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HOW TRANSITION to MENTAL HEALTH Your ICD-10 PRACTICE

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HOW TRANSITION to MENTAL HEALTH Your ICD-10 PRACTICE ICD-10 HOW to TRANSITION your MENTAL HEALTH PRACTICE WITHOUT FEELING LIKE YOU’VE BEEN V0490XA* * ICD-10 CODE FOR HIT by A MAC TRUCK TABLE OF CONTENTS What’s the Code for ICD-10 Success? .................................................. 1 What Is ICD-10? • DSM-5 • Dual Codes • Terminology Changes Unspecified Codes • Type of Encounter • ICD-10 Coding Guidelines More Changes for Mental Health • Special Considerations for Child Psychiatry Strategies for Success Step 1: Get Educated ................................................................................ 9 Why Train • Educational Resources • Who to Train When to Train • Where to Find Training Step 2: Review Coding & Documentation ..........................................11 Documentation Improvement • Code Mapping • Sample Code Map Step 3: Analyze Your Workflow ............................................................ 14 Document Review • Workflow Review Step 4: Financial Planning .......................................................................16 ICD-10 Budget • Cash Reserves • Cost Containment Step 5: Test, Test, Test .......................................................................... 20 Edited by Lea Chatham © 2015 Kareo, Inc How to Transition Your Mental Health Practice WHAT’S THE CODE FOR ICD-10 SUCCESS? Ok, there isn’t really a code for ICD-10 success but if there was it would be plan, plan, plan. The majority of practices have done little or nothing to prepare for ICD-10. This could be disastrous. An effective transition requires planning and preparation to mitigate the potential financial impact as much as possible. What Is ICD-10? On October 1, 2015, medical coding as we know it will change forever. Everyone covered by the Health Insurance Portability and Accountability Act (HIPAA) must be compliant with ICD-10 on that date—not just those who submit to Medicare and Medicaid. ICD-9 ICD-10 Diagnosis Codes are 3-5 Codes are 3-7 characters characters Approximately 14,000+ codes 69,000+ codes First character is numeric or First character is alpha, characters alpha (E or V) and characters 2 and 3 are numeric, 4-7 are 2-5 are numeric alpha or numeric Difficult to analyze data due to Expanded to allow more specificity nonspecific codes and accuracy resulting in improved data analysis No other country uses ICD-9— United States is one of last major limiting interoperability with other countries to transition to ICD-10 countries Table 1. Differences Between ICD-9 and ICD-10 www.kareo.com • 1 How to Transition Your Mental Health Practice ICD-10 will impact many areas of your practice and touch every employee. And it will affect your mental health practice in unique ways. Advanced preparation is the key to success. The first thing to do before you start planning for your ICD-10 transition is to understand what ICD-10 is and how it differs from ICD-9 (table 1). Specifically, you need to know what aspects of ICD-10 may impact your mental health documentation, coding, and billing. DSM-5 Mental health providers currently use The Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), which includes ICD-9, but it will include ICD- 10-CM codes for mental and substance use disorders. ICD-10-CM does not include diagnostic criteria, and the presence of documented DSM-5 diagnos- tic criteria in patient medical records is used by CMS and private insurance contractors for medical chart quality assessment, audit, and fraud/abuse determinations. Dual Codes One of the most significant revisions to the DSM-5 is the inclusion of dual codes for every mental disorder in order to account for the currently used ICD-9-CM codes as well as new ICD-10-CM codes, effective October 2015. • DSM-5 contains the pertinent data required to assign HIPAA-compliant, ICD-10-CM codes to psychiatric diagnoses for that patient demographic. • All ICD-10-CM codes are alpha-numeric. In DSM-5, they can be found in parentheses within the diagnostic criteria box for each disorder. • If there is only one ICD-10-CM assigned to a disorder, it can be found at the top of the Diagnostic Criteria set. For example, Schizophrenia has an ICD-10-CM code of F20.9, it is in parentheses. 2 • www.kareo.com How to Transition Your Mental Health Practice The ICD-10-CM codes are alpha-numeric. In DSM-5, they can be found in parentheses within the diagnostic criteria box for each disorder. • When you look at a disorder in DSM-5, it will appear as below. Note that o If there is only one ICD-10-CM assigned to a disorder, it can be found at the top of the criteria set. For example, Schizophrenia has an ICD-10-CM code of F20.9 the ICD-9-CM code and the ICD-10-CM code have already been listed foro When you: you look at a disorder in DSM-5, it will appear as below. Note that the ICD-9-CM code and the ICD-10-CM code have already been listed for you: The ICD-10-CM codes are alpha-numeric. In DSM-5, they can be found in parentheses within the diagnostic criteria box for each disorder. o If there is only one ICD-10-CM assigned to a disorder, it can be found at the top of the criteria set. For example, Schizophrenia has an ICD-10-CM code of F20.9 o When you look at a disorder in DSM-5, it will appear as below. Note that the ICD-9-CM code and the ICD-10-CM code have already been listed for you: If more than one code can be assigned to a disorder, the codes can be found at the bottom of o the diagnostic The ICDcriteria-10-CM box. codes This are is alphathe ca-numeric.se when In subtypes DSM-5, they are can coded. be found For example,in parentheses for within the Often inschizoaffective mentaldiagnostic health, disorder, criteria the there box bipolar for each is type moredisorder. is coded than F25.0 one and the code depressive that type can is coded be assigned to a F25.1. This will appear in the DSM-5 criteria as below: disorder, the codeso If there iscan only onebe ICD found-10-CM assigned at the to abottom disorder, it can of be the found diagnostic at the top of the criteria criteria box. set. For example, Schizophrenia has an ICD-10-CM code of F20.9 This is the case when subtypes are coded. o When you look at a disorder in DSM-5, it will appear as below. Note that the ICD-9-CM code and the ICD-10-CM code have already been listed for you: For example, for schizoaffective disorder, the bipolar type is coded F25.0 o If more than one code can be assigned to a disorder, the codes can be found at the bottom of andthe the diagnostic depressive criteria box. type This is isthe coded case when F25.1. subtypes This are coded. appears For example, in the for DSM-5 criteria schizoaffective disorder, the bipolar type is coded F25.0 and the depressive type is coded exampleF25.1. This below: will appear in the DSM-5 criteria as below: o For disorders with more complex coding, coding notes and coding tables are provided at the bottom of the criteria box. The substance/medication-induced disorders, for example, have complex codingo If more. than one code can be assigned to a disorder, the codes can be found at the bottom of the diagnostic criteria box. This is the case when subtypes are coded. For example, for schizoaffective disorder, the bipolar type is coded F25.0 and the depressive type is coded Clinicians shouldF25.1. always This check will appear the bottom in the DSM of the-5 criteriadiagnostic as below: criteria box for coding notes, which provide additional guidance. For example, in Schizoaffective disorder, if catatonia is present, an additional code for catatonia should be used, and will be provided in the coding note: o For disorders with more complex coding, coding notes and coding tables are provided at the bottom of the criteria box. The substance/medication-induced disorders, for example, have complex coding. When a disorder is high in complexity, the DSM-5 will indicate that additional informationClinicians should alwaysin the check form the bottomof coding of the diagnostic notes criteriaand coding box for coding tables notes, is which provided at the provide additional guidance. For example, in Schizoaffective disorder, if catatonia is present, an For disorders with more complex coding, coding notes and coding tables are provided at the additional code for ocatatonia should be used, and will be provided in the coding note: bottom of the criteriabottom of the box. criteria In box. the The example substance/medication below,-induced the disorders, substance/medication- for example, have complex coding. induced disorders, which are complex, show us the additional coding notes Clinicians should always check the bottom of the diagnostic criteria box for coding notes, which and____________________________________________________________________________________ related informationprovide additional toguidance. support For example, the in code.Schizoaffective disorder, if catatonia is present, an American Psychiatric Associationadditional code for catatonia shouldwww.dsm5.org be used, and will be provide d in the www.psychiatry.org coding note: ____________________________________________________________________________________ American Psychiatric Association www.dsm5.org www.psychiatry.org ____________________________________________________________________________________ American Psychiatric Association www.dsm5.org www.psychiatry.org www.kareo.com • 3 How to Transition Your Mental Health Practice ICD-10-CM codes can also be found in the “DSM-5 Classification” in the front of the manual, and as alphabetical and numerical listings in the appendices. For further information on ICD-10-CM coding updates, the implementation of DSM-5, and questions for DSM staff at the APA, please visit www.dsm5.org. Reporting Multiple Diagnosis Codes When coding Mental Health for ICD-10-CM, precedence should be given to the diagnosis that best represents “the Nature of the Presenting Problem/ NOPP” and is most relevant to the purpose for the visit.
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