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ICD10 for Therapy – Ready, Set, Go! June, 2015 © 2015 Optima Healthcare Solutions.

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Presentation on theme: "ICD10 for Therapy – Ready, Set, Go! June, 2015 © 2015 Optima Healthcare Solutions."— Presentation transcript:

1 ICD10 for Therapy – Ready, Set, Go! June, 2015 © 2015 Optima Healthcare Solutions

2 Training Objectives  Define ICD10  Discuss Purposes of ICD10  Compare/Contrast ICD9 / ICD10  Discuss Code Selection  Apply ICD10 concepts to therapy diagnosis and conditions  Resources  Review Expectations of Vendors

3 What is ICD10?  Coding History:  Physician Diagnosis (Medical, or Primary)  Treatment Diagnosis (Clinician derived)  ICD10 codes endorsed since 1990  Legislation mandating ICD10 implementation  ICD10 Requirement  HIPAA covered entities  Excludes Worker’s Comp and Auto insurances  CMS encourages all to transition to ICD10

4 Purpose of Transition to ICD10  Purposes:  More accurately reflect current medical practices  Capture more specific data Reform payment methods Facilitate patient care coordination across settings Improve public health reporting and track (outcomes, expenditures) Quality and Safety Supports choices of interventions for patient ICD9 running out of capacity to accommodate new codes and procedures

5 ICD9 and ICD10 Comparison – Similarities Overview Both: Include Index, alphabetical list of terms and corresponding codes Include Tabular list of codes, divided into chapters Use similar “look-up” method Share similar structure / conventions Both have alphas, and both have numeric V54.01 R52 Both have characters after the decimal 438.21 S93.401A “Unspecified” codes available to use Require adherence to official coding guidelines under HIPAA

6 ICD9 and ICD10 Comparison – Differences, Overview  Core Differences  Updated medical terminology  Expanded specificity / detail in codes  Has led to change from 14K codes to 70K codes  Side of body affected has been added to relevant codes  I60.11 (subarachnoid hemorrhage, right side)  I60.12 (subarachnoid hemorrhage left side)  M24.551 (contracture of right hip)  M24.552 (contracture, left hip)  M24.559 (contracture, unspecified hip)  Restructured categories and organization  Organization of codes – in tabular form, codes grouped by site rather than type of injury  V-Codes and E-Codes incorporated

7 ICD9 / ICD10 Detailed Differences ICD9ICD10 Codes are 3 – 5 charactersCodes are 3 – 7 characters 1 st character can be numeric or alpha1 st character always alpha Characters 2 – 5 = numeric2 nd character = numeric Always minimum of 3 charactersCharacters 3 – 7 can be numeric or alpha Decimal used after 3 charactersDecimal used after 3 characters; Alpha characters not case-sensitive (e.g., S93.401A  > S93.401a  > s93.401A) No laterality considerationsLaterality embedded Lacks type of event detailsType of event embedded No effusion considerationsEffusion considerations No 7 th characterAddition of 7 th character: holds different meaning depending on section where it is used

8 ICD9 Code Categories

9 ICD10 Code Categories

10 ICD10 Code Selection / Resources Downloadable files CMS website No cost Purchase Manuals AMA website Optum website HCPRO website Purchase on-line coding, vs. “manual” Optum NOTE: We do not endorse any specific resource; simply sharing those we have experience using.

11 General Coding Guidelines Be as specific as possible Added digits with ICD10 Capture details Prioritize codes when reporting Focus on primary reasons for treatment first Familiarize yourself with resources Chapter organization Symbols, icons, colors Training materials for teams

12 General Coding Guidelines Achieve/maintain consistency with documentation Support use of Evaluation codes Support use of Treatment approaches Actual selection: Utilize both alphabetical index and tabular list Added detail in tabular list

13 Code Selection: Clinical Scenario 1 74 year old female Fell on ice, at home, sustained right hip fracture Difficulty Walking Pain History of CA, HTN, Anemia

14 Code Selection: Clinical Scenario 1 CMS website Downloadable Alphabetical Index Downloadable Tabular code list

15 Clinical Scenario 1: Code Summary 74 year old female Fell on ice, at home, sustained right hip fracture Difficulty Walking, R26.2 Pain in Right Hip: M25.551 Injury: S72.044D Cause of fall: W00.0XXD History of CA, HTN, Anemia

16 Code Selection: Clinical Scenario 1

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27 Code Selection: Alternate Resource Views

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31 Code Selection: Clinical Scenario 2 74 year old female, pain in shoulder, muscle atrophy/weakness Fell at home, sustained right hip fracture and right shoulder fracture History of CA, HTN, Anemia

32 Code Selection: Clinical Scenario 2 CMS website Downloadable Alphabetical Index Downloadable Tabular code list

33 Clinical Scenario 2 Code Summary 74 year old female, pain in shoulder, muscle atrophy/weakness Fell at home, sustained right shoulder fracture Pain in Right Shoulder: M25.551 Muscle Atrophy/Injury: M62.511 Injury: S72.044D Cause of fall: W00.0XXD History of CA, HTN, Anemia

34 Code Selection: Clinical Scenario 2

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41 Code Selection: Clinical Scenario 3 84 year old female, dysphagia Resident of SNF, suffered stroke History of Osteoporosis, Schizophrenia, cataracts

42 Code Selection: Clinical Scenario 3 CMS website Downloadable Alphabetical Index Downloadable Tabular code list

43 Code Selection: Clinical Scenario 3, Summary 84 year old female, dysphagia Resident of SNF, suffered stroke History of Osteoporosis, Schizophrenia, cataracts ICD10 Codes: I69.391 R13.12

44 Code Selection: Clinical Scenario 3

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48 Code Selection: Clinical Scenario 4 74 year old male, w/aphasia and apraxia Intracerebral hemorrhage History of High Blood Pressure, anticoagulants

49 Code Selection: Clinical Scenario 4, Alphabetical List

50 Code Selection: Clinical Scenario 4

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52 Code Selection: Clinical Scenario 4 Summary 74 year old male, w/aphasia and apraxia Intracerebral hemorrhage History of High Blood Pressure, anticoagulants Supportive ICD10 Treatment codes: I69.120: Aphasia following non-traumatic intracerebral hemorrhage I69.190: Apraxia following non-traumatic intracerebral hemorrhage

53 Code Selection: Clinical Scenario 5 73 year old male, difficulty walking, ataxia, shuffling, dysarthria Recent decline in function, exacerbation of symptoms, however, without fall or other traumatic event History, unremarkable

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59 Code Selection: Clinical Scenario 6 81 year old female with bladder incontinence Recent new onset, non-traumatic History, low vision

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66 ICD10 Resources CMS website: www.cms.gov/icd10www.cms.gov/icd10 Features: Fact Sheets FAQs Implementation guides Checklists Training Videos Email updates AMA website Manual Resources Professional Associations Partner with Vendors

67 What to Expect from Software Vendors Testing pre-regulatory-go-live of October 1, 2015 Customers – data entry Claims Configuration options Coding by Payer  Strong and timely search engine  Key Word  ICD9 Mapping ICD10 Updates for entire system, such as: Clinical documentation MAC LCDs Interoperability / Interfaces / Export Capabilities Operational and Clinical Reports Direct Bill Claims Compliant Transition Plan, ICD9 to ICD10

68 Recently Published CMS ICD10“Facts” If you cannot submit ICD-10 claims electronically, Medicare offers several options Practices that do not prepare for ICD-10 will not be able to submit claims for services performed on or after October 1, 2015 Reimbursement for outpatient and physician office procedures will not be determined by ICD-10 codes Costs could be substantially lower than projected earlier. It’s time to transition to ICD-10

69 Webinar Reference Materials CMS ICD10 Industry communications http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/ICD10 Recent Fact Updates: http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10FiveMoreFac ts.pdf http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10FiveMoreFac ts.pdf Updated Resources, including Transition, Basics and Talking to Vendors, http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10Introduction2 0140819.pdf http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10Introduction2 0140819.pdf CMS Downloadable code tables: http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-CM-and- GEMs.html http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-CM-and- GEMs.html MedLearn Matters (MLN) Training Materials and Products: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNProducts/Downloads/MLNCatalog.pdf http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNProducts/Downloads/MLNCatalog.pdf CMS sponsored Teleconferences: http://www.cms.gov/Medicare/Coding/ICD10/CMS-Sponsored-ICD-10- Teleconferences.html http://www.cms.gov/Medicare/Coding/ICD10/CMS-Sponsored-ICD-10- Teleconferences.html

70 Questions/Feedback Questions &/or Comments Please contact: OptimaCEU@OptimaHCS.com

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