ICD-10 for Family Practice

ICD-10 for Family Practice LAFP 68th Annual Assembly and Exhibition New Orleans, LA August 6-9, 2015 Presenter: Patty Harper 1 Intellectual Property Contained in this Presentation These presentations may includes selected content that is the intellectual property of AHIMA. Those portions of the presentation will bear the AHIMA logo and have been extracted from the ICD-10 Academy materials. These slides are used with permission as granted to AHIMA Ambassadors and Trainers. These slides have not been revised or modified by the secondary user other than to renumber the slides for this unique presentation. Slides not bearing the AHIMA logo are the intellectual property of InQuiseek LLC. These slides may or may not bear the InQuiseek LLC logo. These slides may not represent content in the same format or method as the ICD-10 Academy materials although no effort has been made to misrepresent or contradict information otherwise presented. This presentation may be reproduced and redistributed by Winn Community Health Center for the purpose of internal training only. Selected graphics are provided under a licensing agreement with . ICD-10 cartoon provided under a licensing agreement through www.hipaacartoons.com. Other cartoons are identified with were published as public educational tools. 2 What is ICD-10? Why? When? 3 Sweden 1997 Netherlands 1994 Canada 2000 UK 1995 Germany 2000 France 1997 US 2015 Korea 2008 China 2002 Thailand 2002 South Africa 1996 Australia 1998 4 • The World Health Organization (WHO) publishes the International Classification of Disease (ICD) code set, which defines diseases, illnesses, sign & symptoms, complaints, abnormal findings as well as external causes of injury or illness and social factors. • ICD-10 is the tenth edition. ICD-11 is due to be released in 2015. • NCHS is the federal agency responsible for adapting the WHO version to a clinical modification (CM) for use in the United States. • ICD-10-CM is mandatory for all entities covered under HIPAA. It is not mandatory for worker’s comp or MVA liability claims. • Version 5010, electronic health care transaction standards, was a precursor to ICD-10. 5 How did we adopt ICD-10 in the US? • World Health Organization Releases New Version of International Classification of Diseases (ICD-XX) WHO • http://www.who.int/classifications/icd/en/ • National Center for Health Care Statistics develops a Clinical Modification for use in the United States (1999) NCHS • http://www.cdc.gov/nchs/icd/icd10cm.htm • Affordable Care Act (HIPAA Administrative Simplification) mandated an implementation date for ICD-10 in the US. ACA • http://www.gpo.gov/fdsys/pkg/FR-2009-01-16/pdf/E9-743.pdf 6 Used under license agreement with RJ Romero via www.hipaacartoons.com 7 Why ICD-10-CM ? • We are running out of codes. ICD-9 is not expandable in the current format. • ICD-9 codes are not specific enough and do not reflect current terminology or practice. ICD-9-CM has been in use for almost 30 years. • To provide health care statistics that are more easily comparable worldwide. 8 ICD-10: Two Code Sets ICD-10- CM for Diagnosis Coding: This is the US Clinical Modification (CM) of the World Health Organization classification system or ICD-10-CM. ICD-10-CM will be used in ALL settings. It will replace the ICD-9-CM codes in Vol. 1 and Vol. 2 that have been used in the United States since 1988. ICD-10-PCS for Procedure Coding: In 1993, Centers for Medicare and Medicaid Services (CMS) commissioned 3M Health Information Systems to develop the new system. This is ICD-10-PCS. It will be used for Inpatient Procedures only. Will replace ICD-9-CM Volume 3 Codes. Notes: 1. All ICD-10 codes set are in draft version until implementation. 2. CPT Codes will remain in use for all Physician Services and Outpatient/Ambulatory Services. 9 Date of Service or Discharge Date Prior to October 1, 2015 On or After October 1, 2015 10 Effective Dates for Code Sets Type of Code Before 10/1/2015 After 10/1/2015 INPATIENT Diagnoses ICD-9-CM ICD-10-CM Procedures ICD-9, Volume 3 ICD-10-PCS OUTPATIENT/AMBULATORY Diagnoses ICD-9-CM ICD-10-CM Procedures CPT® Codes CPT® Codes There will be a need for dual coding for at least two years for complete claims adjudication and audit. 11 CPT® Coding Will Not Change • CPT® is a registered trademark of the American Medical Association. CPT = Current Procedural Terminology • Codes are updated at least annually with some quarterly revisions or clarifications. • Will still be used after 10/1/2015 for outpatient services. Examples of CPT® Codes Used for Ambulatory Care • Evaluation & Management Services (99201-99215) • Office Procedures, for example: 10060- Simple I & D • Lab Services, for example: 81003- Automated UA w/o micro • X-ray, for example: 71020- CXR 2 View 12 CMS Announcement of ICD-10 Coding Errors 7/6/2015 “With less than three months remaining until the nation switches from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are announcing efforts to continue to help physicians get ready ahead of the October 1 deadline. In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set.” --CMS “We appreciate that CMS is adopting policies to ease the transition to ICD-10 in response to physicians’ concerns that inadvertent coding errors or system glitches during the transition to ICD-10 may result in audits, claims denials, and penalties under various Medicare reporting programs.”--AMA President Steven J. Stack, MD http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015- Press-releases-items/2015-07-06.html 13 So, when did I become a coder? I thought I was a doctor? 14 Physician ≠ Coder Coder ≠ Biller Assigning a code after having completed an Coding is the process of abstracting the assessment and plan seems redundant and medical record to assign a classification. counter-intuitive. The work flow is not Billing is the process of administratively logical. reporting the services to a third-party for reimbursement. The advent and implementation of electronic medical records, especially in physician offices and other outpatient settings have put the burden of code selection on the providers. This is a burdensome task for which most physicians have received minimal training. Certified coders have been trained and educated in medical terminology, anatomy and physiology, medical science, disease processes and epidemiology. They have also been trained to read a medical record and abstract diagnoses. There are several recognized coding credentials which recognize varying levels of training. A medical biller understands the claims reporting processes and third-party billing requirements. A biller may or may not have formal coding training. In physician offices, the coder-biller function is more commonly combined than in hospital settings. But, then came EHRs. If we aren’t assigning codes correctly in ICD-9, then we will not be doing it correctly in ICD-10. There are specific guidelines for assigning and sequencing codes correctly. With more specificity in the ICD-10 codes, there are a more opportunities for coding errors. 18 2015 ICD-10-CM Alphabetic Index and Tabular Code Descriptions The ICD-10-CM Index and Tabular volumes as well as the ICD-10-CM Official Guidelines are available for download from the CDC. http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2015 The formats are not as user friendly as code manuals published by other sources. The GEM files which are also available for download are in text file which requires additional formatting. 19 Sequencing Codes for Outpatient Services • The “first-listed” diagnosis is the condition which occasioned the visit (chief complaint). Use a definitive diagnosis if one is available. • Rule Out or Differential Diagnoses are not used in Outpatient coding. • Refer to the notes in the Tabular for “code first” and “use additional code” notes. • All coexisting conditions which are present at the time of the visit and affect care or treatment can also be listed. • If two conditions co-exist and are both responsible for the service, either may be coded as primary. • Acute conditions are listed above chronic, stable conditions. • Signs and symptoms which are integral to the diagnosis should not be listed. (cough, fever, pneumonia). • Signs and symptoms are listed if there is no definitive diagnosis during the encounter. • Conditions which have been resolved or do not affect current treatment are not coded. • Refer to specific Chapter guidelines for notes on specific conditions. 20 ICD-10-CM: The organization and structure of the diagnoses codes 21 ICD-10: More Codes ICD-9-CM has ± 14,025 diagnosis codes ICD-10-CM has ± 69,823 diagnosis codes One of the biggest challenge for providers and payers is that there is not a one-to-one correlation of the codes. 22 ICD-10: Code Format & Structure • Diagnosis Codes are longer in character length. • ICD-9: 3-5 Characters in length • ICD-10: 3-7 Characters in length • Addition of 7th character Extension character • Use of placeholder in codes not requiring a 4th, 5th or 6th character. 23 Diagnosis Code Structure Comparison ICD-9-CM ICD-10-CM X X X . X X X X X . X X X X Sub- Extension Category Sub- Category or Classification: Classification: Code Block Etiology, Etiology, Anatomical Anatomical Site or Site or Manifestation Manifestation Codes can be 3-7 Codes can be 3-5 characters/positions in length.

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