ICD-10-CM Making a Successful, Timely Transition. Presented by Jerry Bridge President LifeWorks Education Healthcare Collections & Training. Purpose. To provide the knowledge, tools & resources in order to make a successful, timely transition to ICD- 10 . . Objectives.
Presented by Jerry Bridge
President LifeWorks Education
Healthcare Collections & Training
To provide the knowledge, tools & resources in order to make a successful, timely transition to ICD-10.
A patient is diagnosed with acute tonsillitis, his second diagnoses within 6 months. In ICD-9, acute tonsillitis is reported using ICD-9-CM code 463.
Any ICD-9 codes used in transactions for services or discharges on or after October 1, 2014 will be rejected as non-compliant and the transactions will not be processed.
Non-covered entities (those not covered by HIPAA) such as Worker’s Compensation, may choose not to implement ICD-10.
Workers’ Compensation and auto insurance companies are noncovered entities under HIPAA and are not “required” to comply with the October 1, 2014 deadline. However, ICD-9 will no longer be maintained and it will be in the noncovered entities’ best interest to use the new coding system.
Your clinic will need to maintain the ability to submit both ICD-9-CM and ICD-10-CM!
(i.e…..software, hardware capacity and coding capability needed for both code sets)
State Medicaid Programs will not be required to update their systems in order to utilize ICD-10 codes.
State Medicaid Programs are all covered entities under HIPAA; therefore must comply with the October 1, 2014 deadline.
Physicians who choose their own codes will not have to worry about training as their EHR will do this for them.
Although EHRs are starting to do some great things in regards to prompts, problem lists, and other assistive tools for ICD-10, they do not take the place of required education for those physicians selecting their own codes.
ICD-10-CM is a reimbursement system not built for physicians
ICD-10 started its origins at the WHO through the efforts of a team of physicians, clinicians, coders, and other healthcare professionals and then further modified by the United States again by a team of clinicians and other healthcare professionals. ICD-10 is far more rooted in current clinical thought and practice than the ICD-9 system.
ICD-10-CM Code Format
Ex: Unspecified asthma with acute exacerbation
(Etiology means “cause or origin”)
ICD-9-CM Code Format
Just as an increase in the number of words in a dictionary doesn’tmake it more difficult to use, the greater number of codes in ICD-10-CM, the easier it is for you to find the rightcode!
A few hundred new codes =
a few dozen new documentation elements
* ICD-10-CM includes more combination codes containing co-morbidities and associated conditions. (e.g.- Diabetes)
“Physicians may be ICD-10 compliant, but if they abuse the “other” or “unspecified” codes, payment will not occur if a more specific alternative exists.”
Michigan Blue Cross’ Director of Technical Program Management
Justifying medically necessary procedures and services depends on specificity of diagnoses coding!
With increased dx coding specificity comes a requirement for detailed documentation.
Jeri Leong, President, Healthcare Coding Consultants of Hawaii:
“…(for current audits), 40% of the time we were unable to assign a specific ICD-10-CM code based on current documentation.”
How good is YOUR current documentation?
ICD-9-CM = 493.91
Additional documentation required
ICD-10-CM = J45.902
A patient is being treated by his physician for moderate nonproliferative diabetic retinopathy. The physician documents Type II diabetes with macular edema.
GEMs=General Equivalence Mapping:
If all else fails, show them the really fun codes they’ll miss out on if they don’t go ICD-10!
Fall from or off toilet with subsequent striking against an object
W18.12XA Initial Encounter
W18.12XD Subsequent Encounter
Assault by Human Bite, Initial Encounter
Striking against other stationary object,
and ran into a cement wall.
One looked at the other and said, “Dam.”
Striking against other stationary object, Subsequent Encounter
How about this one…
Activity, Milking an animal
…the related W55.22XS
Struck by cow, Sequela
Burn due to water-skis on fire, subsequent encounter
Ok…so I looked everywhere.
I could not find a single burning water skis picture.
But I DID find incidents involving SNOW SKIS
Accident to, on, or involving Ski Lift, initial encounter
Unfortunately, upon rescue our intrepid skier suffered from…
Bitten by other birds, Initial Encounter
Being bitten or struck by…
Turkey, chicken, macaw, parrot, other psittacines, goose, duck, mouse, rodent, rat, squirrel, sea lion, orca, horse, cow, pig, raccoon, lizard, snake, alligator or crocodile.
Bizarre Personal Appearance
If providers start now and learn the unique documentation and coding requirements for 1 or 2 diagnoses codes per week, they will be prepared for ICD-10-CM when the Oct. 1, 2014 deadline arrives.
J45 (ICD-10-CM Root Code) – Asthma
Required Documentation Elements
The AAFP conducted a study by converting the most common dx codes in the family practice environment
In ICD-10 the superbill/encounter form would expand on average to 9 pages!
Start asking the important questions NOW!
Delaying until the last minute could have a devastating effect on cash flow!
When the training will be delivered?
Early, effective preparation can turn the ICD-10-CM transition from a predicament to a significant opportunity for your practice.
Organized and designed specifically for practice-project managers
responsible for ICD-10-CM implementation.
Your ICD-10 Planning Guide includes:
The 4 critical action steps you should be taking now!
‘Project Planner’: broken down by quarter with action steps!
Training & Budget Planner
‘Vendor Tracker & Query Forms’ keep your vendors on track! CD-ROM
Recommendations and resources on how to conduct End to End testing!
ICD-10 Planning Guide $399
With Code Translation Software: Convert ICD-9 codes to ICD-10 in seconds! Features multiple code
lookups, print capabilities, ability to save favorites and create flash cards. Create training tools for your entire staff, accessible anywhere, from any computer!
Planning Guide with Code Translation Software, Only $599
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