Julia M. Pillsbury, DO, FAAP, FACOP Member, AMA CPT Editorial Panel Member, AAP Committee on Coding...

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Transcript of Julia M. Pillsbury, DO, FAAP, FACOP Member, AMA CPT Editorial Panel Member, AAP Committee on Coding...

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Julia M. Pillsbury, DO, FAAP, FACOP Member, AMA CPT Editorial Panel Member, AAP Committee on Coding and Nomenclature Bayhealth Office Managers Program August 20, 2013, Milford Memorial Hospital Slide 2 In the past 12 months, I have had a significant financial interest or other relationship with the manufacturer(s) of the following product(s) or provider(s) of the following service(s) that will be discussed in my presentation. AMA CPT Editorial Panel Editorial Board: AAP Pediatric Coding Newsletter AAP Committee on Coding and Nomenclature Slide 3 Upon completion of this presentation, the participant will be able to: 1. Describe the purpose of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD10 -CM) 2. Describe the similarities and differences in the structure and format of ICD10-CM. 3. Understand the importance of documentation in using ICD10-CM. Slide 4 Slide 5 International Classification of Diseases (ICD) is an official publication of the World Health Organization (WHO) Part of the WHO Family of International Classifications International Classification of Functioning, Disability and Health International Classification of Health Interventions International Classification of Diseases for Oncology Primary purpose is for epidemiological tracking of illness and injury ICD has been used in the US since 1949 (ICD-6) Revised every 8-10 years First US adaption was by the US Public Health Service with ICD-7 Slide 6 Current US version, ICD-9-CM (clinical modification), is a public-private collaboration (cooperating parties) National Center for Health Statistics/CDC (NCHS) Centers for Medicare and Medicaid Services (CMS) American Hospital Association American Health Information Management Association (AHIMA) Formerly the American Medical Record Association HIPAA standard for morbidity and mortality reporting Slide 7 Accurate diagnosis coding is the basis for obtaining medical data for: Reporting and trending vital health statistics Evaluating medical processes and outcomes Reporting data to organizations: quality and cost effectiveness Identifying public health issues and concerns Identifying ways to improve the safety and quality of care Evaluating medical necessity when adjudicating claims Slide 8 ICD9CM = International Classification of Diseases, Ninth Edition, Clinical Modification Developed in early 1970s ICD-9-CM has been used for morbidity and mortality reporting since 1979 in US. ICD-9-CM is divided into 3 chapters Chapters 1 and 2 have morbidity/mortality codes NCHS (CDC) has primary responsibility Chapter 3 is inpatient hospital resource codes CMS has primary responsibility Slide 9 ICD10CM/PCS = International Classification of Diseases, Tenth Edition, Clinical Modification/ Procedure Coding System Developed in 1989, released in 1994. ICD-10 has been in use for mortality reporting in the US since January 1, 1999. 2 Parts: ICD-10-CM = Diagnosis classification system developed the Centers for Disease Control and Prevention ICD-10-PCS = Procedure classification system developed by the CMS for use in the U.S. for inpatient hospitals ONLY. Slide 10 CMS published the Final Rule for US clinical modification (ICD-10-CM) January 16, 2009. Required implementation on October 1, 2013. (Deferred until October 1, 2014.) ICD-9-CM will no longer be accepted for encounters starting on that date. ICD-10-CM will replace ICD-9-CM Volumes 1 (tabular) and 2 (index). ICD-10-PCS will replace ICD-9-CM Volume 3 (inpatient hospital resource utilization) ICD-10-PCS does not replace CPT or HCPCS. Slide 11 ICD-9-CM is no longer supported by WHO. ICD 9 cannot be expanded in the way technology is moving. ICD 9 cannot keep pace with our expanding knowledge of disease and treatment. ICD-9 contains outdated and obsolete terminology that produces inaccurate and limited data, and is inconsistent with current medical practice. Slide 12 ICD-10 includes updated medical terminology and classification of diseases. ICD-10 incorporates much greater specificity and clinical information. ICD-10 will improve the quality of patient care and health databetter public health surveillance. Slide 13 Implementation was delayed from October 1, 2013 until October 1, 2014. The big question: Will more delays occur? ICD-10 has been in use for mortality reporting in the US since January 1, 1999. Current code sets are frozen until October 1, 2015 to reduce annual updates/changes. Slide 14 Encounters that take place on or after October 1, 2014 are reported with ICD-10-CM codes Encounters that take place before October 1, 2014 are reported with ICD-9-CM codes You will have to run simultaneous systems of ICD-9 and ICD-10 until all your claims from before October 1, 2014 have cleared and for non-HIPAA compliant claims. * ICD-10 only applies to patients covered under HIPAA, so Workers Compensation patients, who aren't covered under HIPAA, will still be billed under ICD-9. Slide 15 Look at the current resources that exist. Review your EMR/EHR programs to verify they are ICD-10-CM ready and what steps you have to take to update If you dont have an EMR or billing program look in to one that supports ICD-10-CM Capability to run both codes a bonus Look at costs of the change and start planning for that now. Budget costs of the change. Estimated cost $83,000.00 for a small practice up to $283,000.00 for a 10 physician practice. Slide 16 Review contracts with health plans and see what additional information they need or what will be changing. Test systems and procedures before October 2014 to make sure your office is ready to go. Update forms, documentation, and internal processes. Slide 17 Begin now! Perform a readiness assessment. Is your practice management system ready? If not, when will it be? Are your payers ready? Need to test with vendors ASAP. Anticipate a reduction in cash flow. Training impacts productivity. Begin saving for cash flow issues or arrange a bank LOC. ICD-10 EDUCATION! Slide 18 Educate your providers and staff! Encourage your providers to document and use more specific codes. Especially those who tend to use unspecified codes or whose documentation leads to an unspecifiedcode. Most payers said they won't reimburse for unspecified codes. Work with those providers on their documentation and in areas where you know more documentation is needed (e.g. Otitis Media). Slide 19 Develop an education plan. Begin training 3-6 months prior to implementation. Anticipate a minimum of 4 hours training time/employee. 20-40 hours for coders. Specificity requires more clinical knowledge e.g. Anatomy and physiology. Physician training should focus on documentation concepts. Slide 20 Alphabetical listing. Tabular listing. Code First/Use Additional Code Notations rules are unchanged. Can still use symptoms. Slide 21