Welcome to the APMA “ICD-10 is Here Webinar Series” presented by the APMA Coding Committee

•LIVE: •January 9, 2014 8pm ET

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Tonight’s Webinar: ICD-10-CM Timelines / Rules / Basics

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Welcome to the APMA ICD-10-CM Webinar Series Kick-Off

• Review and planning on ICD-10-CM has been underway since 2010 by the Coding Committee.

• Over the next 9 months the Coding Committee will be providing APMA members ICD-10-CM training.

• Each Webinar will address different portions of the more pertinent 68,000 codes that are relevant to podiatry.

• We feel we have addressed the vast majority of diagnosis codes you need to learn but by no means can every code be covered during the series. 3

The APMA Coding Committee participants for this ICD-10-CM webinar:

1) David J. Freedman, DPM 2) Paul Kinberg, DPM 3) Rick Horsman, DPM 4) Sahani C. Howie DPM 5) Barbara Aung, DPM 6) Seth Rubenstein, DPM 7) Larry Santi, DPM

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What can you do to prepare for upcoming webinars? • Are you considering retirement in lieu of the transition to ICD-10? Answer: 82% said NO • How many seminars / webinars (APMA or other) have you already

attended? Answer: 64% have while 36% this is your first • On a scale of 1-5, with 5 being "Very prepared", how prepared do

you feel you are for the transition to ICD-10? Answer: 6% feel they are either Somewhat prepared or Getting close.

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• link: http://www.apma.org/YourPractice/content.cfm?ItemNumber=1413

• APMA has been Preparing You Over the past year have you read the APMA News Articles?

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APMA Coding Resource Center • You now have the ability to search and look at all the ICD-10-CM codes

at: www.apmacodingcrc.org

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APMA Coding Resource Center

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APMA Coding Resource Center

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APMA Coding Resource Center

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Webinar Series Scheduled

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Webinar Series Scheduled

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Webinar Series Scheduled

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Webinar Series Scheduled

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ICD-10-CM Timelines / Rules / Basics • Need to understand the concept of ICD-10-CM

• Implementation date is Oct, 1 2014 • ICD-10-CM applies to CMS and most private

insurance Companies but there is an EXCEPTION TO THE RULE

• Exception: Workers Compensation and Auto Insurance are NOT mandated to switch, what does this mean to you?

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Potential negative impacts • Decreased productivity • Interrupted cash flow • Increased amount of rejections • Incompatible systems • Increased volumes of work • Incorrect mapping • Increased risk of payer audits

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Discussion Points • History of ICD and WHO? • Why are we changing? • What is ICD-10-CM? • What is the difference between CM and PCS? • Examples • What’s it going to cost? • What do I do to get ready?

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Resources:

CMS links 1. www.cms.gov/ICD10/17_ICD10_MS_DRG_Convers

ion_Project.asp 2. http://www.codingbooks.com/catalogsearch/res

ult/?q=icd+10 3. http://www.cms.gov/Outreach-and-

Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1239.pdf

CDC links 1. http://www.cdc.gov/nchs/icd/icd10cm.htm

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ICD-10 Rules, So Why Bother? FACT • The ICD-10-CM book is set up like the ICD-9-CM. • So how many people watching and/or listening to this

webinar have ever reviewed the ICD-9-CM rules and instructions?

Answer: Typically, the answer at seminars by the vast majority of participants “have never bothered to learn the rules”! So, although it may not seem on the surface as being important, knowing basic rules of ICD-10-CM can only help you!

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ICD-10 Rules “SYMBOLS and CONVENTIONS Continued” 1) The “Excludes 1” is when two conditions can not occur together. 2) The “Excludes 2” means not included here. This is the case where it is acceptable to use both the code and the excluded code together. 3) The Code first/Use additional code means when there are multiple body system manifestations you code the underlying condition first and the manifestation second.

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ICD-10 Rules “SYMBOLS and CONVENTIONS Continued” 4) “In diseases classified elsewhere” these codes are never permitted to be used as first line codes. These codes must be listed after the underlying condition. 5) “Code also” means two codes may be required but the sequencing of the codes is discretionary. 6) “7th characters” means the applicable 7th character must always be used and placeholder “x” used as a 5th character and/or 6th character codes to allow for future expansion. 7) “and” This word is interpreted as either “and” or “or”.

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ICD-10 Rules “SYMBOLS and CONVENTIONS Continued” 8) “Includes” in a colored box further defines or gives examples of the content. This notation appears immediately under a code title. 9) Abbreviations: “NEC”=”Not Elsewhere Classifiable” this is another specified code, used when a more specific code is not available. “NOS” = “Not otherwise specified”, this indicates an unspecified code. 10) Each ICD-10-CM diagnosis codes are to be reported ONCE for an encounter. When bilateral conditions exist, this one listed code counts when no distinct code for laterality or two different conditions are classified. •

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ICD-10 Rules “SYMBOLS and CONVENTIONS Continued” 11) Documentation for BMI should only report as secondary diagnosis codes. 12) The instruction “see” acts as a cross reference and directs the user to look elsewhere. This instruction is often found when the term or condition may not be the appropriate term. This is a mandatory instruction and must be followed for proper code selection. 13) “See also” is a reference instruction note to refer to a specific category, subcategory, or classification before making a code selection if you cannot find the diagnosis listed under a term in Volume 2.

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ICD-10 Rules “SYMBOLS and CONVENTIONS Continued” 14) Laterality. An unspecified side code is also provided should the side not be identified in the medical record. The unspecified side is either ends with a character 0 or 9 depending on whether it is a fifth or sixth character. 15) Dummy Place holders – using the character “x”. The “x” is used as fifth or sixth character placeholder to allow for future expansion. Some codes in ICD-10-CM require either 6th or 7th characters in the code. If the code, for example, had 5 characters and a seventh character was required based on the instructional notes, dummy placeholder would be used in sixth character position to allow for the seventh character to be reported 24

“SYMBOLS and CONVENTIONS Continued” 16) [ ] Brackets are used in the index and to identify manifestation codes. 17) ( ) Parentheses are used in both the Index and Tabular List to enclose supplemental words that do NOT affect the code number. The terms within the parentheses are referred to as nonessential modifiers. 18) : Colon is used after an incomplete term that needs one or more of the modifiers that allow it assignable to a given category. 19) – Dash at the end of a code indicates additional digits are required to complete the diagnostic term. 20) , Comma – words following a comma are essential modifiers. The term in the inclusion note must be present in the diagnostic statement to qualify the code.

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Direct Comparison ICD-9 (five digits) X X X . X X Category etiology anatomic site, manifestation ICD-10 (seven digits) X X X . X X X X Category etiology extension anatomic site, severity

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Characters 1-3

• 1st Character Alpha A-Z • 2nd Character Numeric 0-9 • 3rd Character Numeric 0-9 Describes system or disease process

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ICD-10 Terms • Chapters

• 22 Chapters identifying categories • Blocks

• Subchapters • Etiology, anatomical site, severity

• Rubrics • Identify closely related conditions • Extensions

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ICD-10 Chapters • Chapter 1 A00-B99 Infectious and Parasitic diseases • Chapter 2 C00-D49 Neoplasms • Chapter 3 D50-D89 Hematological and Immune Systems • Chapter 4 E00-E90 Endocrine, Nutritional and Metabolic Diseases • Chapter 5 F01-F99 Mental and Behavioral Disorders • Chapter 6 G00-G99 Diseases of the Nervous System • Chapter 7 H00-H59 Diseases of the Eye and Adnexa

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• Chapter 8 H-60-H95 Diseases of the Ear and Mastoid Process • Chapter 9 I01-I99 Diseases of the Circulatory System • Chapter 10 J00-J99 Diseases of the Repiratory System • Chapter 11 K00-K94 Diseases of the Digestive System • Chapter 12 L00-L99 Diseases of the Skin and Subcutaneous Tissue • Chapter 13 M00-M99 Disease of the Musculoskeletal System and Connective Tissue • Chapter 14 N00-N99 Diseases of the Genitourinary System

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• Chapter 15 O00-O99 Pregnancy, Childbirth and Puerperium • Chapter 16 P00-P96 Certain Conditions Originating in the Perinatal

Period • Chapter 17 Q00-Q99 Congenital Malformations, Deformations and

Chromosomal Abnormalities • Chapter 18 R00-R99 Symptoms, Signs and Abnormal Clinical and

Laboratory findings, not classified elsewhere • Chapter 19 S00-T88 Injury, Poisoning and Certain other Consequences of External Causes • Chapter 20 V00-Y98 External Causes of Disease or Morbidity • Chapter 21 Z00-Z99 Factors Influencing Health Status and Contact with

Health Services • Chapter 22 – Special Purposes

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ICD-10 Example • START WITH INDEX • There is a period after the 3rd character and often a dash • Example Pain

M79. –

• NEXT TO TABULAR - Define the site, etiology, manifestation or state of the disease or condition • Example Pain

• M79. -

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4th Character

• Define the site, etiology, manifestation or state of the disease or condition

• Numeric

• Example Pain • M79. -

• M79.6- pain in limb, hand, foot, fingers, toes

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5th Character

• 5th character identifies a level of specificity • Letter or Number (0-9) • Example

• M79.- Pain • M79.6- pain in limb, hand, foot, fingers, toes

• M79.60- Pain in limb

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• 6th character is even more specific

• Numeric (0-9) • Describes specific location or cause • For laterality

• 1 is right • 2 is left • 3 is unspecified

• Example Pain • M79.-

• M79.6- pain in limb, hand, foot, fingers, toes • M79.60- Pain in limb unspecified • M79.671 Pain in right foot 35

Dummy Character • Just to confuse you even more

• To allow for further expansion some codes have a “dummy” 4th, 5th

place character so that the 6th character structure will not be disrupted when changes are added

• Report these codes as they are in the book including the “dummy”5th character “x”

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7th Character

• Some codes have a so-called character extension

• Typically letters, that describe conditions/timing of the visit

• Used to give more information about the events related to the reason for the visit or service

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• Non-fracture care • A- initial encounter • D- subsequent

encounter • S- sequela

• Fracture care • A- initial encounter (for closed

fracture) • B- initial encounter for open

fracture • D- subsequent encounter for

normal healing fracture • G- subsequent encounter for

delayed healing fracture • K- subsequent encounter for

fracture with non-union • P- subsequent encounter for

fracture with mal-union • S- sequela of fracture

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Strategies for Success • The first place to begin in preparing for ICD-10

implementation is with communication • Keep everyone updated on what is happening • No delay, we need to continue to prepare for the

transition • If you take it seriously, so will the people you are leading • What form of communication will be most effective in

your office/institution

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Impact analysis Create a flow chart to:

• Demonstrate how the action of each individual impacts the entire process

• Identify areas of weakness and quickly create a process to strengthen it

• Clearly illustrates the need for interaction between clinical or business areas

• Generate ownership of each process • Provides a clear picture of how things work today and can

outline how things should work in the future

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Impact analysis

• Determine any area in the practice that currently utilizes an ICD-9-CM code

• Ask for input from the various departments to ensure that nothing is overlooked

• How are performance measures captured • Prior authorizations • Research • Tracking and trending

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Build an action plan

• Build an action plan based on the results of the impact analysis • Create a preliminary needs assessment • Establish timeline parameters to create a roadmap • Adhere to the timeline, but be open-minded to allow for

unexpected circumstances • Begin discussion early with vendors to understand their timelines

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Measure productivity • Understand where productivity is at prior to the implementation of

ICD-10 • Use this as a “goal” to get back to after the official implementation

date • Canada indicates that their productivity has not recovered since

implementation

• Different reimbursement system • Implemented EMR at same time as ICD-10 • Went from DOS system to an electronic world

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Questions for Consideration: • Have you identified all internal systems and processes that will be

impacted by the change to ICD-10?

• Has your office performed a cost analysis to understand the financial impact for your organization? For example, revenue impacts that could result from improperly coded claims

• Have you identified all inter-dependencies on external partners such as coding vendors, clearinghouses, etc.? Have you confirmed that all remediation and testing dates are mutually acceptable?

• Do you know if you will be utilizing the CMS crosswalks and if so, what impact those may have on expected outcomes?

• Will you be trying to realize any benefit or value from this new code set?

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•Our Next Webinar is: •1/23/2014 “Documentation Requirements Fact or Fiction?”

•Now Q&A

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