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Download ICD-10 Transition Planning Considerations For Our Providers
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ICD-10 Transition Planning Considerations For Our Providers CMS Mandated Change • On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. • Claims for ambulatory service dates and hospital discharge dates as of 10/1/2014 must be coded in ICD-10 • Current CMS position – “no additional delays” • Transition is required for all CMS covered entities How Is ICD-10 Different Than ICD-9? • • • • NOT a simple update of the ICD-9 code set. Fundamental changes in structure and concepts Increased specificity Higher level of detail for more precise diagnostic coding • Improvement in ability to measure health care services and conduct public health surveillance. Side By Side Comparison Diagnostic Codes YEAH, THERE IS AN CODE ICD-10 FOR THIS TOO! V9542XA: Spacecraft crash injuring occupant, initial encounter YEAH, THERE IS AN CODE ICD-10 FOR THIS TOO! W5609XD: Other contact with dolphin, subsequent encounter. CMS ICD-10 Timeline CHPW ICD-10 Transition Timeline • ICD-10 transition dependent on core system replacement – in progress • ICD-10 claims testing targeted for Q1, 2014 start CHP Internal Claims Testing Provider-CHP Claims Testing CMS Checklist of Transition Actions CMS Checklist of Transition Actions Planning, continued CMS Checklist of Transition Actions Transition Date! Self-Assessment • Where is my organization relative to CMS guidelines in preparing for the transition? • Is there a firm date for when my practice/EMR software will support generation and submission of ICD-10 claims, receiving ICD-10 HIPAA 835’s? • Has my practice/EMR vendor provided a software tool to facilitate the selection of ICD-10 diagnostic/procedure codes during creation of clinical documentation? • When will my organization (software vendor?) be prepared to test electronic transactions with business partners? • Has ICD-10 training for clinicians, coders and billers been scheduled in the first months of 2014? • Have clinical documentation, forms and procedures been evaluated and updated? • What else is needed to be compliant on October 1, 2014? Questions? References and Resources • CMS http://www.cms.gov/Medicare/Coding/ICD10/index.html • AMA http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billinginsurance/hipaahealth-insurance-portability-accountability-act/transaction-code-set-standards/icd10code-set.page • AHIMA http://www.ahima.org • AAPC http://www.aapc.org • WHO http://www.who.int/classifications/icd/en/ • CHPW http://chpw.org/for-providers/icd10-home/ • Consultants: Priority Management Group (PMG) http://gopmg.com Clinical Documentation Specificity Examples ICD-9 CM vs ICD-10 CM Top 5 CHC Diagnoses Marvel Gray CCS-P, CPC, MCS-P, CHCA, CHCAF, CMPM, CCP, PCS Rhonda Jensen BS, CPC, CPC-H, CEMC, CCS-P ICD-9- CM vs ICD-10 CM Codes ICD-9 CM • V20.2 Routine infant or child health check. ICD-10 CM • Z00.121 Encounter for routine child health examination with abnormal findings. Use additional code to identify abnormal findings • Z00.121 Encounter for routine child health examination with abnormal findings. Use additional code to identify abnormal findings. ICD-9- CM vs ICD-10 CM Codes ICD-9 CM • 465.9 Acute upper respiratory infections of unspecified site. ICD-10 CM • J06.9 Acute upper respiratory infection, unspecified Excludes 1 Note = “Not coded here!” Use 1 Code Only Excludes 1 Note Indicates that the code excluded should never be used at the time as the codes above the excludes 1 note. • Acute respiratory infection NOS ( J22) • Influenza virus (J09 – J11) • Streptococcal pharyngitis (J02.0) ICD-9- CM vs ICD-10 CM Codes ICD-9 CM • V22.1 Supervision of other normal pregnancy • ICD-10 CM • • • • • • • • Z34.80 Encounter for supervision of other normal pregnancy, unspecified trimester Z34.81 Encounter for supervision of other normal pregnancy, first trimester Z34.82 Encounter for supervision of other normal pregnancy, second trimester Z34.83 Encounter for supervision of other normal pregnancy, third trimester Z34.90 Encounter for supervision of normal pregnancy, unspecified, unspecified trimester Z34.91 Encounter for supervision of normal pregnancy, unspecified, first trimester Z34.92 Encounter for supervision of normal pregnancy, unspecified, second trimester Z34.93 Encounter for supervision of normal pregnancy, unspecified, third trimester ICD-9- CM vs ICD-10 CM Codes ICD-9 CM • V04.81 Need for prophylactic vaccination and inoculation, influenza ICD-10 CM • Z23 Encounter for immunization Code first any routine childhood examination. V03.0, V03.1, V03.2, V03.3, V03.4, V03.5, V03.6, V03.7, V03.81, V03.82, V03.89, V03.9, V04.0, V04.1, V04.2, V04.3, V04.4, V04.5, V04.6, V04.7, V04.81, V04.82, V04.89, V05.0, V05.1, V05.2, V05.3, V05.4, V05.8, V05.9, V06.0, V06.1, V06.2, V06.3, V06.4, V06.5, V06.6, V06.8, V06.9 ICD-9- CM vs ICD-10 CM Codes ICD-9 CM • 462 ICD-10 CM Acute pharyngitis • J02.8 Acute pharyngitis due to other specified organisms Use additional code (B95-B97) to identify infectious agent Excludes 1 Note • acute pharyngitis due to coxsackie virus (B08.5) acute pharyngitis due to gonococcus (A54.5) acute pharyngitis due to herpes [simplex] virus (B00.2) acute pharyngitis due to infectious mononucleosis (B27.-) acute pharyngitis due to influenza virus (J09.02, J09.12, J10.1, J11.1) enteroviral vesicular pharyngitis (B08.5) • J02.9 Acute pharyngitis, unspecified Gangrenous pharyngitis (acute) Infective pharyngitis (acute) NOS Pharyngitis (acute) NOS Sore throat NOS Suppurative pharyngitis (acute) Ulcerative pharyngitis (acute ICD-9- CM vs ICD-10 CM Codes ICD-9- CM • 250.00 Diabetes mellitus without mention of complication , type II or unspecified type, not stated as uncontrolled. ICD-10- CM • E11.9 Type 2 diabetes mellitus without complications • E13.9 Other specified diabetes mellitus without complications ICD-9- CM vs ICD-10 CM Codes ICD-9- CM • 382.9 Unspecified otitis media ICD-10- CM • H66.90 Otitis media, unspecified, unspecified ear • H66.91 Otitis media, unspecified, right ear • H66.92 Otitis media, unspecified, left ear • H66.93 Otitis media, unspecified, bilateral ICD-9- CM vs ICD-10 CM Codes ICD-9- CM • 724.2 Lumbago ICD-10- CM • M54.5 Low back pain ICD-9- CM vs ICD-10 CM Codes ICD-9- CM • 786.2 Cough ICD-10- CM • R05 Cough ICD-9- CM vs ICD-10 CM Codes ICD-9- CM • 789.00 Abdominal pain, unspecified site ICD-10- CM • R10.0 Acute abdomen • R10.9 Unspecified abdominal pain
