1. A PORTION OF THESE MATERIALS WERE PRODUCED PURSUANT TO THE SHIP GRANT: Small Rural Hospital Improvement Grant Program

2. 21 Days 15 Working Days

3.  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.

5.  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.

6.  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.

7.  www.roadto10.org/template-library www.roadto10.org/template-library

8.  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. https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD- 10MythsandFacts.pdf

9.  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. https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD- 10MythsandFacts.pdf

10.  Refer to SE1408 & SE1325

11.  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.”

12. ICD-10:

13. ICD-9: Extrinsic Intrinsic Chronic Obstructive With status asthmaticus With acute exacerbation

14.  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.

15.  Valid code.  Document as specific as possible.  Code as specific as possible.  Continue educating yourself.

16.  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.

17.  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.

18.  Develop quick reference sheets for provider’s common diagnoses to assist with documentation.  Develop ICD-10 Query templates for your more common diagnoses.

19.  Example, quick reference sheet for asthma http://bok.ahima.org/PdfView?oid=300621

20.  Example, quick reference sheet for asthma www.aapc.com/icd-10/icd-10-reference-guides.aspx

21.  Example, Query template for asthma

22.  www.CMS.gov www.CMS.gov  2015 ICD-10-CM and ICD-10-PCS GEMs  Download file I9gem: crosswalks 9 to 10 I10gem: crosswalks 10 to 9

23. ICD-10-CMICD-9-CM I10, Essential hypertension 401.0, Malignant hypertension 401.1, Benign hypertension 401.9, Unspecified hypertension

24.  Minimize impact.  Prioritize based on estimated financial impact. Registration  Charging  Coding  Billing  Collections