactionsreceive compliant transactions
January, 2011January, 2011
Begin external testing with trading partnersBegin external testing with trading partners
January 1, 2012January 1, 2012
All covered entities must be in productionAll covered entities must be in production
EDI 5010 Overview
When does 5010 happen?When does 5010 happen?
Covered Entities:Covered Entities:
• PROVIDERS (doctors, clinics, hospitals, psychologists, dentists, chiropractors, nursing homes, pharmacies – submitting information electronically for HHS standard transactions)
• HEALTH PLANS (health insurance companies, HMOs, company health plans, gov’t health plans such as Medicare, Medicaid, etc.)
• HEALTH CARE CLEARINGHOUSES (entities that process non-standard health information from another entity into a standard or vice versa)
EDI 5010 Overview
Who uses 5010Who uses 5010
EDI 5010 Overview
Where is 5010 used?Where is 5010 used?
Covered transactions include:Covered transactions include:
• 837 P, I, and D claims (including 837 P, I, and D claims (including COB)COB)
• 835 health care payment and remittance 835 health care payment and remittance adviceadvice• 270/271 eligibility request/response270/271 eligibility request/response• 276/277 claim status request/response276/277 claim status request/response• 278 referral certification and authorization278 referral certification and authorization• 834 health plan enrollment/disenrollment• 820 health plan premium payment• NCPDP D.0, 5.1, and 3.0
ICD-10 QuestionsICD-10 Questions
What is ICD?
How is ICD used?
Why are we moving to ICD-10
When does ICD-10 happen?
How does ICD-10 differ from ICD-9
Who uses ICD-10?
EDI ICD-10 Overview
The patient is in the office for the first visit because of a closed greenstick fracture of the right radial shaft.
813.21 Fracture of shaft; radius alone
S52.311A Greenstick fracture of shaft of radius, right arm, initial encounter for closed fracture
ICD-10 Code StructureICD-10 Code StructureEDI ICD-10 Overview
Diagnosis Code StructureDiagnosis Code Structure
S52.311AS52.311A Greenstick fracture of shaft of radius, right arm, initial Greenstick fracture of shaft of radius, right arm, initial encounter for closed fracture encounter for closed fracture
RootRoot RootRoot RootRoot SiteSite SeveritySeverity EtiologyEtiology ExtensionExtension
SS 55 22 33 11 11 AA
Injury, Injury, poisoning and poisoning and certain other certain other consequences consequences of external of external causes causes
Injuries to Injuries to the elbow the elbow and forearm and forearm
Fracture Fracture of of Forearm Forearm
Radial Radial ShaftShaft
GreenstickGreenstick Right Right Initial Initial Encounter Encounter
EDI ICD-10 Overview
Procedure Code StructureProcedure Code Structure
OTF4ZZZOTF4ZZZ LithotripsyLithotripsy
SectionSection Body Body SystemSystem
Root Root ProcedureProcedure
Treatment Treatment SiteSite
ApproachApproach DeviceDevice QualifierQualifier
OO TT FF 44 ZZ ZZ ZZ
MedicalMedical UrinaryUrinary Fragment-Fragment-ationation
Left Renal Left Renal PelvisPelvis
No No Approach Approach NotedNoted
No No Device Device NotedNoted
No No Qualifier Qualifier NotedNoted
EDI ICD-10 Overview
S52.3Ø1A S52.3Ø1A Unspecified fracture of shaft of right radius, initial encounter for closed fractureUnspecified fracture of shaft of right radius, initial encounter for closed fracture
S52.3Ø1GS52.3Ø1GUnspecified fracture of shaft of right radius, subsequent encounter for closed fracture with delayed Unspecified fracture of shaft of right radius, subsequent encounter for closed fracture with delayed
healinghealing
S52.321AS52.321A Displaced transverse fracture of shaft of right radius, initial encounter for closed fractureDisplaced transverse fracture of shaft of right radius, initial encounter for closed fracture
S52.325AS52.325A Non displaced transverse fracture of shaft of left radius, initial encounter for closed fractureNon displaced transverse fracture of shaft of left radius, initial encounter for closed fracture
S52.325GS52.325GNon displaced transverse fracture of shaft of left radius, subsequent encounter for closed fracture with Non displaced transverse fracture of shaft of left radius, subsequent encounter for closed fracture with
delayed healingdelayed healing
S52.341AS52.341A Displaced spiral fracture of shaft of radius, right arm, initial encounter for closed fractureDisplaced spiral fracture of shaft of radius, right arm, initial encounter for closed fracture
S52.364AS52.364A Non displaced segmental fracture of shaft of radius, right arm, initial encounter for closed fractureNon displaced segmental fracture of shaft of radius, right arm, initial encounter for closed fracture
S52.381AS52.381A Bent bone of right radius, initial encounter for closed fractureBent bone of right radius, initial encounter for closed fracture
Mapping of 813.21Mapping of 813.21There are 90 ICD-CM code possibilities for mapping of 813.21
EDI ICD-10 Overview
Implementation TasksImplementation Tasks
Phase 1
Create the structure/governance
Begin impact assessments
Awareness and Communication
EDI 5010 and ICD-10 Implementation
Implementation TasksImplementation Tasks
Phase 2:
Determine business and technical strategies
Complete Budget Planning
Complete Impact Assessment
EDI 5010 and ICD-10 Implementation
Define Functional Requirements
Implementation TasksImplementation Tasks
Phase 3:
Complete System Development/ Get Vendor Updates
EDI 5010 and ICD-10 Implementation
Review contracts, reports, …
Implementation TasksImplementation Tasks
Phase 4:
TEST – TEST - TEST
EDI 5010 and ICD-10 Implementation
Implementation TasksImplementation Tasks
Phase 5:
Go-live
Analyze potential cash flow implications
Communicate changes
EDI 5010 and ICD-10 Implementation
HIPAA COW:HIPAA COW: www.hipaacow.comwww.hipaacow.com
WEDI:WEDI: www.wedi.comwww.wedi.com
CMS:CMS: www.cms.govwww.cms.gov
Resources
CMS Transactions & Codesets:CMS Transactions & Codesets:http://www.cms.hhs.gov/TransactionCodeSetsStands/02http://www.cms.hhs.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asp_TransactionsandCodeSetsRegulations.asp
ICD 10 Final Rule: ICD 10 Final Rule: http://edocket.access.gpo.gov/2009/pdf/E9-743.pdfhttp://edocket.access.gpo.gov/2009/pdf/E9-743.pdf
5010 Final Rule:5010 Final Rule:http://edocket.access.gpo.gov/2009/pdf/E9-740.pdfhttp://edocket.access.gpo.gov/2009/pdf/E9-740.pdf
Resources
CMS HIPAA Standards Page (gap information links):CMS HIPAA Standards Page (gap information links):http://www.cms.hhs.gov/ElectronicBillingEDITrans/18_50http://www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp10D0.asp
CMS ICD 10 Fact Sheet: CMS ICD 10 Fact Sheet: http://cms.hhs.gov/MLNProducts/downloads/ICD-http://cms.hhs.gov/MLNProducts/downloads/ICD-10factsheet2009.pdf10factsheet2009.pdf
X12 Presentation to NCVHS on 5010 changes:X12 Presentation to NCVHS on 5010 changes:http://www.ncvhs.hhs.gov/070730p4.pdfhttp://www.ncvhs.hhs.gov/070730p4.pdf
Resources
Questions?Questions?
THANK YOU!THANK YOU!
Contact Information:Contact Information:
Kit CairnsKit [email protected]@deancare.com608.294.6492608.294.6492
Karen NavarroKaren [email protected]@uwhealth.org608.662.0817608.662.0817
Claudia Yoakum-WatsonClaudia [email protected]@weatrust.com608-661-6726608-661-6726
[email protected]@tds.net608-289-4974608-289-4974
Notes
Notes
Notes