PowerPoint Presentation

ICD-10: Prepare for the UnexpectedPresented by Denise Cawley, MHA, CPCBrigette LaBarRBMA Spring ConferenceMay 22, 2012

Disclosure:Denise Cawley is the Vice President of Client Relations at GeBBS Healthcare Solutions, a provider of RCM services.Brigette LaBar is the Client Relations Director at GeBBS Healthcare Solutions, a provider of RCM services.

This presentation does not intend to showcase GeBBS capabilities or solicit any business.

Learning Objectives:What impact ICD-10 will bring to our lives How Radiology Practice Management will be impacted What you should do with the extra time until implementation

What is the implementation date?October 1, 2013On February 16, 2012 HHS announced it delay the implementation until some unknown dateOn April 12 HHS issued a notice of proposed rulemaking (NPRM) to delay the final compliance date for ICD-10-CM/PCS by one year, from October 1, 2013, to October 1, 2014The proposed rule was officially published in the Federal Register on April 17, 2012. There will be a 30-day comment period

Final date not published, but ICD-10 WILL be implemented. Use the extra year4

AgendaWhat is ICD-10? Prepare to implementQuestion & Answer

Show of hands: How many of you are coding managers? billing managers? Practice Managers?5

What is ICD-10?ICD-10-CM (Clinical Modification) is an updated diagnosis code set, moving away from the 30-year-old ICD-9 code set It contains over 65,000 diagnosis codes compared to 4,000 ICD-9 codesICD-10-PCS (Procedure Coding System) consists of 72,081 codes

Really??ICD-10 Code W61.92 Struck by a bird

How is it organized?ICD 10 codes are 3 to 7 characters, the first one is alphabetic, 2nd through 7th are either alphabetic or numeric, with a decimal after 3 characters. These codes are arranged in chapters and sub-chapters with diseases grouped by letter. ICD 10 codes are organized in 22 chapters

REALLY????R46.1 is "bizarre personal appearance" vs. R46.0 is "very low level of personal hygiene" W22.02XA "walked into lamppost, initial encounter and W22.02XD, "walked into lamppost, subsequent encounterAmerican doctors whose patients run afoul of birds will be able to select from nine codes for each speciesThere are separate codes for "bitten by turtle" and "struck by turtle"

Why change it? Patient BenefitsEnhance healthcare by tracking and trending diseases

Payer BenefitsEnhance quality of care through utilization management Support innovation in payment design and contracting

Provider BenefitsImproved care coordinationMore effective case management Improved utilization management

Denise will take Payer bens10

ICD-10 Myths and FactsMYTH: There will be no hard copy ICD-10-CM code books. All coding will need to be performed electronicallyFACTICD-10-CM code books are already available and are a manageable size

Myth: ICD-10-CM/PCS was developed a number of years ago, so it is probably already out of dateFACTICD-10 has been updated annually since its creation

MYTH: Each payer will be required to develop their own mappings between ICD-9-CM and ICD-10FACTGeneral Equivalence Mappings (GEMs) are a crosswalk tool developed by CMS and CDC for use by ALL HIPAA-covered providers, payers, and data users. The mappings are free of charge and are in the public domain

ICD-9-CM to ICD-10-CM MappingCMS and CDC have developed a crosswalk (or mapping) tool from ICD-9 to ICD 10-CM and PCS codes

http://www.cms.gov/ICD10

ICD-9-CM to ICD-10-CM MappingAPPROXIMATE MATCH: 49%Diagnosis has a direct 1 to 1 mapping, but the diagnosis text has changed slightly EXACT MATCH: 24%Diagnosis has a direct 1 to 1 mapping and the diagnosis text remains the same MATCH w/MULTIPLE CHOICES: 19%Diagnosis maps to a set of diagnoses, from which one should be chosen

Source: 2011 GEMS mapping, CMS NO MAPPING: 3%Diagnosis does not exist in the ICD-10 code set COMPLEX MAPPING: 3%Diagnosis matches to multiple sets of ICD-10 diagnoses 1 TO MANY: 2%1 diagnosis code map to 2 or more ICD-10 codes

Significant for RadiologyICD-10-PCS will be used for inpatient hospital procedures, so Radiology practices that validate charge capture will need to map ICD-10-PCS to CPT using the GEMs (General Equivalence Mappings)Translation and Interface engines between Radiology practices and physician EHR systems will changeImplementation is mandated for HIPAA covered entities. Not all payers will adopt ICD-10 on the same time schedule as Federal and commercial payers!

Examples: Work Comp, auto, some Medicaid. Medi-Cal adopts ICD-9 in NOVEMBER instead of January.Ask for show of hands, does anyone know of payers that are already accepting14

Reality CheckICD-10 is like a phone book: Its all there, but you dont use every phone numberWeve been through this before (Y2K, HIPAA, S-OX, 5010, etc.)We just got another year to prepare

AgendaWhat is ICD-10? Prepare to implementQuestion & Answer

You should already be doingInform key stakeholders of recent changes

Create a governance structureExecutive sponsorProject management team or interdisciplinary steering committee

Evaluate the effect of ICD-10 on other projectsVersion 5010 transitionMeaningful UseClinical Documentation Improvement

Complete an inventory of all databases

Perform an impact assessment and identify potential changes to existing work flow and business processes 17

Where do diagnosis codes live?In PrintPractice workflowsClinical documentationEncounter/charge forms and Job AidesTraining documents, tools, media etc.Payer Contracts

In the Cloud: Information technologyPACSRISCAC Interface enginesPMS

Know your vendors plans Which of your vendors are impacted by ICD-10 Do your vendors have a readiness planWhat level of training support will be providedWill there be additional hardware/software retrofit requirementsWhat support will be made available for data migrationWill there be any assistance in practicing ICD-10 based workflows How will existing interfaces with other vendors be affected What additional configuration need to be done (claim rules, interfaces)What are the testing plans Currently, there is no single framework for testing between payers and providers

CDI Clinical Documentation Improvement Documentation to support clinical and reimbursement needs, as well as ICD-10 specificityEvaluate medical records to determine whether the documentation supports the level of detail found in ICD-10Implement documentation improvement strategies to address the areas where documentation is found to be lacking.Examples:Additional specificity in coding injuriesMore detail in fracture coding

More specific codes require improved documentation; so to assign the most specific code available, high-quality medical record documentation will be needed.20

Know your practiceDetermine top 80% of ICD-9 codes by use and devise cross-walksWhat are your most frequently denied ICD-9 codes?Estimate and secure budget including costs associated with implementation such as software license costs, hardware procurement, and staff training costsReview Payer contracts for language related to diagnosis codesExclusionsCarve-outsReporting requirements

Knowledge AssessmentAssess staff knowledge: Coders, Billing editors, Denial resolution teamsPerform parallel coding analyses to determine productivity by team and individualsDetermine potential for loss of productivity

Readiness Assessments & Online Focus Training CoursesCoder Readiness Assessment Anatomy and PhysiologyICD-10 Focus Course: Neoplasms Musculoskeletal, Circulatory, Central & Peripheral Nervous Systems

ICD-10 coding involves knowledge of anatomy and physiology, medical terminology, pathophysiology and surgical methodologies and techniques

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Staff Training PlanCollect information from each department on current use of ICD-9 and the number of staff members who need ICD-10 resources and training Who: RCM staff, coding staff, clinicians, management and IT staffProvide individualized training based on knowledge gapsAnatomy, physiology etc.When? The actual "hands-on" staff training should start six to nine months prior to implementationEducate staff on changes in documentation requirements from health plans

ICD-10 coding involves knowledge of anatomy and physiology, medical terminology, pathophysiology and surgical methodologies and techniques

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ResourcesICD10Watch: http://www.icd10watch.com/ CMS: https://www.cms.gov/ICD10/ AAPC: http://www.aapc.com/ICD-10/AHIMA: http://www.ahima.org/ICD10/RBMAs ICD-10-CM Toolkit

Review Learning ObjectivesWhat impact ICD-10 will bring to our lives How Radiology Practice Management will be impacted What you should do with the extra time until implementation

Who thought of this?!ICD-10 Code V95.44Spacecraft fire injuring pilot

AgendaWhat is ICD-10? Prepare to implementQuestion & Answer

ASRT Code:VAD0052048

AAPC Code:26352HFHTB