Transcript ICD-10-CM – Everything You Need to Know … For Now

ICD-10-CM
An Introduction 2011
Bobbi Buell, MBA
onPoint Oncology LLC
800-795-2633
[email protected]
• Create an awareness of ICD-10-CM.
• Start to consider the impact the
conversion to ICD-10 will have on your
operations.
• Start to understand what it means and
does not mean in Oncology.
Medicare Physician Fee
Schedule FINAL Rule
FINAL MPFS 2011
• On November 2, 2010, the Centers for Medicare &
Medicaid Services (CMS) posted a proposed notice for
Medicare payments in the physician fee schedule for
calendar year (CY) 2011.
• Many of these provisions were specified in Health
Reform (“ACA”). The final rule (CMS-1502-P) affects
physicians and office payment for services paid under the
resource-based relative value scale/system (RBRVS), also
known as, the Medicare Physician Fee Schedule.
• Here are the highlights of Rule which becomes effective
for dates of service on or after 11-2-2010.
https://www.cms.gov/PhysicianFeeSched/PFSFRN/list.asp#TopOfPage
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FINAL MPFS 2011
• Practice Expense: CMS continues for the second
year (at a 50/50 blend), the phasing-in over four
years the implementation of the American Medical
Association (AMA) Physician Practice Information
Survey (PPIS) data administered in 2007/08 for
practice expense (PE) indirect per hour rate.
Oncology is still using the AMA SMS data series.
Of interest is this year's calculation of practice
expense for drug administration because many of
our codes were bumped up slightly to include some
supplies.
https://www.cms.gov/PhysicianFeeSched/PFSFRN/list.asp#TopOfPage
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onPoint Oncology LLC
FINAL MPFS 2011
• Related –TC of Imaging Codes Get Cuts: Well, of course,
this is happening in July 2010. But, what it means is that, as of
July 6, you will get a cut of 50% for secondary –TCs of related
procedures in the same family of imaging procedures. This has
been expanded to include more and unrelated procedures. SEE
ADDENDUM F of the fee schedule for additional procedure
reduction codes.
• Telehealth Services: To perform telehealth services, there must
be two-way communication between provider and patient, plus
you must be in HPSA (Health Provider Shortage) area or
outside an MSA. Additional services proposed as allowable in
2011 are 99231-99233 (every three days) and 99307-99310
every 30 days along with services that are unrelated to
Oncology.
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onPoint Oncology LLC
FINAL MPFS 2011
• Physician Extenders: They are sometimes known as NPs and PAs.
They can now perform certification and periodic re-certification for
SNF patients.
• Bone density payment: The proposal calls for these to be paid 70% of
the 2006 RVUs at the 2006 conversion factor with this year’s GPCIs
for codes 77080-77082. This is retroactive to January 1, 2010.
• Payment for Biosimilars: Here is the payment formula for drugs that
are ‘similar’ to today’s biologics. Down the road, we will see lots of
these in cancer treatment for sure…
• A biosimilar is a product approved under an abbreviated application for a
license of a biological product that relies on a license of another biologic.
• The payment for these biosimilar products will be the sum of all ASPs assigned
to a biosimilar products divided by all applicable units plus six percent of the
REFERENCE PRODUCT…how does that work?
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onPoint Oncology LLC
FINAL MPFS 2011
•
Self-Referral Disclosure Law: Effective for dates of service after January 1,
2011 for CAT, MRI, and PET:
• A list of FIVE (not ten) alternative ‘suppliers’ (not a hospital) within a 25mile radius of the physician’s office who provide the same imaging services.
If there are not five, you must list all.
• The list must include, name, address, phone number of other facilities. If
there is no one they can go to, tell the patient they can get these tests in other
facilities.
• The list is to be given to the patient at the time of referral. EACH time the
patient is referred it must be given.
• No signature or form retention is required. Make a note in the chart or get a
stamp for charts---but there should be a notation that it was given.
• Must be written in a way that patients can understand.
• Emergency situations are not an exception.
• Exceptions include patients who are not on Medicare at the time of the
referral.
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onPoint Oncology LLC
FINAL MPFS 2011
•
Drugs: This rule maintains the current average sales price (ASP) + 6% reimbursement for Part B
drugs; however, it includes proposed changes to ASP reporting, thresholds, and vial amounts.
• Among other provisions, if the manufacturer is late with quarterly reporting, the CMS
proposes to update ASPs by carrying over the previously reported manufacturer ASP for
applicable national drug code(s) (NDC(s)). This is called the “carry over” methodology. This
method will not be implemented if there are not a significant number of involved NDCs. But,
manufacturers are still subject to Civil Monetary Penalties, if they make a habit of not
submitting ASPs.
• CMS also proposes to update the regulations to clearly state that Medicare will not pay for
amounts of “overfill”, i.e. product in excess of the amount reflected on the FDA-approved
label. The ASP plus 6% will be paid for FDA-approved amounts in the vial, but practices may
not bill for and/or pool their overfill.
• Partial quarter ASPs for new drugs were also discussed in the proposed rule. Single-source
drugs will be priced at WAC, plus 6% for that quarter and multisource and line extension drugs
will be added to the weighted average of applicable NDCs.
• CMS also proposes to maintain the applicable threshold percentage for price substitution of
WAMP or AMP for two consecutive quarters at 5%. CMS also finalizes the proposal to
maintain the applicable threshold percentage for price substitution at 5%, however did not
finalize a new proposal for price substitution at 103% of average manufacturer price (AMP) in
certain circumstances when the ASP exceeds the AMP.
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onPoint Oncology LLC
What is Overfill?
• An amount in the vial that is not indicated on the
label.
• It is an amount not included in what you paid for in
terms of vial size.
• Under ‘incident to’, practices may not be reimbursed
for anything which does not represent an expense to
them.
• Prior to the final rule, overfill was statutorily
excluded from payment. But, the FR reinforced this.
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onPoint Oncology LLC
FINAL MPFS 2011
•
Signature on Requisition: CMS will require a physician’s or a nonphysician practitioner’s signature on requisitions for clinical
diagnostic laboratory tests paid under the Clinical Lab Fee
Schedule. This has gotten very negative comments in the past.
• CMS believes that signatures are already required on orders for clinical diagnostic
laboratory tests paid under the Clinical Lab Fee Schedule and there is confusion
about the difference between an order and a requisition.
• The proposed policy will also be consistent with the requirement that orders for
diagnostic tests paid under the MPFS must be signed by a physician or
appropriate non-physician practitioner.
• CMS has updated this policy to state that it will not be enforced First Quarter
2011. There are also very public rumors that this will go away.
•
One-year filing for Part B claims: There has already been a
transmittal about this. But, starting January 1, 2010, there will be a
one-year filing deadline for claims.
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onPoint Oncology LLC
FINAL Fee Schedule 2011
•
PQRI for 2011: This year, there are 194 measures in the rule. Like last year, there are 2
reporting periods: 6 months and 12 months. Other proposed changes to PQRI applicable
to office-based cancer practices include:
•
•
•
•
•
Registries: CMS once again emphasized that Registries are the way to go for more accuracy in PQRI
data submission. CMS wants to get away from claims submissions ASAP. New cancer registry:
[email protected].
Success Criteria: It is PROPOSED for claims ONLY that you report on at least 3 measures (if
applicable) AND you report on at least 50% of applicable patients, instead of 80%---which would
still be the rate for EMR/EHR or Registry submission.
Group Practices: Two types of group practices are proposed to report in 2011. First are practices
over 200 eligible providers called GPROI. Then there are groups 2-199 eligible providers called
GPROII. To report as a GPROII, you must self-nominate; be in the first 500 practices to do so after
the beginning of the year 2011; and, you must report at least one of GPROII groups, which do not
apply to many cancer practices. CMS is looking for specialty measures groups for GPROII.
Deleted Measures: These measures used by cancer folks are leaving (maybe) in 2011:
• Measures 114 and 115 for Tobacco Use (more later about this);
• Measure 136 for Melanoma
Measures Reportable by Registry Only: These are the same as last year:
• 137-138: Melanoma
• 143-144: Pain In Cancer Measures
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onPoint Oncology LLC
FINAL E-Prescribing 2011
• E-Prescribing: E-prescribing will pay 1% of the
providers’ billed and allowed fee schedule services
(all services paid by RVUs) in 2011. 2011 is the last
year where you will not be penalized, if you do not
participate if you qualify. BUT, 2011 is the year that
those that should be penalized will be identified.
The penalty only exists for those who do not have at
least 100 cases in the denominator codes (mostly
E/M); who do not report at least 10 encounters by
mid-2011, or, do not qualify as a physician or
physician extender who has at least 10% of fee
schedule revenue in the denominator codes.
https://www.cms.gov/PhysicianFeeSched/PFSFRN/list.asp#TopOfPage
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onPoint Oncology LLC
E-Rx Reporting
• For successful claims-based reporting in 2011,a single code
should be reported (numerator) G8553 – At least one
prescription created during the encounter was generated and
transmitted electronically using a qualified e-Rx system
• Must be on the same claim (denominator)–90801, 90802,
90804, 90805, 90806, 90807, 90808, 90809, 90862, 92002,
92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202,
99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215,
99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315,
99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335,
99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347,
99348, 99349, 99350, G0101, G0108, G0109
• Combination is reported on at least 25 encounters
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onPoint Oncology LLC
FINAL E-Prescribing
• If you participate in the HIT incentive, you may not receive the
e-prescribing incentive, but you must e-prescribe AND FOR
NOW YOU MUST REPORT!
• Incentive
• Reporting period: Calendar year, but data 1/1/20116/30/2011 will be used to identify those who should be
penalized. So, you must report at least 10 encounters per
NPI before 6/30/11.
• Reporting mechanisms: CLAIMS ONLY!!
• Hardship exceptions—there will be new G-codes for these:
• Rural practices with no high speed internet OR
• Providers near pharmacies that do not process e-rx.
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onPoint Oncology LLC
Hospital Outpatient PPS 2011
• Drug payments– Continue standard packaging
methodology for drugs under a certain benchmark.
• Drugs costing less than $70 per day are packaged into
ambulatory payment classification (APC)
• Drugs costing more than $70 are reimbursed separately
• Separately billable drugs paid at ASP+5%
• Only 5-HT3 antiemetic product exempt from standard
packaging methodology is palonosetron hydrochloride—
used to be all 5 HT-3s
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onPoint Oncology LLC
HOPPS 2011
• Ongoing discussion about supervision requirements
• Under direct supervision CMS clarified that
supervising physician or non-physician practitioner
(NPP) must be “immediately available”– CMS not
defining “immediately available” but referenced as
physically present and interruptible.
• Varies by type of facility.
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onPoint Oncology LLC
HOPPS 2011
• In the New Rule
• Commencing in 2010, CMS allows certain non-physician
practitioners (NPPs) – example, PAs, NPs, clinical nurse
specialists – to provide direct supervision for hospital
outpatient therapeutic services they are authorized to
perform in state scope of practice rules and under hospital
privileging. Chemo requires direct supervision; other drug
administration does not
• For an on-campus hospital outpatient setting the rule is met
by immediate availability of either a physician or NPP
anywhere on the same hospital campus and immediately
available to furnish assistance and direction throughout
performance of the procedure (may be in non-hospital space
on the campus)
• For an off-campus outpatient department, supervising
physician or NPP must be in the provided-based department
(though not
necessarily in the same room)
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FOUR BIG-TIME
INITIATIVES
WILL BEGIN OR HAVE
BEGUN THIS YEAR
Is Your Organization Prepared?
I.A. Beginning in October 2010*
2009 ARRA / HITECH Act
Medicare / Medicaid
Incentive
Payments
MEANINGFUL
USE of
CERTIFIED EHRs
Providers / Hospitals

Division B, Title IV:
Record (EHR) Installations
Electronic Health
Incentive Payments are for “Adoption and Meaningful Use of
Certified EHR Technology”
*Applies to Medicare ONLY – US Hospitals
I.B. Began in February 2010*
2009 ARRA / HITECH Act
HIPAA “TWO”
Confidentiality/
Privacy
and
Security Standards
 Division A, Title XIII - Subtitle D:
1996 HIPAA Title II--Administrative Simplification Standards
Modifications


The Confidentiality and Privacy Standards
The Security Standards
*HHS’ OCR begins to enforce Privacy Rule only after a rule is in
place; Privacy’s Breach Rule already in place
Applies to ALL (new / existing) HIPAA CEs
II. Compliance on January 1, 2012
1996 HIPAA Title II--Administrative
Simplification Standards Modifications
 The EDI Transactions Set
Version 5010 and D.0 Transactions
Applies to ALL (new / existing) HIPAA Covered Entities
and ALL Accredited Standards Committee (ASC) X12
and National Council for Prescription Drug Program
(NCPDP) transactions
HIPAA 5010 COMPLIANCE DATES
 HIPAA 5010 EFFECTIVE DATE:
 LEVEL I COMPLIANCE BY:
March 17, 2009
December 31, 2010
 CMS Medicare Fee-for-Service Schedule:
April 1, 2010 through December 31, 2010
 LEVEL II COMPLIANCE BY:
December 31, 2011
 CMS Medicare Fee-for-Service Schedule:
January 1, 2011 through December 31, 2011
 ALL CEs FULLY COMPLIANT ON:
January 1, 2012
III. Beginning on October 1, 2013
ICD-10-CM / PCS
Physician
Hospital
Behavioral
Health
Inpatient
All Other
Laboratory
Outpatient
Long Term
Healthcare
ICD-9-CM vs. ICD-10CM
1) ICD-9-CM is out of date and running out of space for
new codes.
•
•
Lacks specificity and detail
No longer reflects current medical practice
2) ICD-10 is the international standard to report and
monitor diseases and mortality, making it important
for the U.S. to adopt ICD-10 based classifications for
reporting and surveillance.
3) ICD codes are the core elements of HIT systems,
conversion to ICD-10 is necessary to fully realize
benefits of HIT adoption.
• ICD-10-CM code book retains the same
traditional format
• Index
• Tabular
• Process of coding is similar
• Look up a condition in the Index
• Confirm the code in the Tabular
ICD – 9-CM
ICD – 10-CM
13,600 codes
69,000 codes
Code book contains 17 chapters
Code book contains 21 chapters
Consists of 3 to 5 characters
Consists of 3 to 7 characters
1st character is alpha or numeric
1st character is alpha
Only utilizes letters E and V
Utilizes all letters (except U)
Second, third, fourth, and fifth
characters are always numeric
Second character
is always numeric
Third, fourth, fifth, sixth, and seventh
characters can be alpha or numeric
Shorter code descriptions because
of lack of specificity and
abbreviated code titles
Longer code descriptions because of
greater clinical detail and specificity
and full code titles
ICD-9-CM CODE
• A - Category of code
ICD-10-CM CODE
• A - Category of code
• B - Etiology,
anatomical site, and
manifestation
• B - Etiology,
anatomical site,
and/or severity
• C - Extension
A
B
• 7th character for obstetrics,
injuries, and external causes of
injury
A
B
C
ICD-9-CM Structure – Format
Numeric or
Alpha
(E or V)
V
X
E
5
4
Numeric
X
1
X
4
Category
.
X
0
X
0
Etiology, Anatomic
Site, Manifestation
3 – 5 Characters
ICD-10-CM Structure – Format
Alpha
(Except U)
M
X
A
S X
3 X
2
Category
2 - 7 Numeric or Alpha
.
Additional
Characters
X
0 X
1 X
0
A
X
Etiology, Anatomic
Site, Severity
Added code extensions
(7th character) for
obstetrics, injuries, and
external causes of injury
3 – 7 Characters
ICD-9-CM Codes
ICD-10-CM Codes
Pressure ulcer codes
9 codes
707.00 – 707.09
Pressure ulcer codes
125 codes
L89.0-L89.94
Codes:
707.0 Pressure ulcer
707.00 - unspecified site
707.01 - elbow
707.02 - upper back
707.03 - lower back
707.04 - hip
707.05 - buttock
707.06 - ankle
707.07 - heel
707.09 - other site
Code Examples:
L89.131 – Pressure ulcer of right lower back, stage I
L89.132 – Pressure ulcer of right lower back, stage II
L89.133 – Pressure ulcer of right lower back, stage III
L89.134 – Pressure ulcer of right lower back, stage IV
L89.139 – Pressure ulcer of right lower back,
unspecified stage
L89.141 – Pressure ulcer of left lower back, stage I
L89.142 – Pressure ulcer of left lower back, stage II
L89.143 – Pressure ulcer of left lower back, stage III
L89.144 – Pressure ulcer of left lower back, stage IV
L89.149 – Pressure ulcer of left lower back,
unspecified stage
L89.151 – Pressure ulcer of sacral region, stage I
L89.152 – Pressure ulcer of sacral region, stage II
…
L89.90 – Pressure ulcer of unspecified site,
unspecified stage
• Combination codes for conditions and common symptoms or
manifestations
• Combination codes for poisonings and external causes
• Added laterality
• Expanded codes: injury, diabetes, alcohol/substance abuse,
postoperative complications
• Added extensions for episode of care
• Inclusion of trimester in obstetrics codes and elimination of
fifth digits for episode of care
• Expanded detail relevant to ambulatory and managed care
encounters
• Inclusion of clinical concepts that do not exist in ICD-9-CM
• Changes in timeframes specified in certain codes
Useful in Cancer??
• Laterality – Left Versus Right
• C50.1 Malignant neoplasm, of central portion of breast
• C50.111 Malignant neoplasm of central portion of
right female breast
• C50.112 Malignant neoplasm of central portion of left
female breast
Useful In Cancer???
• ICD-9-CM
• 143 Malignant neoplasm of gum
• 143.0 Upper gum
• 143.1 Lower gum
• ICD-10-CM
• C03 Malignant neoplasm of gum
• C03.0 Malignant neoplasm of upper gum
• C03.1 Malignant neoplasm of lower gum
General Equivalence
Mappings
• “GEMs” stands for General Equivalence Mappings
• The CMS and the CDC created GEMs to ensure consistent
national data when the U.S. adopts ICD-10.
• The GEMs will act as a translation dictionary to bridge the
“language gap” between the two code sets and can be used to
map an ICD-9 code to an ICD-10 code and vice versa.
• Designed to give all sectors of the healthcare industry that
use coded data the tools to:
•
•
•
•
Convert large databases and test system applications
Link data in long-term clinical studies
Develop application-specific mappings
Analyze data collected before and after the transition to ICD-10CM
• The GEMs should not be used as a substitute
for learning how to use the ICD-10-CM code
sets.
• “GEMs are not a substitute for learning ICD-10-PCS
and ICD-10-CM coding. They’ll help you convert
large data sets.”
• Mapping simply links concepts in the two code
sets, without consideration of context of specific
patient information, whereas coding involves
assigning the most appropriate code based on
documentation and applicable coding guidelines.
• A clear one-to-one correspondence between an ICD-9 or
ICD-10 code is the exception rather than the rule.
• ICD-9 codes: 414.01 Coronary atherosclerosis of native
coronary artery and 411.1 Intermediate coronary syndrome
(unstable angina)
• ICD-10 code :I25.110 Atherosclerotic heart disease of native
coronary artery with unstable angina
• There are situations when a code in the target
system does not exist
• T503x6A Underdosing of electrolytic, caloric and water-balance
agents, initial encounter
Forward Mapping
ICD-9
Code
820.8
Description
(Source)
ICD-10
Code
Fracture of unspecified part of
neck of femur, closed
S72.009A
Description
(Target)
Fracture of unspecified part of
neck of femur, initial encounter for
closed fracture
Backward Mapping
ICD-9
Code
820.8
Description
(Target)
Fracture of unspecified part of
neck of femur, closed
ICD-10
Code
Description
(Source)
S72.001A
Fracture of unspecified part of neck
of right femur, initial encounter for
closed fracture
S72.002A
Fracture of unspecified part of neck
of left femur, initial encounter for
closed fracture
S72.009A
Fracture of unspecified part of neck
of femur, initial encounter for
closed fracture
GEMS Example #1
GEMS Example #2
GEMS #3
GEMS Example #4
Preparing for ICD-10
Checklist: http://www.ahima.org/icd10/ICD-10PreparationChecklist.mht
Year
Phase I
Phase II
Phase III
Phase IV
48
2009/ 2010
2011
2012
2013
Awareness and
Impact Assessment
Preparing for Implementation
Go Live
Preparation
Post –
Implementation
• The increased specificity of the ICD-10 codes
requires more detailed clinical documentation in
order to code some diagnoses to the highest level
of specificity.
• There are “unspecified” codes in ICD-10-CM for
those instances when medical record
documentation is not available to support more
specific codes.
• The benefits of ICD-10 can not be realized if nonspecific codes are used rather than taking
advantage of the specificity ICD-10 offers.
• Conduct medical record documentation
assessments
• Evaluate records to determine adequacy of
documentation to support the required level of detail
in new coding systems
• Implement a documentation improvement
program to address deficiencies identified during
the review process
• Educate providers about documentation requirements
for the new coding system through specific examples
• Emphasize the value of more concise data capture for
optimal results and better data quality
• DHHS agrees that some physicians will want intensive
training on ICD-10 but some will seek “awareness training”.
• Nolan study estimates 8 hours of intensive physician training
• Nachimson Advisors, LLC study predicts 12 hours of
physician training in both the code set and documentation
procedures.
• AHIMA believes most physicians would want no more than
4 hours of training.
Solo Practitioner Or Small Group (2-10)
Practice Implementation Planning
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Organize Implementation Effort
Establish Communication Plan
Conduct Impact Analysis
Contact System Vendors
Estimate Budget
Implementation Planning
Develop Training Plan
Analyze Business Processes
Education and Training
Policy Change Development
Deployment of Code
Implementation Compliance
52
1. Organize Implementation Effort
• Enlist staff person (coder, biller, manager) to oversee effort
who will be key point person
―Prepare information to share with other providers and staff
―Identify work and scope for implementation
• Should be a team effort involving all medical practice staff
53
1. Organize Implementation Effort
• Look at all areas that will impact practice and identify each one
that will be affected
―
―
―
―
Practice management system
Electronic Medical Record (EMR), if applicable
Super bills
Clinical areas
• Schedule regular meeting to share information
with physicians and discuss progress and barriers
of implementation
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2. Establish Communication Plan
• How will point person communicate with all staff ?
• Most small practices communicate via meetings or memos
 No need to change method of communications
 Develop regular schedule
• Monthly until 6 months prior to implementation
• Bi-weekly thereafter
 Include information, publications, and articles
55
3. Conduct Impact Analysis
• Take this step prior to development of budget
• In depth look at resources required for implementation
• Helps determine what costs might be involved as well as work
processes
• What systems will be affected?
•
•
•
•
•
Practice management
Coding look up programs (if applicable)
EMR
Remittance systems
Hardware space
• What are the potential costs involved?
56
3. Conduct Impact Analysis
• Develop reasonable timeline that can be accomplished in
the solo or small medical practice
―Map out a project plan on a simple Excel spreadsheet with
benchmarks and status of completion
• Managers and/or coders should get physician approval
57
Sample Project Plan
Item
1.0
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
Steps to Implementation
Organize the implementation effortEstimated timeline 2 months
Review ICD-10 final rule
Start
1/16/09
Due
7/1/09
Completed
Assigned to
1/16/09
2/1/09
1/31/09
Manager
Point person/lead for ICD-10-CM
implementation
Prepare briefing materials to review with
physician(s) related to work and scope of
work that needs to be accomplished
Contact our consultant to review materials
and offer assistance
Review impact of ICD-10 with all providers
Establish regular meeting schedule with
provider(s) to discuss progress
Identify areas that will impact the practice
2/1/09
3/1/09
3/1/09
Manager
3/4/09
4/30/09
4/30/09
Manager
4/1/09
5/1/09
4/15/09
Manager
5/1/09
5/15/09
6/1/09
6/1/09
6/1/09
6/1/09
Manager
Manager
6/1/09
7/1/09
6/1/09
7/1/09
Start
Due
7/1/09
8/1/09
Establish who has final decision making
authority
Manager
and Coder
Physicians
Completed
Assigned to
2.0
Establish communication Plan
Manager
2.1
Manager
2.2
Develop method of communication on ICD10-CM
Develop materials for physicians and staff
2.3
Develop communication schedule
Manager
Manager
58
3. Conduct Impact Analysis
• Coding and documentation go hand in hand
• Based on complete and accurate documentation
• ICD-10 should impact documentation as physicians are
required to support medical necessity using appropriate
diagnosis code
• Will not change the way a physician practices medicine
• Complete and accurate documentation will continue to
be important in 2013 as it is today
59
4. Contact System Vendors
• Will they be able to accommodate the need to move to ICD10?
• Will they be ready for 5010 on January 1, 2012?
• What costs will be involved with the transition to 5010 and
ICD-10?
• What plans do they have in place for implementation?
• When will they have software available for testing?
• Will we need new hardware or is current hardware sufficient?
60
5. Estimate Budget
• Budget considerations should include
• Hardware costs
• Software costs and licensing
• Training
61
6. Implementation Planning
• Begin planning early in 2010
• Break down planning into stages
• Training for a small practice does not need to begin until 6
months prior to implementation
• Review super bills and remove rarely used codes
• Crosswalk common codes from ICD-9-CM to ICD-10-CM
―Look up codes in ICD-10-CM book and use GEMs if
necessary
62
Crosswalk Example
Iron Deficiency Anemia
ICD-9-CM
280
ICD-10-CM
Iron deficiency anemia
D50
Iron deficiency anemia
280.0 Secondary to blood loss
D50.0 Secondary to blood Loss
280.1 Secondary to inadequate dietary
intake
D50.8 Other iron deficiency anemias
280.8 Other specified iron deficiency
anemias
D50.1 Sideropenic dysphagia
D50.8 Other iron deficiency anemias
280.9 Iron deficiency anemia, unspecified
D50.9 Iron deficiency anemia
unspecified
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7. Develop Training Plan
• Who needs training?
•
•
•
•
•
Physicians
Coders
Billing staff
Administrative staff
Clinical Staff
• Required number of hours depends on their role
• What resources are available?
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7. Develop Training Plan
• Many organizations will have several mechanisms for
training
•
•
•
•
•
•
Distance learning
Workshops
Conferences
Audio Conferences
Webinars
Books
• Establish training schedule
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7. Develop Training Plan
• Determine if temporary staff or overtime will be necessary
during training period
• What materials will the office need for ongoing support
after training?
• Books
• Software (code look up programs)
• Other
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8. Analyze Business Processes
• Identify all systems and processes that currently use ICD-9CM
• Review existing medical policies related to ICD-9-CM
• Which contracts tied to reimbursement are tied to a
particular diagnosis?
• Modify any contract agreements with health plans
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9. Education and Training
• Education should begin approximately 6
months prior to implementation
• Large practices may need to begin earlier to
accommodate all staff who need training
• Use various methods of training
• Training time depends on their role
• Physicians and coders/billers will need more
training time than administrative staff
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10. Policy Change Development
• After health plans complete and change medical policy for
procedures and services a specialty provides
• Review new payment policies
• Identify opportunities to improve coding processes
• Communicate policy changes to applicable staff
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11. Deployment of Code
• Vendor delivers software update with ICD-10CM
• Vendors should
Test system
Integrate software into your systems
Make internal customizations
Test systems with clearinghouses, payers, electronic
claims transmission (end to end)
• Ensure that the vendor will maintain updates to code
during transition period
•
•
•
•
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12. Implementation Compliance
• Compliance date for implementation – October 1, 2013
• Monitor compliance activities to identify any problems
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Other Considerations
• Consider use of electronic tools to facilitate coding
process
– Could reduce costs and claims rejections
– Could increase productivity and coding accuracy
• Don’t convert superbills/charge documents too
early
– Currently, ICD-10-CM is still updated annually
– 6 –12 months prior to implementation or after code set
has been “frozen”
– Assign ICD-10-CM codes directly, not by applying ICD9-CM to ICD-10-CM map
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CMS’ Web Resources
• ICD-10 General Information
http://www.cms.hhs.gov/ICD10
• ICD-10 Educational Resources (fact
sheets)
http://www.cms.hhs.gov/ICD10/05_Educational_R
esources.asp
• ICD-10 CMS Sponsored Calls (2008 and
2009 discussion materials and transcripts)
http://www.cms.hhs.gov/ICD10/07_Sponsored_Ca
lls.asp
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CDC’s Web Resources
• General ICD-10 information
http://www.cdc.gov/nchs/about/major/dvs/icd10de
s.htm
• ICD-10-CM files, information, and General
Equivalence Mappings (GEM) between ICD-10-CM
and ICD-9-CM
http://www.cdc.gov/nchs/about/otheract/icd9/icd1
0cm.htm
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AHA’s Resources
• Regulatory member advisories
• Presentations and articles
• ICD-10 2009 audio seminar series
• Central Office on ICD-9-CM
http://www.ahacentraloffice.org
• AHA Central Office ICD-10 Resource Center
http://www.ahacentraloffice.org/ICD-10
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In Summary…
• Part B providers must select their incentive programs carefully
this year. May not participate in E-Rx and HIT/ EHR in the
same year.
• Evaluate whether your providers are going to get hit with the ERx penalty in 2012…time is running out.
• Update your Superbill or in HOPDs, your CDM for all J-code
changes.
• Don’t think you will escape Medicare and Medicaid audits--that where ACA revenue is coming from.
• Get prepared or HIPAA 2 and 5010. ICD-10 will be coming up
soon after (YUCK)…
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• CAN Web Site
• The latest news
• Forms
• Regulations
• Newsletters
• Presentations
• http://can.communityoncology.org
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CONTACT INFO
• Contact
• [email protected]
• [email protected]
• 800-795-2633
• Newsletter is free!
• Send all RAC information to me at the ABOVE E-mails
or FAX to 650-618-8621
• Go to our website: http://www.onpointoncology.com
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