ICD-10 Compliance Project Status · 2012. 5. 23. · Presented by Hewlett-Packard Enterprise Services 1 March 2012 ICD-10 Compliance Project Status . Statement of Confidentiality:

Presented by Hewlett-Packard Enterprise Services 1 March 2012

ICD-10 Compliance Project Status

Statement of Confidentiality: This information is privileged and confidential. It is intended only for the use of this specific audience. You are hereby notified that disseminating, distributing, forwarding, or copying this information is strictly prohibited.

Managed Care Entity Technical Meeting


Topics

Your ICD-10 questions ICD-10 education ICD-10 Information web pages ICD-10 Training web page ICD-10 readiness surveys ICD-10 Vendor Readiness Survey ICD-10 readiness surveys next steps Advice to HP vendors Where is HP in ICD-10 readiness? Contact information Questions?


Your ICD-10 questions

How will the Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) announcement that the implementation date for ICD-10 will be extended affect Indiana’s plans? HHS and CMS have provided no definitive strategy or timeline for a delay in ICD-10 implementation. As such, the Indiana’s plans for migration to ICD-10 remains unaltered. Further information will be forthcoming once definitive guidance is received regarding the ICD-10 implementation dates for both the ICD-10-CM and the ICD-10-PCS code sets.

More information from CMS about the implementation delay follows.



CMS has provided states with an update on the ICD-10 delay announcement. The following are important takeaways: • States should not alter existing plans to become compliant with

ICD-10 on October 1, 2013. • Medicaid responses were split between states wishing to keep the

implementation date October 1, 2013, and those programs preferring a delay.

• CMS confirms that the initial implementation date (October 1, 2013) is still under consideration as is a one year delay.

• CMS confirmed that splitting the implementation of the ICD-10-PCS and ICD-10-CM code sets is not under consideration at this time.



Is there going to be a freeze on claims? For providers or any system processors there will not be a freeze on claims processing, enrollment of providers, eligibility, or the Help Desk.

However, there will be a freeze on updating the ICD codes as of October 1, 2012. There is a link to the CMS article about the Partial Code Freeze Prior to ICD-10 Implementation on the ICD-10 Information page of indianamedicaid.com.

http://pwb.mm.inxix.sod.eds.com/localdocs/Claims Processing/Change Orders/1845/12 - Documentation & Training/20100112 CMS Partial Code Freeze SE1033.pdf�




http://provider.indianamedicaid.com/general-provider-services/icd-10-information.aspx�




http://www.indianamedicaid.com/�



Will there be changes to the codes used on the CMS 1500 form and the 837P files? Yes. The codes will change from ICD-9 to ICD-10 and there will be a version indicator (web claims) or a qualifier (paper claims) required to indicate which code set is being used.

Another proposed revision to the CMS 1500 claim form is to expand the number of diagnosis spaces from 4 spaces to 12.

The CMS 1500 claim form is under review by CMS. We will inform you when it is approved and ready for use.



Are a list of ICD-10 codes and the cross-walking information for ICD-9 to ICD-10 available? The current list of ICD-10 codes is available for purchase from most online vendors. Some of the codes may be accessed online by searching on “ICD-10 codes”.

Cross walking ICD-9 to ICD-10 codes is addressed in the CMS General Equivalence Mappings (GEMs) publications available on the CMS website. A link to these publications is provided on the ICD-10 Information web page of indianamedicaid.com.

Consider subscribing to the CMS Email Updates to stay current on ICD-10.




ICD-10 education Examples of coding changes between ICD-9 and ICD-10

ICD-9 ICD-10

991.1 Frostbite of hand T33.5 Superficial frostbite of wrist, hand, and fingers

T33.52 Superficial frostbite of hand

T33.521 Superficial frostbite of right hand T33.521A initial encounter T33.521D subsequent encounter T33.521S sequela

T33.522 Superficial frostbite of left hand T33.522A initial encounter T33.522D subsequent encounter T33.522S sequela

T33.529 Superficial frostbite of unspecified hand T33.529A initial encounter T33.529D subsequent encounter T33.529S sequela


ICD-9 ICD-10

E917.0 Striking against or struck accidentally in sports without subsequent fall Applies to • Kicked or stepped on during

game • Struck by hit or thrown ball • Struck by hockey stick or

puck

W21 - Striking against or struck by sports equipment • W21.00 Struck by hit or thrown ball, unspecified type • W21.01 Struck by football • W21.02 Struck by soccer ball • W21.03 Struck by baseball • W21.04 Struck by golf ball • W21.05 Struck by basketball • W21.06 Struck by volleyball • W21.07 Struck by softball • W21.09 Struck by other hit or thrown ball • W21.31 Struck by shoe cleats, stepped on by shoe

cleats



ICD-9 ICD-10

463 Acute tonsillitis J03 Acute tonsillitis • J03.0 Streptococcal tonsillitis • J03.00 Acute streptococcal tonsillitis unspecified • J03.01 Acute recurrent streptococcal tonsillitis • J03.8 Acute tonsillitis due to other specified organisms

(Use additional code [B95-B97] to identify infectious agent)

• J03.81 Acute recurrent tonsillitis due to other specified organisms

• J03.9 Acute tonsillitis, unspecified • J03.91 Acute recurrent tonsillitis, unspecified



ICD-9 ICD-10

599.7 Hematuria (blood in urine) R31.0 Gross hematuria R31.1 Benign essential microscopic hematuria R31.2 Other microscopic hematuria R31.9 Hematuria, unspecified


There are four ICD-10 codes described on this slide that match the ICD-9 code for “hematuria”, as derived from the General Equivalency Mappings (GEMs). There are many more matches to hematuria in the official ICD-10 coding manuals; however, that are not included in the GEMs (more than 20 in total). It is important to reference both the coding manuals and the GEMs to identify the proper code assignment.



Hematuria – ICD-10 Index listing

Hematuria R31.9 - due to sulphonamide, sulfonamide —see Table of drugs and chemicals, by drug - benign (familial) (of childhood) —see also Hematuria, idiopathic - - essential microscopic R31.1 - endemic (see also Schistosomiasis) B65.0 - gross R31.0 - idiopathic N02.9 - - with glomerular lesion - - - crescentic (diffuse) glomerulonephritis N02.7 - - - dense deposit disease N02.6 - - - endocapillary proliferative glomerulonephritis N02.4 - - - focal and segmental hyalinosis or sclerosis N02.1 - - - membranoproliferative (diffuse) N02.5 - - - membranous (diffuse) N02.2

- - - mesangial proliferative (diffuse) N02.3 - - - mesangiocapillary (diffuse) N02.5 - - - proliferative NEC N02.8 - - - specified pathology NEC N02.8 - intermittent —see Hematuria, idiopathic - malarial B50.8 - microscopic NEC R31.2 - - benign essential R31.1 - paroxysmal —see also Hematuria, idiopathic - - nocturnal D59.5 - persistent —see Hematuria, idiopathic - recurrent —see Hematuria, idiopathic - tropical (see also Schistosomiasis) B65.0 - tuberculous A18.13


ICD-10 Information web pages

The ICD-10 Information web pages may be accessed from the General Provider page on the IHCP website (indianamedicaid.com). The web pages are updated frequently so visit them often.

ICD-10 Training This page is new to the website and contains a list of ICD-10 training resources from state agencies and associations that will be updated frequently.

Note: The Internet has links to ICD-10 training classes and materials. Locate them by searching on “ICD-10 training”. Research them carefully to find the training that fits your need and your budget.

The state of Indiana, its agencies, and agents are not responsible for the content of any external websites to which links are provided.






http://provider.indianamedicaid.com/general-provider-services/icd-10-information/icd-10-training.aspx�




ICD-10 Training web page



ICD-10 readiness surveys What information are you gathering?

HP and FSSA are capturing the following information from survey responses. Updates on the progress of the survey respondents (forward

progress, no progress, or inability to start).

Information about the root causes for failure of respondents to start or move forward on the project.

Requests from respondents needing additional information (planning, training, etc).

Responses that drive the links and information being added to the ICD-10 Information web pages.



ICD-10 readiness surveys What are you doing with the information?

HP and FSSA are responding to survey responses as follows: Respondents who request additional information on topics like

planning, training, etc., and who provide contact information, will receive email(s) with links to related resources.

Frequently expressed requests are driving the posting of additional information to the ICD-10 Information web pages and topical articles in IHCP publications. (Bulletins, Banner Pages, and Newsletters).

The need for ICD-10 training tops the list of needs cited by survey respondents, resulting in an ICD-10 Training page being added to the ICD-10 Information web pages on indianamedicaid.com.





FSSA ICD-10 Vendor Readiness Survey

This is a high level overview of the FSSA vendor readiness survey responses to date. The average response rate is 27%.

Aug 2011 Nov 2011 Feb 2012

Invitations sent 479 358 351

Number opt out 29 21 15

Number completed 227 177 119

Provider 163 111 59

Health plan/MCE/payor 12 17 12

Clearinghouse 9 1 1

Software vendor 2 5 2

Other 100 67 23

Not all vendors that participate in the survey complete all questions. The Number completed is not a total of vendors that participated in the survey.

It is the number of vendors who completed all of the questions in the survey.


HP ICD-10 Vendor Readiness Survey

This is a high-level overview of the HP vendor readiness survey response to date. The average response rate is 24%.

Aug 2011 Nov 2011 Feb 2012

Invitations sent 221 484 472

Number opt out 14 30 18

Number completed 76 116 92

Provider 16 30 19

Health plan/MCE/payor 0 5 4

Clearinghouse 21 48 33

Software vendor 26 60 40

Other 11 16 5


HP ICD-10 Vendor Readiness Survey

The Other category included vendors that categorized themselves as the following:

Aug 2011 Nov 2011 Feb 2012

• Analytics consulting • Billing company • Billing service • Contractor • Medical billing service • Pharmacy • Revenue cycle • Management Medicaid • TPL contractor

• Billing agency • Billing center • Billing service • Consulting • HP data warehouse • In-house software support • Management consultants • Pharmacy • Third party biller • TPL vendor

• Billing agent • Billing company • Billing service • Medicaid/Medicare fraud

abuse • TPL vendor

The February 2012 survey asked vendors if they would like to receive training information. Of the 92 HP vendors that responded, 50 requested training information.


ICD-10 readiness surveys Next steps

CSG Government Solutions, the state’s assessment vendor, is analyzing survey results from the February surveys. Relevant information will be included in the April ICD-10 Compliance Project Status presentation. Stay tuned.

The next ICD-10 Vendor Readiness Survey is scheduled for May 6 – 8. Watch your inbox or mailbox for information.


To keep abreast of developments surrounding ICD-10 planning and implementation, we recommend that you visit the ICD-10 Information pages at indianamedicaid.com frequently.

If you have not been contacted by your software vendor and/or clearinghouse about ICD-10 readiness, be proactive and contact them.

Advice to HP vendors





http://indianamedicaid.com/�


Where is HP in ICD-10 readiness?

Requirements are being finalized.

Business design and technical design work have begun for the ICD10 Gap Remediation.

HP continues to be on track for implementation October 1, 2013.


Contact information

You are encouraged to submit your ICD-10-related questions to FSSA and HP throughout this project.

Submit your questions to your Provider Representative or to [email protected].

Questions will be acknowledged and answered directly to the submitter and, as appropriate, posted to the ICD-10 FAQs page and included in Q&A articles and presentations.

mailto:[email protected]�

http://provider.indianamedicaid.com/general-provider-services/icd-10-information/faqs---icd-10.aspx�




Questions?

Documents

ICD-10 Compliance Project Status · 2012. 5. 23. · Presented by Hewlett-Packard Enterprise Services 1 March 2012 ICD-10 Compliance Project Status . Statement of Confidentiality: