ready or not here comes icd-10 presented by valerie milot, bs, ccs, ahima approved icd-10 cm/pcs...
TRANSCRIPT
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Ready or Not Here Comes ICD-
10Presented by
Valerie Milot, BS, CCS, AHIMA Approved ICD-10 CM/PCS Trainer
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DISCLAIMER
This material is designed and provided to communicate information about the implementation of ICD-10.
The author is not providing or offering legal advice but, rather, practical and useful information and tools to achieve compliant results in the area of clinical documentation, data quality, and coding which will help to reduce reimbursement delays & denials when ICD-10 goes live.
Every reasonable effort has been taken to ensure that the educational information provided is accurate and useful.
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Objectives
The five W’s
Dual Coding
Changes & Future Reimbursement Implications
Comparisons
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WHY are we doing this now?
The United States is the ONLY industrialized country that is not using ICD-10 for our coding & reporting of diseases, illnesses, & injuries.
Many Countries have been using ICD-10 for their case mix for decades.
Canada was the last country & they have been using ICD-10 for their case mix since 2001.
By changing to ICD-10-CM/PCS, the US healthcare system’s will be able to more accurately gauge healthcare services, improve the monitoring and surveillance of diseases, and produce quality healthcare data to improve patient outcomes.
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When do we have to
As of today- the implementation date is…. OCTOBER 1, 2015-
JUST 321 more days
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WHERE The entire country will start using ICD-10 when submitting
health claims when the implementation date comes
A few exceptions to the mandate for using ICD-10 are:
Worker’s Compensation Carriers may choose to continue to use ICD-9
Dentists may or may not be required to use ICD-10 when submitting their electronic claims (In combination with their CDT (current dental terminology) codes
Although required, some State Medicaid systems will not be ready
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What’s the Difference?
Diagnosis
ICD-9-CM 3-5 Digits or characters
1st character is numeric (with exception of E & V codes)
2nd-5th characters are numeric
Decimal is placed after the first 3 characters
17 chapters and the “V & E” codes are supplemental
Approximately 14,000 diagnosis codes
ICD-10-CM 3-7 Digits or characters
1st character is alpha (all letters are used except the “u”)
2nd-7th characters can be alpha and/or numeric
Decimal is placed after the first 3 characters
21 chapters and the “V & E” codes are NOT supplemental
Approximately 69,000 diagnosis codes
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Diagnosis ExampleICD-9-CM
Pressure ulcer codes 9 location codes
(707.00 – 707.09) Shows broad location, but not depth (stage)
ICD-10-CM Pressure ulcer codes 150 codes Show more specific location as well as depth, including:
L89.131 – Pressure ulcer of right lower back, stage 1
L89.132 – Pressure ulcer of right lower back, stage 2
L89.133 – Pressure ulcer of right lower back, stage 3
L89.134 – Pressure ulcer of right lower back, stage 4
L89.139 – Pressure ulcer of right lower back, unspecified stage
L89.141 – Pressure ulcer of left lower back, stage 1
L89.142 – Pressure ulcer of left lower back, stage 2 L89.143 – Pressure ulcer of left lower back, stage 3 L89.144 – Pressure ulcer of left lower back, stage 4 L89.149 – Pressure ulcer of left lower back, unspecified stage L89.151 – Pressure ulcer of sacral region, stage 1 L89.152 – Pressure ulcer of sacral region, stage 2
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What’s the Difference?
ProcedureICD-9-CM (Volume 3)
Minimum characters is 3
Maximum characters is 4
**Numeric format **
Decimal point
Approximately 3,000 procedure Codes
ICD-10-PCS Minimum characters is 7
Maximum characters is 7
**Alphanumeric format **
NO Decimal point
Approximately 71,920 procedure Codes
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Procedure Example
ICD-9-CM (Procedure) 86.04, Other incision with
drainage of skin and subcutaneous tissue
Doesn’t differentiate between skin or subcutaneous tissue
Doesn’t specify site (scalp, left arm, abdomen, buttocks)
ICD-10_PCS OH96XOZ, Drainage of back skin, with
drainage device, external approach
OH96XZZ, Drainage of back skin, external approach
PLUS- an additional 264 other codes specifying location (back, left arm, genitalia, etc.) the depth (skin or subcutaneous) the approach (external, open, percutaneous, percutaneous endoscopic) and drainage device.
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Who will be Ready
Providers
Hospitals
Payers
Vendors
It will depend on where you are at with implementation this time. October 1st will be here very soon
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Dual Coding When do you start- It’s never too soon! How often- Depends on the type of Facility/Provider
At a minimum recommendation is monthly, bimonthly for at least one day.
By starting earlier- will minimize some of the back log on the Health Care Organization as
staff will be comfortable & ready for the “Go Live” date
Starts identifying needs of coding, provider, & system risks/issues
Make sure you are logging any concerns, issues, risks identified-
Track your information on spreadsheets then sort to identify patterns of areas to determine the system, the condition(s), or the providers so education and corrections can be done BEFORE the implementation date
Clinical Documentation Improvement Specialist is crucial for success
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How long will dual coding/billing be needed
Within the Industry, you will hear a variety of timelines. There is the potential the dual coding & dual systems may be indefinite
Majority of Medical claims: minimum is potentially up to two years, depending on filing limits of the various carriers
HOWEVER- because of various Regulatory agencies such as the RAC’s, MAC’s, & even the OIG reviews, it may be longer because of appeals on denials & take backs
If Worker’s Carriers chose not to make the transition, the dual coding & it’s costs to manage two systems may be indefinite
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Estimated Costs of Implementation
CMS estimates the costs to the private sector to exceed $130 million
System upgrades throughout the organization may be needed For example- dietary, pharmacy, management, OR systems all
may use diagnosis and/or codes to perform their duties
Reduction in productivity in coding & billing AHIMA suggests after ICD-10 coders will be 50% slower for the
first 3 months.
Various figures have indicated even after staff have become comfortable with new processes, volumes will not return to ICD-9 numbers
Expect a 50 percent increase in provider queries
AAPC agrees & indicates that with current documentation, only 50 percent of encounters could be coded under ICD-10
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Hidden Costs with Implementation
Education & Training
Staff throughout the organization (not just coding)
Providers
Vendors may not be able or ready to accept ICD-10 which will delay reimbursements
Creating/revising current Query processes because the volume will be very high once implementation has occurred
Potential impact to Case Mix Index
Staffing shortages & overtime
Will work need to be Outsourced
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How soon will we start seeing changes in Reimbursement
Time after implementation will truly define how much reimbursement will change
If you spend the time now to determine the areas needed for improvement, it will minimize- The volume of queries to providers Reduce delays in completing visits (aka- DNFB) Reduce denials from Carriers
CMS has already been providing information on what the DRG (as well as CC and MCC’s) will be on specific final diagnosis
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Comparisons Following industries recommendations is strongly
suggested. You will need to review your top ten (or twenty if possible) current DRG’s. Have them dual coded to determine: Potential impact with the new coding structure If current documentation supports the necessary
information needed to code to the highest level of coding accuracy
Current processes such as forms, query processes and policies will support the new structure
Let’s take a look at a couple of examples on the differences….
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Example 1: Pressure ulcer of buttock stage III with gangrene (both present on admission) (ICD-10-CM guidelines specify a sequencing change that changes the principal Dx and the MS-DRG)
ICD-9 707.05 Pressure ulcer, buttock
707.23 Pressure ulcer, stage III (MCC)
785.4 Gangrene (CC)
MS-DRG 592 Skin Ulcers W MCC
RW 1.4753
ICD-10 I96 Gangrene, NEC
L89.303 Pressure ulcer of unspecified buttock, stage III (MCC)
MS-DRG 299 Peripheral vascular disorders W MCC
RW 1.4072
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Example 2: Pneumonia patient with NSTEMI MI two weeks ago (treated during the inpatient stay) (ICD-10-CM defines AMIs as 4 weeks, and classifies them differently, resulting in an MCC for this example) ICD-9 486 Pneumonia
410.72 subendocardial infarction, subsequent episode of care
MS DRG 195 Simple pneumonia w/o CC/MCC
RW 0.7096
ICD-10 J18.9 Pneumonia
I21.4 Non-ST elevation (NSTEMI) myocardial infarction (MCC)
MS DRG 193 Simple pneumonia w MCC
RW 1.4796
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QUESTIONS?
So who has a headache now
Will it really happen
If it does- Will you be ready
Does anyone have any questions
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Helpful Resources/Links from CMS http://cms.gov/Medicare/Coding/ICD10/index.html
http://www.roadto10.org/quick-references/
http://cms.gov/Medicare/Coding/ICD10/ICD-10-MS-DRG-Conversion-Project.html
http://cms.gov/Medicare/Coding/ICD10/Medicare-Fee-For-Service-Provider-Resources.html
http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD-10Overview.pdf
http://www.roadto10.org/action-plan/phase-2-train/common-codes-family-practice/
http://www.cms.gov/Medicare/Coding/ICD10/index.html
http://www.cms.gov/Medicare/Coding/ICD10/Medicare-Fee-For-Service-Provider-Resources.html
http://cms.gov/Medicare/Coding/ICD10/CMSImplementationPlanning.html
http://www.cms.gov/Medicare/Coding/ICD10/ICD-10ImplementationTimelines.html
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/Guided_Pathways_Provider_Specific_Booklet.pdf
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_049750.hcsp?dDocName=bok1_049750
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Contact Information
Presentation by Valerie Milot, BS, CCS, AHIMA Approved ICD-10 CM/PCS Trainer, Director of Physician Services
Tel: (603) 530-1459Medical Reimbursement Specialists, LLC Codeaid LLC
PO Box 486266A Summer StBristol, NH 03222
Main Office Tel: 603-217-0006FAX: (603)-947-1458
www.mrsnh.com
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References American Academy of Professional Coders, https://www.aapc.com/
American Health Information Management Association, http://www.ahima.org/icd10/
California Health Information Management Association, June 2014 presentation obtained at http://californiahia.org/sites/californiahia.org/files/docs/events/handouts/convention/mon-red-100.pdf
Center for Medicare and Medicaid Services, see the previous ‘resources’ slide for various sites/documents used for this presentation
UASI, Stanfill, Jan 2012, obtained at http://www.uasi-qc.com/insights-education/news/article/power-10-reimbursement-impact-icd-10