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Medtronic Cardiac Rhythm and Heart Failure ICD-10 Coding for Physicians May 19, 2015 Disclaimer This presentation is intended for educational use. Any duplication is prohibited without written consent of Medtronic’s Economics and Health Policy department. This information does not replace seeking coding advice from the payer and/or your coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for their interpretation of the appropriate codes to use for specific procedures. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service. 2 Topics Implementation Background ICD-10-CM Diagnosis Codes Diagnosis Code Crosswalks ICD-10-PCS Procedure Codes Implementation Issues Appendix : Key Resources Questions Attachment : Diagnosis Code Crosswalks 3 Implementation Background 4 Effective Date ICD-10 goes into effect October 1, 2015. Use of ICD-10 in the United States was formally proposed in August 2008 and finalized in January 2009. Implementation of ICD-10 was initially scheduled for October 2013 and has been postponed twice since then. ICD-10 is effective by date of discharge, not by date of admission. ICD-10-CM for diagnosis codes and ICD-10-PCS for procedure codes go into effect together on the same date. 5 Who Uses What Physicians, hospitals and all other providers must use ICD-10 diagnosis codes. Hospitals must also use ICD-10-PCS procedure codes for inpatient cases. Implementation of ICD-10 does not affect use of CPT®. 6 Provider Setting Diagnoses Procedures Physicians Facility/Office ICD-10-CM CPT Hospitals Outpatient ICD-10-CM CPT ASCs Outpatient ICD-10-CM CPT Hospitals Inpatient ICD-10-CM ICD-10-PCS ICD-10-CM Diagnosis Codes 7 Need an ICD-10-CM Codebook? ICD-10-CM diagnosis codes are administered by the Centers for Disease Control. Physician offices can download a copy of the entire ICD-10-CM codebook from the CDC website: http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105 This version is official, complete, current, and free. Offices will need at least the Tabular and the Index. The Tabular is the running list of diagnosis codes with their descriptions and instructions for use. The codes are updated once a year on October 1. 8 Diagnosis Code Structure Codes are organized by chapter, mostly by body system. The chapters are virtually identical to those in ICD-9-CM. Codes are alpha-numeric and can be 3 to 7 digits long. Category T alpha R I 9 8 2 number 5 5 Details Decimal 1 2 Extension 0 alpha or number A T82.120A Displacement of cardiac electrode, initial encounter 5 R55 Syncope 0 I50.23 Acute on chronic systolic heart failure 2 3 Volume of Diagnosis Codes ICD-10-CM has far more diagnosis codes than ICD-9-CM and provides a greater level of specificity. Most physicians will use a small subset of the total codes. ICD-9-CM 14,567 codes ICD-10-CM 69,823 codes Physicians do not use external cause codes. Many of the additional codes are due to laterality. Specialty societies have been very active in requesting new diagnosis codes with additional clinical detail. There are still ‘unspecified’ codes. Much of the additional specificity captured by ICD-10-CM diagnosis codes is already documented by physicians. 10 Greater Specificity … Or Less Some conditions that use the same code in ICD-9-CM are differentiated in ICD-10-CM and have separate codes. Example: Non-ischemic cardiomyopathy ICD-9-CM 425.4 Other primary cardiomyopathies ICD-10-CM I42.0 I42.5 I42.8 I42.9 Dilated cardiomyopathy (congestive) Other restrictive cardiomyopathy (constrictive cardiomyopathy) Other cardiomyopathies Cardiomyopathy, unspecified For some conditions though, it’s the opposite. Example: Bifascicular blocks ICD-9-CM 426.51 Right bundle branch block and left posterior fascicular block 426.52 Right bundle branch block and left anterior fascicular block 426.53 Bilateral bundle branch block, other 11 ICD-10-CM I45.2 Bifascicular block ICD-10 Guidelines Guidelines for use of ICD-10-CM are offered by multiple sources, but two sources are mandatory: Instructions within the ICD-10 codebook itself The ICD-10 Official Guidelines for Coding and Reporting Use of these guidelines is mandated under HIPAA. Physicians only need to use the diagnosis guidelines (there’s a separate set of official guidelines for procedures) The guidelines can be found at: http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105 Physicians will be most interested in Section IV: Diagnostic Coding 12 Diagnosis Code Crosswalks 13 General Equivalence Mappings CDC posts General Equivalence Mappings (GEMs) on its website. These are a useful tool for going back-and-forth between ICD-9-CM codes and ICD-10 codes. The first GEM goes forward from ICD-9 to ICD-10. The second GEM goes backward from ICD-10 to ICD-9. Both GEMs are updated once a year. The GEMs can be found at: http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105 Although GEMs are useful, CDC and CMS strongly recommend using the ICD-10-CM codebook directly, as studies have consistently indicated that this is most accurate. 14 Crosswalk: Heart Failure Hypertensive Heart Disease with Heart Failure ICD-9-CM ICD-10-CM 402.01 Hypertensive heart disease, malignant, with heart failure Hypertensive heart disease with heart 402.11 Hypertensive heart disease, benign, with heart failure I11.0 failure 402.91 Hypertensive heart disease, unspecified, with heart failure Hypertensive heart and chronic kidney disease, malignant, 404.01 with heart failure and with chronic kidney disease stage I through stage IV, or unspecified Hypertensive heart and chronic kidney Hypertensive heart and chronic kidney disease, benign, with disease with heart failure and stage 1 404.11 heart failure and with chronic kidney disease stage I through I13.0 through stage 4 chronic kidney disease, or stage IV, or unspecified unspecified chronic kidney disease Hypertensive heart and chronic kidney disease, unspecified, 404.91 with heart failure and with chronic kidney disease stage I through stage IV, or unspecified Hypertensive heart and chronic kidney disease, malignant, 404.03 with heart failure and with chronic kidney disease stage V or end stage renal disease Hypertensive heart and chronic kidney Hypertensive heart and chronic kidney disease, benign, with disease with heart failure and with stage 5 404.13 heart failure and chronic kidney disease stage V or end I13.2 chronic kidney disease, or end stage renal stage renal disease disease Hypertensive heart and chronic kidney disease, unspecified, 404.93 with heart failure and chronic kidney disease stage V or end stage renal disease There’s no distinction between malignant and benign hypertension. The specific type of heart failure is coded separately. 15 Crosswalk: Heart Failure ICD-9-CM 428.0 428.1 428.20 428.21 428.22 428.23 428.30 428.31 428.32 428.33 428.40 428.41 428.42 428.43 428.9 Congestive heart failure, unspecified Left heart failure Systolic heart failure, unspecified Acute systolic heart failure Chronic systolic heart failure Acute on chronic systolic heart failure Unspecified diastolic heart failure Acute diastolic heart failure Chronic diastolic heart failure Acute on chronic diastolic heart failure Unspecified combined systolic and diastolic heart failure Acute combined systolic and diastolic heart failure Chronic combined systolic and diastolic heart failure Acute on chronic combined systolic and diastolic heart failure Unspecified heart failure ICD-10-CM I50.9 I50.1 I50.20 I50.21 I50.22 I50.23 I50.30 I50.31 I50.32 I50.33 I50.40 I50.41 I50.42 I50.43 I50.9 Heart failure, unspecified Left ventricular failure Unspecified systolic (congestive) heart failure Acute systolic (congestive) heart failure Chronic systolic (congestive) heart failure Acute on chronic systolic (congestive) heart failure Unspecified diastolic (congestive) heart failure Acute diastolic (congestive) heart failure Chronic diastolic (congestive) heart failure Acute on chronic diastolic (congestive) heart failure Unspecified combined systolic (congestive) and diastolic (congestive) heart failure Acute combined systolic (congestive) and diastolic (congestive) heart failure Chronic combined systolic (congestive) and diastolic (congestive) heart failure Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure Heart failure, unspecified Documentation must still specify if the heart failure is acute or chronic, systolic or diastolic. “Congestive” heart failure does not have its own code. 16 Crosswalk: Conduction Disorders Atrioventricular Block ICD-9-CM 426.0 426.10 426.11 426.12 426.13 AV block, complete AV block, unspecified AV block, first degree AV block, Mobitz II AV block, other second degree ICD-10-CM I44.2 Atrioventricular block, complete I44.30 Unspecified atrioventricular block I44.0 Atrioventricular block, first degree I44.1 Atrioventricular block, second degree Bundle Branch Blocks ICD-9-CM 426.2 Left bundle branch hemiblock 426.3 Other left bundle branch block 426.4 Right bundle branch block 426.50 426.51 426.52 426.53 426.54 17 Bundle branch block, unspecified RBBB and left posterior fascicular block RBBB and left anterior fascicular block Bilateral bundle branch block, other Trifascicular block ICD-10-CM I44.4 I44.5 I44.60 I44.69 I44.7 I45.0 I45.10 I45.19 I45.4 Left anterior fascicular block Left posterior fascicular block Unspecified fascicular block Other fascicular block Left bundle branch block, unspecified Right fascicular block Unspecified right bundle branch block Other right bundle branch block Nonspecific intraventricular block (BBB NOS) I45.2 Bifascicular block I45.3 Trifascicular block Crosswalk: Conduction Disorders Other Blocks ICD-9-CM 426.6 Other heart block ICD-10-CM I45.5 Other specified heart block Other Conduction Disorders ICD-9-CM 426.7 426.81 426.82 426.89 426.9 18 Anomalous atrioventricular excitation (WPW) Lown-Ganong-Levine syndrome (LGL) Long QT syndrome Other specified conduction disorders Conduction disorder, unspecified ICD-10-CM I45.6 Pre-excitation syndrome (WPW) (LGL) I45.81 Long QT syndrome I45.89 Other specified conduction disorders I45.9 Conduction disorder, unspecified Crosswalk: Arrhythmias Tachycardia ICD-9-CM 427.0 Paroxysmal supraventricular tachycardia 427.1 Paroxysmal ventricular tachycardia 427.2 Paroxysmal tachycardia, unspecified 785.0 Tachycardia, unspecified ICD-10-CM I47.1 I49.2 I47.0 I47.2 I47.9 R00.0 Supraventricular tachycardia (includes AVNRT) Junctional premature depolarization Re-entry ventricular arrhythmia Ventricular tachycardia Paroxysmal tachycardia, unspecified Tachycardia, unspecified “Paroxysmal” does not need to be documented SVT and VT. Tachycardia that’s unspecified is assigned to symptom code R00.0. Atrial Fibrillation and Flutter ICD-9-CM 427.31 Atrial fibrillation 427.32 Atrial flutter ICD-10-CM I48.0 I48.1 I48.2 I48.91 I48.3 I48.4 I48.92 Paroxysmal atrial fibrillation Persistent atrial fibrillation Chronic atrial fibrillation Unspecified atrial fibrillation Typical atrial flutter (type I) Atypical atrial flutter (type II) Unspecified atrial flutter Documentation should specify the type of atrial fibrillation, and the abbreviation “PAF” should be avoided. 19 Crosswalk: Arrhythmias Ventricular Fibrillation and Flutter ICD-9-CM 427.41 Ventricular fibrillation 427.42 Ventricular flutter ICD-10-CM I49.01 Ventricular fibrillation I49.02 Ventricular flutter Bradycardia ICD-9-CM 427.81 Sinoatrial node dysfunction (SSS) — ICD-10-CM I49.5 Sick sinus syndrome (tachy-brady syndrome) R00.1 Bradycardia, unspecified Particularly for surgical patients, documentation should specify bradycardia as “sick sinus syndrome” or “tachycardia-bradycardia syndrome”. Bradycardia that is unspecified or documented only as “sinoatrial bradycardia” or “sinus bradycardia” is assigned to symptom code R00.1. 20 Crosswalk: Arrhythmias Other Arrhythmias ICD-9-CM 427.60 Premature beats, unspecified 427.61 Supraventricular premature beats 427.69 Other premature beats 427.89 Other specified cardiac dysrhythmias 427.9 Cardiac dysrhythmia, unspecified 794.31 Abnormal electrocardiogram ICD-10-CM I49.40 I49.1 I49.3 I49.49 I49.8 I49.9 R94.31 Unspecified premature depolarization Atrial premature depolarization Ventricular premature depolarization Other premature depolarization Other specified cardiac arrhythmias Cardiac arrhythmia, unspecified Abnormal electrocardiogram Cardiac Arrest (Sudden Cardiac Death) ICD-9-CM 427.5 Cardiac arrest ICD-10-CM I46.2 I46.8 I46.9 Cardiac arrest due to underlying cardiac condition Cardiac arrest due to other underlying condition Cardiac arrest, cause unspecified If the underlying cause is known, it should be documented and coded separately. The cause code is sequenced before code I46.-. ICD-9-CM Personal history of sudden cardiac arrest (SCD) (successfully resuscitated) Family history of sudden cardiac death V17.41 (SCD) V12.53 21 ICD-10-CM Z86.74 Personal history of sudden cardiac arrest (SCD) (successfully resuscitated) Z82.41 Family history of sudden cardiac death Crosswalk: Acute Myocardial Infarction ICD-10-CM handles acute myocardial infarction differently from ICD-9-CM. AMI: ICD-9-CM ICD-9-CM 410.0x 410.1x 410.2x 410.3x 410.4x 410.5x 410.6x 410.7x 410.8x 410.9x Acute myocardial infarction, of anterolateral wall Acute myocardial infarction, of other anterior wall Acute myocardial infarction, of inferolateral wall Acute myocardial infarction, of inferoposterior wall Acute myocardial infarction, of other inferior wall Acute myocardial infarction, of other lateral wall Acute myocardial infarction, true posterior wall Acute myocardial infarction, subendocardial (NSTEMI) Acute myocardial infarction, of other specified sites Acute myocardial infarction, unspecified site 5th digit 0 – unspecified episode of care 1 – initial episode of care 2 – subsequent episode of care AMI: ICD-10-CM Episode of care is not identified per se. AMI is differentiated between initial AMI (I21) and subsequent AMI (I22) The AMI site identifies the specific coronary artery involved. 22 Crosswalk: Acute Myocardial Infarction Initial AMI (I21) ICD-10-CM I21.01 I21.02 I21.09 I21.11 I21.19 I21.21 I21.29 I21.3 I21.4 ST elevation (STEMI) myocardial infarction involving left main coronary artery ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall ST elevation (STEMI) myocardial infarction involving right coronary artery ST elevation (STEMI) myocardial infarction involving other coronary artery ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery ST elevation (STEMI) myocardial infarction involving other sites ST elevation (STEMI) myocardial infarction of unspecified site Non-ST elevation (NSTEMI) myocardial infarction Documentation should specify the coronary artery or wall involved. Initial AMI codes continue to be assigned to encounters for continued care, including transfer to another hospital or post-acute setting, while the AMI is within 28 days of onset. 23 Crosswalk: Acute Myocardial Infarction Subsequent AMI (I22) ICD-10-CM I22.0 I22.1 I22.2 I22.8 I22.9 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall Subsequent ST elevation (STEMI) myocardial infarction of inferior wall Subsequent non-ST elevation (NSTEMI) myocardial infarction Subsequent ST elevation (STEMI) myocardial infarction of other sites Subsequent ST elevation (STEMI) myocardial infarction of unspecified site A subsequent AMI is a new AMI that occurs within 28 days of a previous AMI, regardless of site. Codes from I22 cannot be assigned alone. They must always be assigned with a code from I21. Sequencing of the codes depends on the circumstances. Old AMI ICD-9-CM 412 24 Old myocardial infarction ICD-10-CM I25.2 Old myocardial infarction Crosswalk: Other Heart Disorders Cardiomyopathy ICD-9-CM ICD-10-CM Other specified forms of chronic ischemic heart I25.5 disease (used for ischemic cardiomyopathy) 425.11 Hypertrophic obstructive cardiomyopathy I42.1 I42.0 414.8 425.4 Other primary cardiomyopathies I42.5 I42.8 I42.9 Ischemic cardiomyopathy Obstructive hypertrophic cardiomyopathy Dilated cardiomyopathy (congestive) Other restrictive cardiomyopathy (constrictive cardiomyopathy) Other cardiomyopathies Cardiomyopathy, unspecified Shock ICD-9-CM 785.50 Shock, unspecified 785.51 Cardiogenic shock 785.59 Shock, other 25 ICD-10-CM R57.9 R57.0 R57.1 R57.8 Shock, unspecified Cardiogenic shock Hypovolemic shock Other shock Crosswalk: Symptoms Syncope ICD-9-CM 780.2 Syncope ICD-10-CM R55 Syncope Chest Pain ICD-9-CM 786.50 Chest pain, unspecified 786.51 Precordial pain 786.59 Chest pain , other ICD-10-CM R07.9 Chest pain, unspecified R07.2 Precordial pain R07.89 Other chest pain Other Symptoms ICD-9-CM 780.4 Dizziness 785.1 Palpitations 26 ICD-10-CM R42 Dizziness R00.2 Palpitations Crosswalk: Cerebrovascular Disorders Cryptogenic Stroke ICD-9-CM 434.91 Cerebral artery occlusion, unspecified (used for cryptogenic ischemic stroke) ICD-10-CM I63.9 Cerebral infarction, unspecified Transient Cerebral Ischemia ICD-9-CM 435.9 Unspecified transient cerebral ischemia 27 ICD-10-CM G45.9 Transient cerebral ischemic attack, unspecified Crosswalk: Device Complications Mechanical Complication of Pacemaker and Defibrillator ICD-9-CM Mechanical complication 996.01 due to cardiac pacemaker Mechanical 996.04 complication due to implantable defibrillator ICD-10-CM T82.110A T82.111A T82.118A T82.120A T82.121A T82.128A T82.190A T82.191A T82.198A Breakdown (mechanical) of cardiac electrode, initial encounter Breakdown (mechanical) of cardiac pulse generator, initial encounter Breakdown (mechanical) of other cardiac electronic device, initial encounter Displacement of cardiac electrode, initial encounter Displacement of cardiac pulse generator, initial encounter Displacement of other cardiac electronic device, initial encounter Other mechanical complication of cardiac electrode, initial encounter Other mechanical complication of cardiac pulse generator, initial encounter Other mechanical complication of other cardiac electronic device, initial encounter Mechanical complication is defined the same way in ICD-10-CM as it is in ICD-9-CM. Mechanical obstruction of device Breakage of device Perforation of device Malposition of device Protrusion of device Leakage of device 28 Crosswalk: Device Complications Infection of implanted cardiac device ICD-9-CM Infection due to 996.61 cardiac device, implant and graft ICD-10-CM T82.7xxA Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter “x” is a placeholder. This code is only four digits but extension “A” must always be in the 7th position. So “x” holds the empty 5th and 6th positions. Other complications ICD-9-CM ICD-10-CM T82.817A Embolism of cardiac prosthetic devices, implants and grafts, initial encounter T82.827A Fibrosis of cardiac prosthetic devices, implants and grafts, initial encounter Other complication due to other cardiac 996.72 device, implant and graft T82.837A Hemorrhage of cardiac prosthetic devices, implants, grafts, initial encounter T82.847A Pain from cardiac prosthetic devices, implants and grafts, initial encounter T82.857A Stenosis of cardiac prosthetic devices, implants and grafts, initial encounter T82.867A Thrombosis of cardiac prosthetic devices, implants, grafts, initial encounter T82.897A Other specified complication of cardiac prosthetic devices, implants and grafts, initial encounter A diagnosis of “failed” device must be further specified. 29 Crosswalk: Encounters and Status Encounters ICD-9-CM ICD-10-CM Encounter for checking and testing of cardiac pacemaker pulse generator [battery] V53.31 Fitting and adjustment of cardiac pacemaker Encounter for adjustment and management of other Z45.018 part of cardiac pacemaker Fitting and adjustment of automatic Encounter for adjustment and management of V53.32 Z45.02 implantable cardiac defibrillator automatic implantable cardiac defibrillator Encounter for adjustment and management of other V53.39 Fitting and adjustment of other cardiac device Z45.09 cardiac device Z45.010 Use Z45.- for encounters for device replacement due to expected end-oflife and expected device removal (eg, end of surveillance). These types of encounters are not coded as complications. Device Status ICD-9-CM V45.01 Cardiac pacemaker in situ V45.02 Automatic implantable cardiac defibrillator in situ V45.09 Other specified cardiac device in situ 30 ICD-10-CM Z95.0 Z95.810 Presence of cardiac pacemaker Presence of automatic (implantable) cardiac defibrillator Z95.818 Presence of other cardiac implants and grafts ICD-10-PCS Procedure Codes 31 ICD-10-PCS Format ICD-10-PCS procedure codes are administered by CMS. Codes are alpha-numeric and are always 7 digits long. There are virtually no unspecified or default codes. ICD-10-PCS uses standardized definitions throughout. Each position in an ICD-10-PCS procedure code represents a distinct element. 1 section 32 2 3 4 5 root operation approach body system body part 6 7 qualifier device Structure of ICD-10-PCS Codes In ICD-10-PCS, codes are not assigned per se. They are constructed, character by character. Rather than a Tabular list of codes, ICD-10-PCS displays tables from which values for each position are selected. 33 Defibrillator generator: Evera CRT-D generator: Viva 0JH608Z Insertion of defibrillator generator, into chest subcutaneous tissue and fascia, open approach 0JH609Z Insertion of cardiac resynchronization defibrillator pulse generator into chest subcutaneous tissue and fascia, open approach ICD-10-PCS Terminology Pulmonary vein isolation (ie. for atrial fibrillation) 02583ZZ Destruction of conduction mechanism, percutaneous approach “It is the coder’s responsibility to determine what the documentation in the medical record equates to in the PCS definitions. The physician is not expected to use the terms used in PCS code descriptions…” No need to document Destruction, keep documenting PVI or ablation No need to document Percutaneous Endoscopic, thoracoscopic is fine 34 Volume of Procedure Codes ICD-10-PCS has far more procedure codes than ICD-9-CM and provides much greater specificity. Full system CRT-D ICD-9-CM 1 code ICD-10-PCS 4 codes ICD-9-CM 3,882 codes ICD-10-PCS 71,962 codes CRT-D generator with transvenous RA, RV, LV leads 0JH609Z 02H63KZ 02HK3KZ 02H43KZ 35 Insertion of CRT-D generator into chest subcutaneous tissue, open approach Insertion of defibrillator lead into right atrium, percutaneous approach Insertion of defibrillator lead into right ventricle, percutaneous approach Insertion of defibrillator lead into coronary vein, percutaneous approach Implementation Issues 36 Documentation Practices ICD-10 raises the bar on specificity in documentation for diagnoses. Documentation for Diagnosis Specificity Culprit lesion or site of acute myocardial infarction Type of cardiomyopathy: ischemic/non-ischemic, congestive, constrictive Acuity and type of heart failure: acute/chronic, systolic/diastolic Type of atrial fibrillation: paroxysmal, persistent, chronic Type of atrial flutter: type I, type II Nature of bradycardia: SSS, tachycardia-bradycardia syndrome Nature of tachycardia: SVT, VT, AVNRT Device complication: true complication or expected end-of-life? Nature of device complication: stenosis, breakdown, premature depletion “tachycardia” “PAF” “CHF” “device failure” 37 “STEMI” (unspecified) “bradycardia” “decompensated HF” Documentation Practices ICD-10 also raises the bar on specificity in documentation for procedures. Documentation for Procedure Specificity Conventional or resynchronization pacemaker or defibrillator Exact anatomic location of subcutaneous devices: chest, back, abdominal wall Specific name and model of devices used Other documentation considerations Take note of coder queries requesting additional information and include those details in similar cases going forward. CMS has a useful primer for cardiology documentation: http://www.roadto10.org/action-plan/phase-2-train/primer-cardiology/ 38 Coverage Issues CMS has converted its NCDs and ICD-10-CM codes are already being displayed on LCDs and on private payers’ medical policies. Identify the practice’s largest payers and check the codes on their on-line medical polices for familiarity as well as omissions. Check practice superbills against payer policies for differences. Alert the payer to possible discrepancies. Be aware that the specificity of ICD-10-CM may allow payers to now enforce existing coverage rules more stringently. 39 Practice Implementation Checklist 1. Lay out a plan Identify which ICD-9 codes you use heavily Identify the staff that need to be trained in coding and/or documentation Contact vendors to learn their plans, ICD-10 related costs to the practice, and resources available to the practice Contact the specialty society for any resources available to the practice Visit the CMS website for useful tools and materials 2. Get trained Buy or download an ICD-10 diagnosis codebook Arrange and implement ICD-10 coding training for staff Arrange and obtain documentation training for physicians and other clinicians Crosswalk common diagnosis codes to ICD-10 and identify new requirements or differences in essential documentation Sign up for key CMS webinars to increase understanding of the ICD-10 environment 3. Update internal practice tools Convert superbills to ICD-10 Convert other materials to ICD-10, such as authorizations, orders and referrals Identify common code-related causes for current claim denials and identify areas where ICD-10's specificity in documentation and code assignment can address this Obtain payer medical polices with ICD-10 codes for comparison 40 Practice Implementation Checklist 4. Work with vendors and payers Arrange and implement ICD-10 software upgrades Train staff on use of new software, either directly or via the vendor Identify EHR documentation templates and assess how they support ICD-10 specificity for claims submission and medical necessity Engage payers on any discrepancies and omissions in ICD-10 coding for medical policies Identify if payers anticipate any changes in processing and payment due to ICD-10 Identify availability of testing with major payers 5. Test the process Perform testing on systems within the practice Perform end-to-end testing with vendors and/or payers Identify and correct issues raised during testing Educate staff on the impact of ICD-10 to payer edits, adjudication, and other claims elements to processes within the practice Repeat! http://coalitionforicd10.org/2015/01/12/you-can-do-it-guide-to-physician-icd-10-conversion/ 41 Appendix 42 Key Websites CDC and CMS have a wealth of resources and educational materials available on-line for physician practices. CDC http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105 • ICD-10-CM Tabular and Index • Official ICD-10-CM guidelines • Diagnosis code GEMS CMS http://www.roadto10.org/ • Webcasts • FAQs on ICD-10 • Templates for assessing vendors, billing services, payers • Specialty references (common codes, documentation primers) • Customizable practice action plans 43 Medtronic Contacts Medtronic is available to assist with your ICD-10 questions and issues. Hotline: 1-866-877-4102 Email us: [email protected] Visit the CRHF reimbursement website at: www.medtronic.com/crdmreimbursement 44 We’re here to help make this transition smoother for you Questions
