ICD-10-CM: Coding and Clinical Documentation Changes ...

1 ICD-10-CM: Coding and Clinical Documentation Changes Maternal & Child Care Presented by: Angie Audler, MBA, RHIT, CCS, CPC, AHIMA Approved ICD-10-CM/PCS Trainer Copyright c 2015 Confidential and Proprietary Information Disclaimer This PowerPoint presentation is an education tool to provide basic information for Coding . The information is the sole view of the author and was put together based on experience, research and expertise in the Coding profession. It is not intended to be an exhaustive review and should not be considered a substitution for Coding Guidelines.

2 The presenter does not accept any responsibility or liability with regard to errors, omissions misinterpretations or misuse by the audience. Copyright c 2015 Confidential and Proprietary Information Today s Topics Brief Overview of ICD-10-CM/PCS How does ICD-10 Impact you as a Provider Common ICD-10 Codes Clinical Documentation Awareness Tips for ICD-10 Copyright 2015 Confidential and Proprietary Information Brief Overview of ICD-10-CM/PCS ICD-10 is composed of two parts.

3 ICD-10-CM ( Clinical modification) ICD-10-PCS (procedural Coding system) Copyright c 2015 Confidential and Proprietary Information The Difference Between ICD-10-CM/PCS ICD-10-CM Replaces ICD-9-CM Vol. 1 & 2 Codes ICD-10-CM will be used to identify diagnosis codes in all health care settings ICD-10-PCS Replaces ICD-9 Vol. 3 Procedure Codes (facility use only) ICD-10 PCS will be used by facilities to report procedures in the hospital inpatient setting Physicians and Other Healthcare Professionals will continue to use CPT and HCPCS (Level II) codes to report office and other procedures and services Hospital Outpatient Departments/OPSurgery and Ambulatory Surgery Centers will also continue to use CPT and HCPCS (Level II)

4 Codes for reporting outpatient procedures and ancillary services Copyright c 2015 Confidential and Proprietary Information ICD-10-PCS Under ICD-10, new and cutting-edge technology that have been problematic to code in ICD-9 will be assigned based on surgeon s Documentation in the operative note Type of surgery Body system Root operation Body part Approach Device Qualifiers ( biopsy, second site, etc.) Copyright c 2015 Confidential and Proprietary Information Compliance Date October 1, 2015 Date of service on or after 10/01/2015 for office and other outpatient services (including Hospital Observation)

5 ED and Observation services prior to 10/1 with overlap on or after 10/1 will use ICD9 codes for reporting Discharge date on or after 10/01/2015 for hospital inpatient discharges Claims for services prior to 10/1/2015 will continue to flow through systems utilizing ICD-9-CM diagnosis and ICD-9-CM Vol. 3 procedure codes (for facilities) for a period of time 7 Overview of ICD-10-CM The transition to ICD-10 affects all HIPAA-covered entities hospitals, physicians, allied health professionals, home health, skilled nursing, etc.; as well as payers, business associates billing companies, vendors, clearinghouses Non-covered entities ( automobile insurance and worker s compensation programs are not required to transition to ICD-10)

6 , although it is recommended Copyright 2015 Confidential and Proprietary Information ICD-10-CM Changes There are three main categories of Changes in ICD-10-CM - Definition Changes - Differences in Terminology - Increased Documentation Specificity ICD-10 doesn t affect Coding only; it involves physician reporting, billing, information technology, and revenue management Copyright 2015 Confidential and Proprietary Information Comparison 10 ICD-10-CM Although there are approximately 70,000 codes in ICD-10, specialists will use only a small subset of those codes You will be surprised at how much of this work you are already doing Over 1/3 of the expansion codes are due to laterality (physicians are already documenting right, left, bilateral)

7 If bilateral and there is no specific code for bilateral, you code both right and left sides 11 Overview of ICD-10-CM ICD-9 codes will no longer be maintained once ICD-10 is implemented A claim cannot contain both ICD-9-CM and ICD-10-CM (CMS Transmittal 950, effective 10/1/2013) 12 Risk Mitigation Denials can run high for not medically necessary reasons In the beginning there is risk of payers not fully mapping procedures with new allowed diagnosis reasons Be prepared for short term reduced revenues 13 HOT OFF THE Source: Modern Healthcare, 9/4/2015 14 Four State Medicaid Programs will NOT Transition to ICD-10 by 10/1 CMS will allow four states - California, Louisiana, Maryland and Montana - to use a "crosswalk technique" to continue using the older code sets for Medicaid fee-for-service programs because their claims processing systems in these four states are unable to use the new ICD-10 codes.

8 Under the crosswalk technique, the Medicaid programs will convert claims using the ICD10 system into ICD-9 codes to calculate payments Some provider groups and healthIT experts say the use of such a technique could result in payment delays and other issues. It was not stated whether this applies to straight Medicaid and/or the Medicaid Bayou Plans. Stay tuned for additional information to be released Administrative Considerations Reimbursement Potential effect of delays, initial decrease in coder productivity (Industry estimates 20-30% reduction in coder productivity due to additional specificity; physician queries; loss of memorized codes; learning curve.)

9 Decrease in physician/provider productivity due to additional specificity needed in charting; additional specificity needed for orders; additional specificity for authorizations; answering queries; increased selection on charge tickets and/or order sets 15 ICD-10-CM Structure 16 Noteworthy Changes that Fall into Other Specialty Areas Clinical Area ICD-9-CM Codes ICD-10-CM Codes Fractures 787 17099 Pregnancy 1104 2155 Diabetes 69 239 Hypertension 33 14 ESRD 11 5 Brain Injury 292 574 17 Reporting Differences, Trending and Analytic Modifications Converting from ICD9 to ICD10 more than triples the number of available codes Looking at historical data becomes problematic unless you can identify and capture needed information from the two Coding systems Simple forward mapping will not be sufficient for most providers to make a successful transition Copyright 2015 MEDKODER LLC Confidential and Proprietary Information 18 ICD-10-CM You will need to map your most frequently used ICD-9-CM codes to ICD-10-CM Due to the number of code choices

10 With some diagnoses, there may be some challenges with charge ticket/superbill options and EHR template drop-downs Copyright 2015 Confidential and Proprietary Information General Equivalency Maps (GEMS) CMS GEMS (General Equivalency Maps) demonstrate the complexity involved in moving between the two Coding systems Copyright 2015 MEDKODER LLC Confidential and Proprietary Information 20 ICD9/ICD10 Relationships 1:1, Cluster, Combination, Complex Individual ICD-9 codes that map to several ICD-10 code alternatives; Individual ICD-9 codes that map to a set of two of more ICD-10 codes; Two or more ICD-9 codes that map to individual ICD-10 codes; ICD-9 codes with no representation in ICD-10; ICD-9 codes with an exact match in ICD-10.