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July 17, 2015

ICD­10 Transition Preparation and Preparedness

ICD­10 Overview

ICD­10­CM/PCS (International Classification of Diseases, 10th Edition, ClinicalModification/Procedure Coding System) consists of two parts: ICD­10­CM for diagnosiscoding and ICD­10­PCS for inpatient procedure coding.

The transition to ICD­10 is occurring because ICD­9 produces limited data about patients' medical conditions and hospital inpatient procedures. ICD­9 is 30 years old, has outdated terms, and is inconsistent with current medical practice. Also, the structure of ICD­9 limits the number of new codes that can be created, and many ICD­9 categories are full.

ICD­10 CMS Update Plans for Implementation

CMS and AMA released on 7/6/2015 that Medicare will not deny any medical claims withinthe first 12 months "based solely on the specificity of the ICD­10 Diagnoses code as long asthe practitioner used a valid code from the right family." CMS will also hire a CMS ICD­10Ombudsman to help manage any questions regarding the submission of claims to help easethe transition.

Who needs to transition?

ICD­10 will affect diagnosis and inpatient procedure coding for everyone covered by HealthInsurance Portability Accountability Act (HIPAA), not just those who submit Medicare orMedicaid claims.The change to ICD­10 does not affect coding for outpatientprocedures.

How does the ICD­10­CM compares to the ICD­9­CM

ICD­10­CM uses 3­7 alpha and numeric digits and full code titles, but the format is verymuch the same as ICD­9­CM (for example, ICD­10­CM has the same hierarchical structureas ICD­9­CM).

The 7th character in ICD­10­CM is used in several chapters including, the Injury, Musculoskeletal, and External Cause chapters. It has a different meaning depending on the section where it is being used. An example of this is in the Injury and External Cause sections, the 7th character classifies an initial encounter, subsequent encounter, or late effect.

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Primarily, changes in ICD­10­CM are in itsorganization and structure, code composition,and level of detail.

ICD­9­CM Diagnoses Codes: ICD­10­CM Diagnosis Codes:

Are 3­5 digits;

The first digit is alpha (E or V) ornumeric(aplha characters are not casesensitive)Digits 2­5 are numeric; and A decimal is used after the thirdcharacterExamples:

496­Chronic airway obstruction, notelsewhere classfed (NEC) 511.9 ­Unspecified pleural effusion; andV02.661 ­ Hepatitis B carrier.

Are 3­7 digits;

Digit 1 is alpha; Digit 2 is numeric; Digits 3­7 are alpha or numeric (alphacharacters are not case sensitive); and A decimal is used after the thirdcharacter.Examples:

A78­Q fever;A69.21 ­ Meningitis due to Lymedisease; and s52.131A ­ Displaced fracture ofneck of right radius, initialencounter for closed fracture.

New Features For ICD­10­CM

The following new features can be found inICD­10­CM:

Laterality (Left, Right, Bilateral)Examples: C50.511 ­ Malignant neoplasm oflower­outer quadrant of right female breast; H16.013 ­ Central corneal ulcer, bilateral; andL89.012 ­ Pressure ulcer of right elbow, stageII.

Combination Codes For CertainConditions and Common Associated Symptoms and ManifestationsExamples: K57.21 ­ Diverticulitis of large intestine with perforation and abscess withbleeding; E11.341 ­ Type 2 diabetes mellitus with severe nonproliferative diabeticretinopathy with macular edema; and I25.110 ­ Atherosclerotic heart disease of nativecoronary artery with unstable angina pectoris.

Combination Codes for Poisonings and Their Associated External CauseExample: T42.3x2S ­ Poisoning by barbiturates, intentional self­harm, sequela.

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Obstetric Codes Identify Trimester Instead of Episode of CareExample: O26.02 ­ Excessive weight gain in pregnancy, second trimester.

Character "x" is Used as a 5th Character Placeholder in Certain 6 Character Codesto Allow for Future Expansion and to Fill in Other Empty Characters (For Example,Character 5 and/or 6) When a Code That is Less Than 6 Characters in LengthRequires a 7th CharacterExamples: T46.1x5A ­ Adverse effect of calcium­channel blockers, initial encounter; and T15.02xD ­ Foreign body in cornea, left eye, subsequent encounter.

Two Types of Excludes Notes

Excludes 1 ­ Indicates that the code excluded should never be used with the codewhere the note is located (do not report both codes). Example: Q03 : Congenitalhydrocephalus. Excludes 1: Acquired hydrocephalus G91.

Excludes 2 ­ Indicates that the condition excluded is not part of the conditionrepresented by the code but a patient may have both conditions at the same time, inwhich case both codes may be assigned together (both codes can be reported tocapture both conditions). Example: L27.2 ­ Dermatitis due to ingested food. Excludes 2:Dermatitis due to food in contact with skin (L23.6, L24.6, L25.4).

Inclusion of Clinical Concepts That Do Not Exist in ICD­9­CM (For Example,Underdosing, Blood Type, Blood Alcohol Level)

Examples: T45.526D ­ Underdosing of antithrombotic drugs, subsequent encounter; Z67.40­ Type O blood, Rh positive; and Y90.6 ­ Blood alcohol level of 120 ­ 199 mg/100 ml.

A Number of Codes Are Significantly Expanded (For Example, Injuries, Diabetes,Substance Abuse, Postoperative Complications)

Examples: E10.610 ­ Type 1 diabetes mellitus with diabetic neuropathic arthropathy;F10.182 ­ Alcohol abuse with alcohol­induced sleep disorder; and T82.02xA ­ Displacementof heart valve prosthesis, initial encounter.

Codes for Postoperative Complications Are Expanded and a Distinction is MadeBetween Intraoperative Complications and Postprocedural Disorders

Examples: D78.01 ­ Intraoperative hemorrhage and hematoma of spleen complicating aprocedure on the spleen; and D78.21 ­ Postprocedural hemorrhage and hematoma ofspleen following a procedure on the spleen.

TMC & JBS Software Solutions ICD­10 Transition Implementation Plan & Timelines

JBS Software Solutions Database Upgrades Complete to Allow for Concurrent

Utilization of ICD­9 & ICD­10 for Testing Purposes

JBS has already completed the internal testing phase.

June 2015

Begin entry of any LCD and crosswalks that have been entered for the MACs

Internal education to begin July/August 2015Internal educational seminars initiated for TMC clinicians for ICD­10 utilization

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August 2015All cases initiated in JBS will be selectedusing the ICD­10 code and both the ICD­10and the equivalent ICD­9 will display ondocument. All electronic information will continue to ONLY contain ICD­9 CMS states there will be no testing submission period prior to October 1, 2015 transitionThere will be a query to double check to ensure no outliers that are excessively long cases.

September 15, 2015All current patient data will now reflect ICD­10 codes in the database and ondocumentation, as well as the ICD­9 codes.Internal query to ensure all active cases are compliant with following:

ICD­9 and ICD­10 data for transition dateSupportingcCodes for any/all new crosswalk & LCD based on ICD­10

October 1, 2015All information dated ON or AFTER October 1, 2015 will display ONLY ICD­10information.

Tools and Guides to be Available Through TMCMapping Software Mapping Guide

Forward Map (ICD9 to ICD10) orBackward Map (ICD10 to ICD9)Keyword search functionality

JBS therapist interfaceJBS Facility Portal for facilitystaff

Nursing staff top 100 medical diagnoses for geriatric population Top 30 therapy related medical diagnosesTop 30 therapy related treatment

Sample of Mapping Guide

558.9: Other and unspecified noninfectiousgastroenteritis and colitis gastroenteritis and colitis

K52.9 Noninfective gastroenteritis and colitis,unspecified

ICD­9 Code/Description ICD­10 Code/Description

486: Pneumonia organism unspecified J18.9 Pneumonia, unspecified organism

ExtendedJ18.8 Other pneumonia, unspecifiedorganism

492.0: Emphysematous bleb J43.9 Emphysema, unspecified

493.90: Asthma unspecified J45.909 Unspecified asthma, uncomplicated

J45.998 Other asthma

496: Chronic airway obstruction, notelsewhere classified

J44.9 Chronic obstructive pulmonary disease,unspecified

530.81: Esophageal reflux K21.9 Gatro­esophageal reflux diseasewithout esophagitis

558.9: Other and unspecified noninfectiousgastroenteritis and colitis

K52.89 Other specified noninfective gastroenteritis and colitisK52.9 Noninfective gastroenteritis and colitis,unspecified

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Important Reminders:

Even if you submit your claim on or after the ICD­10 deadline, if the date of service wasbefore the October 1, 2015, deadline, you will use ICD­9 to code the diagnosis.

For dates of service on or after the October 1, 2015, deadline, you will use ICD­10. You maynot be able to use ICD­9 and ICD­10 codes on the same claimbased on your payers' instructions.

This may mean splitting services that would typically be captured on one claim into two claims: one claim with ICD­9 diagnosis codes for services provided before October 1, 2015, and another claim with ICD­10 diagnosis codes for services provided on or after October 1, 2015

Some trading partners may request that ICD­9 and ICD­10 codes be submitted on the sameclaim when dates of service span the compliance date. Trading partner agreements willdetermine the need for split claims.

Here's an example of a split claim:A patient has an appointment on September 27, 2015, and is diagnosed with bronchitis. Hereturns for a follow­up appointment on October 3, 2015. In this case, a practice will submit aclaim with an ICD­9 diagnosis code for the first visit and another claim with an ICD­10diagnosis code for the follow­up visit.

Please contact us in the event you have any compliance concerns

Leslie Welch, RAC­CT/COTASenior Director of Reimbursement and Regulatory ComplianceContact Info: (352)­382­1130 Email: corporatecompliance@therapymgmt.com

"We must become the change we want to see in the world"

Mahatma Gandhi

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