Transcript EDI – 5010/ICD 10 Working Session

Overview of 5010 and ICD-10:
Definitions, Planning and Readiness
Facilitators:
Kit Cairns, WIITTS
Karen Navarro, University of WI Hospital & Clinics
Claudia Yoakum-Watson, WEA Trust and CCRS
Welcome!
Introductions
Review of this afternoon’s sessions:
• Overview of 5010 and ICD-10
• 5010 Working Session
• ICD-10 Working Session
Agenda for Overview Session
5010
ICD-10
Implementation
Resources
Questions
EDI 5010 Overview
5010 Questions
What is 5010 and why do we have to do this?
When does 5010 happen?
Who uses 5010?
Where is 5010 used?
EDI 5010 Overview
What is 5010?
• Started with requirement that the Secretary of the Department of
Health and Human Services (HHS) adopt standards for covered
entities to use when they electronically conduct certain health care
administrative transactions.
• The Transactions and Code Sets final rule published on Aug. 17,
2000, adopted standards for the statutorily identified transactions,
some of which were modified in a subsequent final rule published
on Feb. 20, 2003.
• On January 16, 2009, HHS announced a final rule that replaces the
current Version 4010/4010A and NCPDP Version 5.1 with Version
5010 and Version D.0, respectively.
EDI 5010 Overview
What is 5010?
• Improvements in structural, front matter, technical, and data
content.
• More specific in requiring the data that is needed, collected, and
transmitted in a transaction.
• Significant improvements for the reporting of clinical data, enabling
the reporting of ICD–10–CM diagnosis codes and ICD–10–PCS
procedure codes, and distinguishes between principal diagnosis,
admitting diagnosis, external cause of injury and patient reason for
visit codes.
EDI 5010 Overview
Why do we have to do this?
Because of the Final Rule published
by the US Department of Health and
Human Services on 1/16/2009:
http://edocket.access.gpo.gov/2009/pdf/E9-740.pdf
EDI 5010 Overview
When does 5010 happen?
December, 2010
Complete internal testing – able to send &
receive compliant transactions
January, 2011
Begin external testing with trading partners
January 1, 2012
All covered entities must be in production
EDI 5010 Overview
Who uses 5010
Covered Entities:
• PROVIDERS (doctors, clinics, hospitals,
psychologists, dentists, chiropractors, nursing homes,
pharmacies – submitting information electronically for
HHS standard transactions)
• HEALTH PLANS (health insurance companies,
HMOs, company health plans, gov’t health plans such
as Medicare, Medicaid, etc.)
• HEALTH CARE CLEARINGHOUSES (entities that
process non-standard health information from another
entity into a standard or vice versa)
EDI 5010 Overview
Where is 5010 used?
Covered transactions include:
• 837 P, I, and D claims (including
COB)
• 835 health care payment and remittance
advice
• 270/271 eligibility request/response
• 276/277 claim status request/response
• 278 referral certification and authorization
• 834 health plan enrollment/disenrollment
• 820 health plan premium payment
• NCPDP D.0, 5.1, and 3.0
EDI ICD-10 Overview
ICD-10 Questions
What is ICD?
Who uses ICD-10?
When does ICD-10 happen?
How is ICD used?
Why are we moving to ICD-10
How does ICD-10 differ from ICD-9
EDI ICD-10 Overview
ICD-10 Code Structure
The patient is in the office for the first visit because of
a closed greenstick fracture of the right radial shaft.
813.21
Fracture of shaft; radius alone
S52.311A Greenstick fracture of shaft of radius, right
arm, initial encounter for closed fracture
EDI ICD-10 Overview
Diagnosis Code Structure
S52.311A
Greenstick fracture of shaft of radius, right arm, initial
encounter for closed fracture
Root
Root
Root
Site
Severity
Etiology
Extension
S
5
2
3
1
1
A
Injuries to
the elbow
and forearm
Fracture
of
Forearm
Radial
Shaft
Greenstick
Injury,
poisoning and
certain other
consequences
of external
causes
Right
Initial
Encounter
EDI ICD-10 Overview
Procedure Code Structure
OTF4ZZZ
Lithotripsy
Section
Body
System
Root
Procedure
Treatment
Site
Approach
Device
Qualifier
O
T
F
4
Z
Z
Z
No
Device
Noted
No
Qualifier
Noted
Medical
Urinary
Fragmentation
Left Renal No
Pelvis
Approach
Noted
EDI ICD-10 Overview
Mapping of 813.21
There are 90 ICD-CM code possibilities for mapping of 813.21
S52.3Ø1A
Unspecified fracture of shaft of right radius, initial encounter for closed fracture
S52.3Ø1G
Unspecified fracture of shaft of right radius, subsequent encounter for closed fracture with delayed
healing
S52.321A
Displaced transverse fracture of shaft of right radius, initial encounter for closed fracture
S52.325A
Non displaced transverse fracture of shaft of left radius, initial encounter for closed fracture
S52.325G
Non displaced transverse fracture of shaft of left radius, subsequent encounter for closed fracture with
delayed healing
S52.341A
Displaced spiral fracture of shaft of radius, right arm, initial encounter for closed fracture
S52.364A
Non displaced segmental fracture of shaft of radius, right arm, initial encounter for closed fracture
S52.381A
Bent bone of right radius, initial encounter for closed fracture
EDI 5010 and ICD-10 Implementation
Implementation Tasks
Phase 1
Awareness and Communication
Begin impact assessments
Create the structure/governance
EDI 5010 and ICD-10 Implementation
Implementation Tasks
Phase 2:
Complete Impact Assessment
Complete Budget Planning
Determine business and technical strategies
Define Functional Requirements
EDI 5010 and ICD-10 Implementation
Implementation Tasks
Phase 3:
Complete System Development/ Get Vendor Updates
Review contracts, reports, …
EDI 5010 and ICD-10 Implementation
Implementation Tasks
Phase 4:
TEST – TEST - TEST
EDI 5010 and ICD-10 Implementation
Implementation Tasks
Phase 5:
Communicate changes
Analyze potential cash flow implications
Go-live
Resources
HIPAA COW:
www.hipaacow.com
WEDI:
www.wedi.com
CMS:
www.cms.gov
Resources
CMS Transactions & Codesets:
http://www.cms.hhs.gov/TransactionCodeSetsStands/02
_TransactionsandCodeSetsRegulations.asp
ICD 10 Final Rule:
http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf
5010 Final Rule:
http://edocket.access.gpo.gov/2009/pdf/E9-740.pdf
Resources
CMS HIPAA Standards Page (gap information links):
http://www.cms.hhs.gov/ElectronicBillingEDITrans/18_50
10D0.asp
CMS ICD 10 Fact Sheet:
http://cms.hhs.gov/MLNProducts/downloads/ICD10factsheet2009.pdf
X12 Presentation to NCVHS on 5010 changes:
http://www.ncvhs.hhs.gov/070730p4.pdf
Questions?
THANK YOU!
Contact Information:
Kit Cairns
[email protected]
608.294.6492
Karen Navarro
[email protected]
608.662.0817
Claudia Yoakum-Watson
[email protected]
608-661-6726
Or
[email protected]
608-289-4974
Notes
Notes
Notes