A PORTION OF THESE MATERIALS WERE PRODUCED PURSUANT TO THE SHIP GRANT: Small Rural Hospital Improvement Grant Program
21 Days 15 Working Days
ABC ’s of getting ready A ssess how ICD-10 will affect your practice and make a plan. B e sure your systems are ready. C ontact your vendors.
You do not need to register. You can submit an unlimited number of claims. You can submit directly or through a clearinghouse or billing agency. You must use: Current dates of service. The test indicator “T” in the Interchange Control Structure (ISA) 15 field.
If you think your systems won’t be ready: ◦ Free billing software available from every MAC website. ◦ Part B claims submission by online provider portal. ◦ Paper claims for providers who meet Administrative Simplification Compliance Act Waiver requirements (rare exceptions). ◦ However, you still must code in ICD-10.
There is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless otherwise mandated locally, chapter 20 is not required. They do, however, provide valuable data. 10MythsandFacts.pdf
You should code each encounter to the level of certainty known for that encounter. When sufficient clinical information is not known or available about a particular health condition to assign a more specified code, it is acceptable to report the appropriate unspecified code. It is inappropriate to select a specified code that is not supported by the documentation or to conduct medically unnecessary diagnostic testing to determine a more specific code. 10MythsandFacts.pdf
Refer to SE1408 & SE1325
Medicare will not deny Part B claims based solely on the specificity of ICD- 10 as long as the valid code is within the “right family”. Family = Category ◦ “…the same as the ICD-10 three-character category.”
ICD-10:
ICD-9: Extrinsic Intrinsic Chronic Obstructive With status asthmaticus With acute exacerbation
The coding specificity required by LCDs and NCDs will not change. LCDs and NCDs will require no greater specificity in ICD-10 than was required in ICD-9, with the exception of laterality, which does not exist in ICD-9. ◦ LCDs and NCDs that contain ICD-10 codes for right, left, or bilateral do not allow for an unspecified side.
Valid code. Document as specific as possible. Code as specific as possible. Continue educating yourself.
ICD-10 Coordination Center Located in Baltimore & will begin operations in late September. New ICD-10 Ombudsmand, William Rogers. Help receive & triage physician and provider issues.
2% of test claims were rejected due to invalid submission of ICD-10 diagnosis or procedure code. less than 1% were rejected due to invalid submission of ICD-9 code Other rejections were unrelated to ICD-10.
Develop quick reference sheets for provider’s common diagnoses to assist with documentation. Develop ICD-10 Query templates for your more common diagnoses.
Example, quick reference sheet for asthma
Example, quick reference sheet for asthma
Example, Query template for asthma
2015 ICD-10-CM and ICD-10-PCS GEMs Download file I9gem: crosswalks 9 to 10 I10gem: crosswalks 10 to 9
ICD-10-CMICD-9-CM I10, Essential hypertension 401.0, Malignant hypertension 401.1, Benign hypertension 401.9, Unspecified hypertension
Minimize impact. Prioritize based on estimated financial impact. Registration Charging Coding Billing Collections