PYA Staff Consultant Kim-Marie Walker updated physicians at Robins Air Force Base on the latest in ICD-10 as part of “Soaring Together: A Collaboration in Continuing Medical Education."

1. Preparing Now For ICD-10-CM
Warner Robins AFB
CME Event
November 1, 2013
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2. Agenda
• ICD-9 and ICD-10
Comparison
• ICD-10 Organization and
Structural Differences
• ICD-10-PCS
• Vendor Recommendations
and Resources Available
• Discuss Transition Planning
and Roles
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3. ICD-10 vs. ICD-9
Issue
ICD-9-CM
ICD-10-CM
Volume of codes
Approximately 13,600
Approximately 69,000
Composition of codes
Mostly numeric, with E and V codes
alphanumeric.
All codes are alphanumeric, beginning
with a letter and with a mix of numbers
and letters thereafter. Valid codes may
have three, four, five, six or seven digits.
Valid codes of three, four, or five
digits.
Duplication of code sets
Currently, only ICD-9-CM codes are
required . No mapping is necessary.
For a period of up to two years, systems
will need to access both ICD-9-CM codes
and ICD-10-CM codes as the country
transitions from ICD-9-CM to ICD-10-CM.
Mapping will be necessary so that
equivalent codes can be found for issues
of disease tracking, medical necessity
edits and outcomes studies.
Source: http://www.aapc.com/icd-10/faq.aspx#why
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4. What are the benefits of ICD-10?
The new, up-to-date classification system will provide much better data needed to:
•
Measure the quality, safety, and efficacy of care
•
Reduce the need for attachments to explain the patient’s condition
•
Design payment systems and process claims for reimbursement
•
Conduct research, epidemiological studies, and clinical trials
•
Set health policy
•
Support operational and strategic planning
•
Design healthcare delivery systems
•
Monitor resource utilization
•
Improve clinical, financial, and administrative performance
•
Prevent and detect healthcare fraud and abuse
•
Track public health and risks
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5. • ICD-9 is out of room
• Because the classification is
organized scientifically, each
three-digit category can have
only 10 subcategories
• Most numbers in most
categories have been assigned
diagnoses
• Medical science keeps making
new discoveries, and there are
no numbers to assign these
diagnoses
Benefits:
Barriers:
Why is the United States moving to
ICD-10-CM?
• ICD-10-CM, will allow for better
analysis of disease patterns and
treatment outcomes that can
advance medical care
• Streamline claims submissions
(code combinations )
• Details will make the initial claim
much easier for payers to
understand
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6. But…
• ICD-10 will influence billing documentation, provider
contracting, payment, and other major business
functions, as well as IT systems for trend analysis and
analytics; claims and documentation in both paper
and electronic form have been overhauled.
• Moving to ICD-10 is intended to bring the benefits of
greater coding accuracy, higher data quality for
measuring service and outcomes, more efficiency,
lower costs, better use of the electronic health record,
and better alignment worldwide, to name a few.
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7. What can we learn from other
countries’ implementation?
• Planning and preparation are the keys to success
– Start early to allow time to understand the impact and
come up with solutions
• Education and training are all important
– Prepare for productivity loss and longer turn around
times
• Collaborate with others
– Share information and experiences to learn what
works and what to avoid
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8. CPT (Yes) – Volume 3 (No)
Current Procedural Terminology (CPT)
• CPT remains for professional procedure coding
(these codes are used to describe medical, surgical
and diagnostic services to third party payers for
reimbursement.
ICD-9-CM Volume 3
• ICD-9-CM Volume 3 will be replaced with ICD-10PCS for facility procedure coding
• ICD-10-PCS will increase from 4,000 to 200,000
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9. Two sets of codes
are being replaced
ICD-10-CM
• Diagnosis Coding System – Used to
report the patient‟s condition (i.e., what‟s
wrong with the patient)
• Direct replacement for ICD-9-CM
Volumes 1 & 2
• Will be used in all settings – hospital
inpatient, hospital outpatient, physician
office, etc.
• Like ICD-9-CM, developed and
maintained by the World Health
Organization (WHO) and the National
Center for Health Statistics within the
Centers for Disease Control
ICD-10-PCS
• Procedure Coding System – Used to
report surgical procedures performed
• Direct replacement for ICD-9-CM
Volume 3
• Only used in a hospital inpatient setting
(and only for reporting facility services)
• Like ICD-9-CM Volume 3, ICD-10-PCS
was developed and is maintained by
CMS
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10. ICD-10-PCS
• Each code must have 7 characters
• Each can be either alpha or numeric
– Numbers 0-9
– Letters A-H, J-N, P-Z
• Alpha characters are not case-sensitive
• Index provides the first 3 characters of code,
associated with a code table
• Table is referenced to build the last 4 characters
• Table arranged in rows to allow only valid character
combinations
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11. Anatomy of an ICD-10-PCS Code
1
2
3
Root
Operation
Section
Body
System
1.
2.
3.
4.
5.
6.
7.
4
5
6
Approach
Body Part
7
Qualifier
Device
Section relates to type of procedure
Body system refers to general body system
Root operation specifies objective of procedure
Body part refers to specific part of body system on which procedure is being performed
Approach is the technique used to reach the site of the procedure
Device specifies devices that remain after procedure is completed
Qualifier provides additional information about procedure
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12. How will ICD-10-PCS affect
Physician Coding ?
•
ICD-10-PCS will not affect coding of physicians‟ services in their offices; however,
providers should be aware that documentation requirements under ICD-CM-PCS are
quite different, so their inpatient medical record documentation will be affected by this
change
•
The ICD-10-PCS codes are for use only on hospital claims for inpatient procedures
•
ICD-10-PCS codes are not to be used on any type of physician claims for physician
services provided to hospitalized patients; these codes differ from the ICD-9-CM
procedure codes in that they have 7 characters that can be either alpha (non-case
sensitive) or numeric. The numbers 0 - 9 are used (letters O and I are not used to
avoid confusion with numbers 0 and 1), and they do not contain decimals.
Examples:
– 0FB03ZX - Excision of liver, percutaneous approach, diagnostic
– 0DQ10ZZ - Repair, upper esophagus, open approach
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13. How will ICD-10-PCS affect
Physician Coding ?
• Although physicians do not need to know
precisely how the system works, the importance
of operative report documentation is vital
• Hospital coders will need to translate the clinical
information from the physician‟s operative report
into the new ICD-10-PCS system
• Incomplete documentation will result in queries,
delaying the billing process
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14. What does ICD-10-CM
look like?
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15. ICD-10-CM Organization
The CM Manual divided into three main parts:
Official Guidelines
21 Chapters
Expanded injury
codes grouped
by site vs. type
of injury
Index to Diseases
and Injuries
Laterality (left
and right)
Tabular List of
Diseases and
Injuries
V and E codes
incorporated into
main
classification
Added a
placeholder X
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16. Anatomy of an ICD-10-CM Code
3-7 Alphanumeric characters (digits)
X
X
X
character –
Alpha (A-Z)
1st
.
X
2nd
X
X
X
character Numeric
3rd - 7th
characters –
Alpha or
Numeric
Decimal
placed after
the first 3
characters
• All letters but U are used
• The letters I & O are used only in the 1st character position
• Each letter is associated with a particular chapter (Except C&D
Neoplasms )
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17. ICD-10-CM Characters and
Extensions
Alpha
(Except U)
2 - 7 Numeric or
Alpha
M X X
A
X 0 2
S
Category
.
X X X
6 5 x
Etiology, anatomic
site, severity
Additional
Characters
A
X
Added code
extensions (7th
character) for
obstetrics,
injuries, and
external causes
of injury
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18. Placeholder Character
• X Marks the Spot
– ICD-10-CM uses a placeholder character
“X” this will allow the code future expansion.
– Where a placeholder, the X must be used in
order for the code to be valid. (The X is not
case sensitive.)
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19. 7th Character Extension
• Certain ICD-10-CM categories have a 7th character
feature; this “character” must always be in the 7th
character field.
• These extensions are found predominantly in two
chapters:
– Chapter 19 – Injury, Poisoning and Certain Other
Consequences of External Causes
– Chapter 15 – Pregnancy, Childbirth and the Puerperium
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20. If a diagnosis code requires a
7th digit and the code is a
4-digit code, what do you do?
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21. Place an x in the 5th and 6th digit
ICD-10-CM utilizes a placeholder: Character “x” is used as
a 5th character placeholder in certain 6 character codes.
• To fill in other empty characters (e.g., character 5 and/or 6)
when a code that is less than 6 characters in length requires
a 7th character
Examples:
• T46.1x5A – Adverse effect of calcium-channel blockers, initial encounter
• S03.4xxA- Sprain of jaw, initial encounter
• T15.02xD – Foreign body in cornea, left eye, subsequent encounter
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22. Fetus Identification
When applicable, a 7th character is
to be assigned to identify the fetus to
which the complication applies.
The following are the 7th characters:
• 0 - not applicable or unspecified
• 1 - fetus 1
• 2 - fetus 2
• 3 - fetus 3
• 4 - fetus 4
• 5 - fetus 5
• 9 - other fetus
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23. Episode of Care – Fractures
Fractures
• Assigning episode of care 7th characters for
fractures is a bit more complicated because
the episode of care provides additional
information about the fracture including:
– whether the fracture is open or closed
– whether healing is routine or with complications
such as delayed healing, nonunion, or malunion
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24. Episode of Care – 7th digit
• Initial encounter. Initial encounter is defined as the period
when the patient is receiving active treatment for the injury,
poisoning, or other consequences of an external cause. An
„A‟ may be assigned on more than one claim.
– For example, if a patient is seen in the emergency department
(ED) for a back injury that is first evaluated by the ED
physician who requests a MRI that is read by a radiologist and
a consultation by a neurologist, the 7th character „A‟ is used by
all three physicians and also reported on the ED claim.
– If the patient required admission to an acute care hospital, the
7th character „A‟ would be reported for the entire acute care
hospital stay because the 7th character extension „A‟ is used
for the entire period that the patient receives active treatment
for the injury.
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25. Episode of Care – 7th digit
• Subsequent encounter. This is an encounter after the
active phase of treatment and when the patient is
receiving routine care for the injury during the period of
healing or recovery.
– For example a patient with a knee injury may return to
the office to have joint stability re-evaluated to ensure
that it is healing properly. In this case, the 7th character
„D‟ would be assigned.
• Sequela (Late Effects)The 7th character extension „S‟ is
assigned for complications or conditions that arise as a
direct result of an injury. There is no time limit when these
codes can be used.
– An example of a sequela is a scar resulting from a
burn.
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26. Episode of Care – Fractures
A
• Initial encounter for closed fracture
B
• Initial encounter for open fracture
D
• Subsequent encounter for fracture with routine healing
G
• Subsequent encounter for fracture with delayed healing
K
• Subsequent encounter for fracture with nonunion
P
• Subsequent encounter for fracture with malunion
S
• Sequela
 If the fracture is not documented as open or closed, it is coded to closed.
 Additionally, if the fracture is not documented as displaced or not displaces, it
should be coded as displaced.
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27. More Information Reported,
Higher Level of Detail in
Coding
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28. Laterality
• Some ICD-10-CM codes indicate laterality, specifying
whether the condition occurs on the left, right or bilateral.
• If no bilateral code is provided and the condition is
bilateral, assign separate codes for both the left and right
side.
• If the side is not identified in the medical record, assign
the code for the unspecified side.
Examples:
– C50.511 – Malignant neoplasm of lower-outer quadrant of right
female breast
– H16.013 – Central corneal ulcer, bilateral
– L89.012 – Pressure ulcer of right elbow, stage II
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29. Combination Codes
Combination codes for certain conditions and common associated
symptoms and manifestations
Examples:
• K57.21 – Diverticulitis of large intestine with perforation and abscess with
bleeding
• E11.341 – Type 2 diabetes mellitus with severe nonproliferative diabetic
retinopathy with macular edema
• I25.110 – Atherosclerotic heart disease of native coronary artery with
unstable angina pectoris
Combination codes for poisonings and their associated external cause
Example:
• T42.3x2S – Poisoning by barbiturates, intentional self-harm, sequela
(late effect)
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30. ICD-10-CM continued…
Obstetric codes identify trimester
instead of episode of care.
• 1st Trimester – less than 14
weeks 0 days
• 2nd Trimester – 14 weeks 0 days
to less than 28 weeks 0 days
• 3rd Trimester – 28 weeks 0 days
until delivery
Example:
• O26.02 – Excessive weight gain in
pregnancy, second trimester
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31. New Clinical Concepts
Inclusion of clinical concepts that do not exist in ICD9-CM (e.g., underdosing, blood type, blood alcohol
level)
Examples:
• T45.526D – Underdosing of antithrombotic drugs,
subsequent encounter
• Z67.40 – Type O blood, Rh positive
• Y90.6 – Blood alcohol level of 120–199 mg/100 ml
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32. Codes That Have Been Significantly
Expanded
A number of codes have been significantly expanded
(e.g., injuries, diabetes, substance abuse, postoperative
complications).
Examples:
• E10.610 – Type 1 diabetes mellitus with diabetic
neuropathic arthropathy
• F10.182 – Alcohol abuse with alcohol-induced sleep
disorder
• T82.02xA – Displacement of heart valve prosthesis,
initial encounter
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33. Post/intra-operative designation
Codes for postoperative complications have a
distinction made between intraoperative
complications and postprocedural disorders
Examples:
• D78.01 – Intraoperative hemorrhage and hematoma of
spleen complicating a procedure on the spleen
• D78.21 – Postprocedural hemorrhage and hematoma of
spleen following a procedure on the spleen
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34. Additional changes in ICD-10-CM
• Injuries are grouped by anatomical site rather than by
type of injury.
• Category restructuring and code reorganization have
occurred in a number of ICD-10-CM chapters,
resulting in the classification of certain diseases and
disorders that are different from ICD-9-CM.
• Certain diseases have been reclassified to different
chapters or sections in order to reflect current medical
knowledge.
• New code definitions (e.g., definition of acute
myocardial infarction is now 4 weeks rather than 8
weeks)
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35. Use of External
Causes
If a payer required
E-Codes with ICD-9,
then continue to
submit in ICD-10. In
the absence of a
mandatory reporting
requirement, you are
encouraged to
report these codes
as they add valuable
data.
This infographic first appeared in the Healthcare IT News and Healthcare Finance
News eSupplement, ICD-10 Compliance and Beyond: Completing the Journey.
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http://www.healthcareitnews.com/infographic/infographic-top-zaniest-icdPage 34
10-codes

36. Where can I find the
ICD-10-CM Codes?
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37. Crosswalk
• Partial solution-these are tools to
convert ICD-9 to ICD-10 and vice
versa.
• To assist with the transition,
cross-walking between the code
sets will assist you with identifying
the differences between ICD-9
and ICD-10.
• Not a high percentage of accuracy
due to increased complexity of
ICD-10 versus ICD-9
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38. GEMs
GEMs are a comprehensive translation dictionary that can be used to accurately
and effectively translate any ICD-9-CM-based data, including data for:
– Tracking quality
– Recording morbidity/mortality
– Calculating reimbursement
– Converting any ICD-9-CM-based application to ICD-10-CM/PCS
The GEMs are not a substitute for learning how to use the ICD-10 codes.
More information about GEMs and their use can be found on the CMS website at:
•
http://www.cms.gov/Medicare/Coding/ICD10/index.html
(select from the left side of the web page ICD-10-CM or ICD-10-PCS to find
the most recent GEMs)
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39. Practical Mappings
GEM Examples – ICD-9 to ICD-10
ICD-9-CM: 902.41 Injury to renal
artery
ICD-10-CM GEM:
S35.403A Unspecified injury
of unspecified renal artery,
initial encounter
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40. How Does the Mapping Work?
ICD-9-CM
• 493.92 Asthma,
Acute Exacerbation
ICD-10-CM
• J45.21 Mild, intermittent,
w/acute exacerbation
• J45.41 Moderate,
persistent, w/acute
exacerbation
• J45.51 Severe,
persistent, w/acute
exacerbation
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41. Percentages of Types of Matches
Mapping
Categories
ICD-10 to
ICD-9
ICD-9 to
ICD-10
No Match
1.2%
3.0%
1-to-1 Exact Match
5.0%
24.2%
1-to-1 Approximate Match with 1 Choice
82.6%
49.1%
1-to-1 Approximate Match with Multiple Choices
4.3%
18.7%
1-to-Many Matches with 1 Scenario
6.6%
2.1%
1-to-Many Matches with Multiple Scenarios
0.2%
2.9%
Source: http://www.ama-assn.org/ama1/pub/upload/mm/399/crosswalking-between-icd-9-and-icd-10.pdf
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42. Where should I be in my
ICD-10-CM Implementation Process?
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43. Implementation Process
Analysis of all Departments
Processes
Reports
Work Flow
Information
Systems and
Software
All Forms of
Documentation
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44. Implementation Issues
Training
• Will be required for various users
• Will require coder retraining
– Coding rules and conventions are similar, but not exactly
the same
• Some short-term loss of productivity is expected during the
learning curve
• Will require changes in data retrieval/analysis
• Will require changes to data systems
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45. Training
Coding and Billing Staff
• Assess training needs and develop a plan.
– Professional coding staff – ICD-10-CM
– Determine who will train staff and how
this will be accomplished
– Factor in time away from work, consider
post-testing and ongoing support
– Make ICD-10 proficiency part of your
coding staff‟s performance goals
» ICD-9-CM to ICD-10-CM Dual Coding
• Assign staff members to be the
“ICD-10 Expert” looking at the impact
from the billing to the clinical side .
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46. Training
Clinicians
• Physicians – focus on codes germane to their practice.
• Review clinical documentation improvement efforts and develop new
strategies.
• Incorporate documentation improvement as component to compliance
training.
• Ancillary staff – identify needs and level of training needed, nursing,
financial services, quality, utilization, ancillary departments…
Information Technology
• Training to ensure that codes are accurately cross-walked in
organization‟s IT systems.
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47. ICD-10 Timeline for
Small-Medium Practices at a Glance
Source: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10SmallMediumTimelineChart.pdf
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48. ICD-10 Timeline for
Large Practices at a Glance
Source: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10LargePracticesTimelineChart.pdf
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49. ICD 10 & EHR
•
Analyze EHR for functionality and
compliance
•
Review:
– templates
– interfaces
– default documentation
– level of detail
•
Confirm EHR is updated with the ability to
communicate to the billing system in ICD10 language
– Is your PM integrated with your EHR?
– Look for products to include drop down
menus and selection edits
– Need appropriate “granularity” to accurately
capture correct code
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50. EHR Vendor Questions
• Can EHR translate ICD-9 to ICD-10 format?
• Can your EHR differentiate date of service for reporting ICD9 or ICD-10?
• Will ICD-9 code from previous visit translate in new
encounter as ICD-10?
• Will system document ICD-10 on and after October 1, 2013?
• Are diagnoses linked from diagnostic results?
• What are the capabilities of automated and manual
documentation entry?
• Do you anticipate any pricing changes due to the switch to
ICD-10?
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51. Vendor Readiness
Our billing software vendor indicates they will be ready for
these transitions. What can I do in the meantime, besides train
for ICD-10 coding?
• Ask your billing software vendor for a detailed schedule of
deliverables and begin preparing to test implementation of the
modified software at your location.
• Be sure to verify the following:
– The vendor is addressing the ICD-10 upgrades
– The number and schedule of planned ICD-10 software releases
– Their ICD-10 conversion plan accommodates your clearinghouse
testing schedule
– Any related costs to your organization
– Customer support and training they will provide
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52. Computer Assisted Coding (CAC)
• Is this the answer?
– Select the right codes
– Ensuring that those codes are justified and
supported in the documentation
– Interfacing coded data correctly to billing systems
– Education billing teams about appropriate codes
– Provide documentation and feedback/education
to physicians
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53. Clinical Documentation
• Preparing for ICD-10 from a clinical documentation
perspective is somewhat different than preparing for
ICD-10 from a coding perspective
• Focusing on increasing the specificity of
documentation related to the most current, clinically
accurate descriptions of diseases and surgical
procedures
– Laterality
– Initial, Subsequent, or Sequela Encounters
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54. Physician Work Flow
• Will the EMR allow the physician to enter a descriptive
diagnosis rather than a specific diagnosis code?
• Is the physician prepared for the dramatic increase in
diagnosis codes now displayed on the drop-down list?
• How will the physician‟s workflow change when more
time is needed to assign the appropriate diagnosis
code?
• Can the EMR support a workflow that sends patient
encounters to coders for review and assignment of
the most specific diagnosis code based on the
physician‟s documentation?
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55. How will ICD-10 Benefit the
Physicians
• Grow compensation and reimbursement
• Determine severity and prove medical
necessity
• Better information about patient populations
for use in quality and outcome programs
• Reduce the hassle of audits
• Gain access to better clinical information
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56. Fact or Fiction
ICD-10-CM-based super bills will be too long or too complex to be of much use
Fiction (sort of)
•
Practices may continue to create super bills that contain the most common
diagnosis codes used in their practice. ICD-10-CM-based super bills will not
necessarily be longer or more complex than ICD-9-CM-based super bills. Neither
currently-used super bills nor ICD-10-CM-based super bills provide all possible
code options for many conditions.
•
The super bill conversion process includes:
– Conducting a review that includes removing rarely used codes; and
– Cross walking common codes from ICD-9-CM to ICD-10-CM, which can be
accomplished by looking up codes in the ICD-10-CM code book or using the General
Equivalence Mappings (GEM).
– Vendors electronic superbill and posting scrubber that assist physicians in the
transition to ICD-10.
Source: http://www.whiteplume.com/learn-more/icd-10
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57. Payer’s Role
• Communicate with your top payers to see what,
if any, ICD-10-CM changes will take place prior
to the Oct 1, 2014 deadline
– When will their testing begin?
– What will be required on your end?
• Additional staff recourses
– Prior authorizations granted for services to be
performed after Oct 1, 2014
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58. Payer Response
Will the ICD-10 conversion have an effect on
provider reimbursement and contracting?
• “Possibly. We are evaluating the impact of ICD-10
on our contracting and clinical operations. The ICD10 conversion is not intended to transform payment
or reimbursement. However, it may result in
reimbursement methodologies that more accurately
reflect patient status and care.”
•
http://www.aetna.com/healthcare-professionals/policiesguidelines/icd_10_faq.html
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59. Industry Readiness Survey
•
The Workgroup for Electronic Data Interchange (WEDI), the leading authority on
the use of Health IT to improve the exchange of healthcare information,
announced submission of the latest ICD-10 industry readiness survey results to
the Centers for Medicare & Medicaid Services (CMS).
• Some key results from the survey include:
– Almost half of the health plans expect to begin external testing by the end of this year.
In the 2012 survey all health plans had expected to begin in 2013.
– About half of the providers responded that they did not know when testing would occur
and over two fifths of provider respondents indicated they did not know when they
would complete their impact assessment and business changes.
– About two thirds of vendors indicate they plan to begin customer review and beta
testing by the end of this year. This is similar to the number who expected to begin by
the end of 2012 in the prior survey.
•
http://www.wedi.org/news/press-releases/2013/04/11/wedi-provides-vital-icd-10-industry-readinesssurvey-results-to-cms
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60. What do I need to do to get the claim
out the door?
• Medicare will begin accepting a revised 1500 (version
02/12) on January 6, 2014.
– Identify whether they are using ICD-9 or ICD-10 codes
– Use as many as 12 codes in the diagnosis field (the current
limit is four)
– Qualifiers to identify the following providers role (on item 17)
• Ordering, Referring, Supervising
• Starting April 1, 2014 Medicare will accept only the revised
version of the form.
– The revised form will give providers the ability to indicate
whether they are using ICD-9 or ICD-10 diagnosis codes
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61. What do I need to know to get the
claim out the door?
• Reporting ICD-10 diagnosis codes
• Claims submission of diagnosis codes
– ICD-9 codes no longer accepted on claims with date of service after
October 1, 2014
– ICD-10 codes will not be recognized/accepted on claims before
October 1, 2014
– Claims cannot contain both ICD-9 and ICD10 codes-they will be
returned as “Unprocessable”
• Date span requirements
– Outpatient claims-split claim form and use from date
– Inpatient claims-use only through date/discharge date for ICD-10
code submission
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62. National Coverage Determinations
(NCDs)
• CMS is responsible for converting approximately 330
NCDs
• Not all are appropriate for translation
– Edits based on HCPCS
– Older, obsolete technology or considered outdated
CMS has determined which NCD should be translated
and is in the process of completing system changes for
those NCDs
http://www.cms.gov/outreach-and-education/medicarelearningnetworkmln/mlnmattersarticles/downloads/MM7818.pdf
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63. Local Coverage Determinations
(LCDs)
• According to CMS, LCDs are made by the
individual Medicare Auditing Contractor (MAC
– i.e. CAHABA)
• Contractors shall publish all ICD-10 LCDs
and ICD-10 associated articles on the
Medicare Coverage Database (MCD) no later
than April 10, 2014
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8348.pdf
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64. Code Analysis
Review top 20-50 diagnosis codes
• Evaluate documentation currently in
the notes
• Crosswalk them to ICD-10
• Review new codes for additional
required codes, additional code
descriptions and “code also”
requirements
• Identify areas where additional
documentation will be required
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65. Budget
How much emergency cash should providers keep in case of cash
flow disruption?
•
Review what happened to your practice with HIPAA 5010, this would be a good
baseline; with the transition of ICD-10 there will be delays in reimbursement.
•
Vendors and Clearinghouses have been working hard, but we will not know the
true effects until Oct 1, 2014.
•
It is recommended that you have up to several months' cash reserves or access
to cash through a loan or line of credit to avoid potential headaches.
•
The amount of money that you will need to set aside will be impacted by the
preparation work you do for ICD-10.
•
Will need to cover at a minimum practice operation expenses for three to six
months:
– Medical supplies
– Payroll
– Rent
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66. Budget
Determine financial impact, budget, resources,
cash reserve needed for ICD-10 migration
•
Cost of training/decreased staff productivity
•
Cost of hardware/software upgrades
•
Forms redesign
•
Testing costs/Consulting services
•
Vendor readiness – external testing
•
Temporary maintenance of dual systems
•
Cash reserves for denials increase, payment
delays, decreased productivity
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67. Resources Available
• http://www.cms.gov/Medicare/Coding/ICD10/index.html
• http://www.ahima.org/icd10/
• http://www.aapc.com/icd-10/index.aspx
• http://www.cdc.gov/nchs/icd/icd10.htm
• http://www.who.int/classifications/icd/en/
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68. Questions?
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69. Thank you!
Kim-Marie Walker, CPC, CCVTC, CHAP
AHIMA-Approved ICD-10-CM Trainer
Pershing Yoakley & Associates, P.C.
(404) 266-9876
kwalker@pyapc.com
www.pyapc.com
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