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4010 Moorpark Avenue, Suite 222 San Jose, CA 95117
www.prognocis.com [email protected] Copyright March 2015 – Bizmatics, Inc.
ICD-10 In PrognoCIS
Transitioning
to ICD-10
Webinar (Revised: Sept 23, 2015)
The Road to ICD-10 Current ICD Analysis
New Tabular Reports in EMR to analyze the most commonly used
ICD-9 in your practice with and without patient content
Develop an internal crosswalk or superbill based on these codes
Transition Tools applicable in both EMR & Billing
Manage your master files by mapping appropriate ICD-10/SNOMED
codes to your ICD’s (if you use auto-populate functionality)
Encounter-level tools provide real-time update “as you go”
ICD-10 becomes effective October 1, 2015
October 1, 2015
DOS will determine whether “ICD-9 Encounter/Claim” or “ICD-10”
New ICD-10 Search tools moving forward
ICD-9 to ICD-10 Crosswalk
EMR Tabular Reports Use to build a new custom ICD-10 Crosswalk Superbill in preparation for October 1
Sort by ICD-9 Code at a diagnosis count overall or in the context of patient count
Count of ICDs per Given Period List
EMR Report Tabular Count of ICDs for Given Period
Analyze ICD-9 codes you are currently assessing by overall count, with no patient data in context
Identifies the most frequently-used
ICD-9, which you may want to
crosswalk first.
Diagnosis-wise Patients in a Given Period
EMR Report Tabular Diagnosis-wise Patients in a Given Period
Analyze ICD-9 codes you are currently assessing at the patient level rather than overall count
Gives you the ability to update PMH in advance for patients
scheduled prior to start of ICD-10.
Custom Superbill/Crosswalk Many clients use a Superbill or Encounter Form that lists their frequently used ICD-9 codes.
Here is a general idea based on client feedback as to how they are transitioning.
Simple Example Expanded Example A 1-to-1 crosswalk of basic ICD-9 to basic
ICD-10
Each basic ICD can be expanded at various
levels/conditions and may or may not have
same ICD-10/SNOMED
SNOMED not necessarily
needed
Hyperlink Tool
Encounter Level from any screen that includes diagnosis search/assign (i.e.: , , or ) or
where the ICD auto-populates from a master file or auto-copy functionality
Past Medical History and Transition Of Care
Assessment
Lab/Radiology Order
PQRS
New Feature
Hyperlink Tool ICD-9 Code will display as an underlined label (usually blue) to match ICD-10 Codes
Claim Details Page ICD Table
Master File Level
ICD-10 Transition Tool (new feature)
Preferred ICD (Clinic/Specialty level) + Doctor Preferred ICD
Complaints Master
Vaccines Master
Note: HM Protocols & Education masters also support ICD-10 but not
via Hyperlink Tool.
Invokes 1 of 2 filtered searches specific to the linked ICD-9; Preferred and Standard
Note: This Hyperlink Tool lets you assign an ICD-10 SNOMED to your ICD-9.
Preferred Filtered IMO Search New Feature
• The Preferred tab defaults, auto-filtered to only the specific ICD-9 code selected if it has been defined as a Preferred ICD.
• Includes all 3 levels of Preferred Codes; i.e.: CP, DS, & MP as applicable for your practice
The same ICD can be defined as Preferred
multiple times
Standard Filtered IMO Search New Feature
An alert will prompt that the code is not on your Preferred lists & default
to Standard tab.
• The Standard tab defaults, auto-filtered to only the specific ICD-9 code selected when it is not defined under Preferred
• The Keyword Search allows you to further search based upon conditions or other specificity criteria
Master Files
ICD-10 Transition Tool A single screen utility to modify master file values from one screen*
EMR Settings ICD-10 Transition
*Important Note: Users require Update
permissions to the appropriate master files to use the auto-
update feature.
Displays only primary, pre-defined ICD-9 Codes from the applicable master files (i.e.: Preferred,
Complaints, Vaccines). Complaint Optional ICD Codes are not applicable under Transition Tool.
To associate codes for the first time, you must update each master file directly under Configuration.
New Feature
This utility applies now for transitioning but also remains available to managing ICD-10 values moving
forward.
Clinic Preferred ICDs Settings Configuration Clinic Pref ICD (both Clinic & Specialty level)
ICD-10 Transition Tool
Clinic-level Preferred ICD
master
Specialty picklist allows you to modify DS codes if applicable
Complaints Settings Configuration Workflow Complaints (Primary ICD only) ICD-10
Transition Tool
Workflow Complaints
master
Optional ICD n/a on Transition Tool
Vaccines ICD-10
Transition Tool
Vaccines master
Settings Configuration Codes/Drugs Vaccines
Transition Tool displays only Vaccines for which you have predefined an ICD-9 to default when administering it.
Doctor Preferred ICDs Doctor’s Home Page My Preferences Search List ICD
ICD-10 Transition Tool
Preferred ICD master
ICD-10 Transition Tool – No Administrative Rights Users who do not have the appropriate Update rights for their User Role will be prompted accordingly
Health Maintenance Protocols
Every ICD-10 still has an ICD-9 associated.
New ICD-10 Range trigger may be created as needed
Existing ICD-9 Range triggers will continue to apply at the patient & system levels
New protocol can be defined per ICD-10 while keeping the 9
Education Master New ICD-10 Range trigger may be created as needed
Existing ICD-9 Range triggers will continue to apply/be valid
New handout can be defined per ICD-10 while keeping the 9
Every ICD-10 still has an ICD-9 associated.
Encounter Level
Past Medical History Existing ICD-9 codes will display as a hyperlink when carried forward under PMH after October 1, 2015
Hyperlink color will be blue by default; however, for Medicare Advantage HMO patients which are
subject to HCC (Hierarchical Conditional Coding), it will be green (current) or red (needs re-assessed)
Unless you are using the auto-populate-from-PMH feature, it is at your local discretion if you want to update history ICD-9 at this level. Note: If you are auto-populating Assessment from
here, however, you will want to update accordingly.
Transition of Care Add New ICD When adding new codes through Transition of Care, the user can invoke the filtered IMO search
and map the appropriate ICD-10/SNOMED before reconciling (i.e.: adding to PMH above)
Update Complaint Primary ICD When the Assessment ICD defaults from HPI Complaint Primary ICD
Local process may vary whether ICD auto-populates
Assessment & if it was already updated.
The user will be prompted to also update the Complaints Master based on User Role Permissions.
Update Complaint Primary ICD (cont’d)
This prompt will not display for users without
configuration update rights
Note: A user may have clinical access to the encounter but not have administrative access at
the configuration level; e.g.: a Scribe who updates the encounter for the physician.
Update Complaint Optional ICDs (from button) When the Assessment ICD is chosen from HPI Complaint Optional ICD Codes, it must already be
mapped to an ICD-10. The user can modify it from the Assessment screen if applicable.
Update Complaint Optional ICDs (cont’d) When ICD-9 is chosen on Assessment from the Complaint button ( ) and you modify the ICD-10 for
that Assessment, you will be prompted if you also want to update that Optional ICDs in the master.
This prompt will not display for users without
configuration update rights
Update Vaccine Default ICDs When a vaccine is administered on the Face Sheet, and the ICD defaults from the Vaccine Master.
Update Vaccine Default ICDs The user will be prompted to also update the Vaccines Master based on User Role Permissions.
This prompt will not display for users without
configuration update rights
Update PMH from Assessment ICDs When ICD on the Assessment is set to auto-populate PMH based on system properties or user decision,
it will automatically update both screens (effective as of that encounter date)
This works well for HCC when it needs to
be reassessed.
CAUTION:
When MH check box is selected here, it updates PMH, but it reflects that Encounter Date as the
Assessment Date.
Lab/Radiology Order Assign ICD
Some vendors have already been requiring
both ICD-9 & ICD-10 (temp.lab.icd.bothcodes)
Lab/Radiology Orders may be required prior to knowing the actual diagnosis & may be ordered outside
of an encounter; hence the hyperlink is provided and may be auto-populated to Assessment if desired.
Prescription Assign ICD
Note: The Hyperlink tool is not available
at this level.
The diagnosis will already be known when ordering a Prescription – whether within an encounter or as
a Refill; hence the hyperlink is not available. Assessment or PMH diagnoses are filtered in the pop-up.
Doctor Form Only existing Forms where the ICD element is a check box option supports Hyperlink functionality.
In this case, Doctor Form does not have to be redesigned; it will automatically be updated.
Current IMO Master Search includes Hyperlink functionality (previous Master Search did not)
Other ICD element types (e.g.: Text, selection list, etc.) do not support Hyperlink functionality.
PQRS Assign ICD Hyperlink functionality applies in reverse (clicking the ICD-10 allows you to select the ICD-9)
PrognoCIS requires and stores both ICD-9 & ICD-10
PQRS Info Info table displays both ICD-10 and ICD-9 details
Validation Alerts
IMO Search – ICD-9 w/o associated ICD-10 When selecting an ICD-9 from the Preferred or Custom tabs that is not yet mapped to an appropriate
ICD-10/SNOMED, the system will prompt you and will not let you update the selection to the screen
you are on (i.e.: PMH, Assessment, CPOE, Claim)
Assessment – ICD-9 w/o associated ICD-10 When an ICD-9 defaults to the Assessment and you attempt to save additional data without updating the
ICD, the system will prompt accordingly and will not save the Assessment & Plan data until you map it.
Assessment – No Administrative Update Rights When the clinical user is able to update the Assessment at the encounter level but does not also have
administrative/configuration rights for the underlying master file, system will prompt accordingly.
Encounter Close – ICD-9 w/o associated ICD-10 If ICD-9 codes are not updated at the individual screens, an alert will display upon Encounter Close and
prevent you from closing the encounter & creating the claim
Duplicate Codes Selecting a code that already exists on the patient’s Assessment based on same ICD9, ICD10, and
SNOMED combination will error as a duplicate and not let you save it.
Note: Validation scenarios apply system-wide whenever a code is added or modified.
Trying to add a code via Transition of Care that already exists on the patient’s PMH based on same
ICD9, ICD10, and SNOMED combination will error as a duplicate and not let you save it.
Practice Management (Billing)
Claim Details Screen – ICD-9 Claim All claims with a DOS prior to October 1, 2015 will be an ICD-9 Claim & will contain ICD-9 codes
• ICD-9 codes may or may not display with matching ICD-10*
* ICD-10 matching has been available since v3b1 upgrade; hence some may already be present.
• Pointers will populate the ICD-9 to charge row even if ICD-10 present
Claim Details Screen – ICD-10 Claim All claims with a DOS October 1, 2015 or after will be an ICD-10 Claim & will require ICD-10 codes
• ICD-10 codes must be present to send or print an ICD-10 claim
• Pointers will populate the ICD-10 to all charge rows even though the ICD-9 is present
Hyperlink Tool Functionality ICD9-Code with no ICD-10 Code Attached
Associate the unmatched ICD-9 code to an appropriate ICD-10 code if not yet assigned.
ICD-9 Code with an ICD-10 Code Attached
Modify the ICD-10 code associated to the ICD-9 code so it is billed with a different one than
originally assessed (as per local workflow processes)
Note: Hyperlink updates made at the claim level are applicable to the claim only. They do not sync into EMR master files nor prior claims history.
The Hyperlink Tool is available in the ICD Table on the claim itself; however, it is not applicable on the
History or Assessment pop-ups
Hyperlink is n/a because you cannot
modify claims history nor EMR master files
from Billing side.
Update Claim Details ICD (from / button)
UB04 Inpatient Claims – U button Behavioral change from auto-complete text (ICD-9 only) field to Assign ICD pop-up with both ICD-9 and
ICD-10 codes that are already assigned to the claim ICD Table
Similar to the Prescription, the ADM DX must already be assessed to the patient
Encounter/PMH
Validation for Missing Codes – Claim Level
Validation for Duplicate Codes – Claim Level*
SNOMED codes are not figured in the equation of duplicates on Billing side
Duplicate ICD-10s in the ICD Table are not allowed even if the associated ICD-9 is unique for each one
ICD-10 Claim vs. ICD-9 Claim
ICD-9 or ICD-10 codes will apply based on New Visit DOS regardless of
DOS being copied
Rebilling as same Visit ID will keep codes in tact as
the one being copied
Date of Service will determine whether ICD-9 claim or ICD-10 claim.
Payer Not Ready for ICD-10 (Payer Master Flag)
Settings Configuration Vendors Insurance Extra Info button
Work Comp carriers are not mandated to accept ICD-10 Codes; otherwise, all paper & EDI Payers do
Locally, some payers may not be ready; hence you are able to manage via the Insurance Master
Payer Not Ready for ICD-10 (Validation Alert) Such claims will initially go with ICD-9 although they are considered an ICD-10 Claim
Claim can later be re-sent w/ICD-10 claims if applicable once Payer Master flag is updated*
Alert will display upon every Save or Ready to
Send. This is not an error; you can still send the
claim.
Rebilling Payer Not Ready for ICD-10
Remove the Not Ready for ICD-10 flag in the Payer Master
Select claims you want to rebill Click the Resend icon ( )
Select Claims Processed By Claims Set filter per the insurance (i.e.: ABC Insurance in this example)
Once the payer is ready to accept ICD-10, you can easily resubmit them based on local workflow and
processes
ICD-10 Management Enhancements
IMO Search Screen
*Settings Configuration Admin Properties icd.search.tabs.sequence
Search tabs can be customized per local
preference*
The Hyperlink Tool becomes disabled on the standard IMO search once the ICD-9 has been mapped to an ICD-10. The Preferred & Custom lists are
available at this level; hence the hyperlink is not required.
Locally, you can now decide which search tab is your default when executing the ICD Search ( )
If you use Custom codes, your local description will be retained even after you map it to an ICD-10.
Drill-Down Tab New Feature
https://www.e-imo.com/solutions-ehr-systems
A new tab available on standard ICD Search screen expands the logic of the Standard
tab by allowing you to identify specific code based on specificity requirements
Drill-Down Tab (cont’d) Type any ICD-9, ICD-10 code, or Description and click to execute the search
New Feature
All matching combinations for the value entered will display with applicable action buttons
Expand the code to display additional specificity criteria until you drill it down to highest code
Add the code to the Conditions tab, which will then populate the assessment/claim
Drill-Down Tab (cont’d)
Expanding a Code When clicking , additional tables appear with additional conditions or specificity criteria
As you select a value in a table on the left, the tables to the right will change accordingly
Notice for migraine, I must also select a Type, Status, & Intractability
The number of tables that display will vary based upon the root disease/code being drilled-down
Expanding a Code (cont’d) Once you have selected a value in each applicable table (based on the patient’s situation), the
expanded code will display below the tables
Click to add it to the Conditions tab, which will then populate the assessment/claim.
Each table to the right filters based on values
selected to the left
Adding Selected ICD-10s to Encounter All codes you are selected via the icon, they are added to the Conditions tab
Expanded view of the Conditions tab with selected
ICD-10 codes that will populate assessment/claim.
The OK button adds them to the Assessment/Claim (depending from where you executed Drill-down).
Populated ICD-10 from Drill-Down All codes that were added to the Conditions tab during the Drill-down now populate the screen from
which the IMO search was executed (e.g.: Assessment, Claim Details, etc.)
Billing Scrubber Checks All existing ICD-9 scrubber checks remain valid while new ICD-10 operands have been added
Billing Settings Claim Scrubber Checks
Bill Filters New Filters
Custom Report Layouts New Fields
Labels, Tags, and Other Indicators
Patient Band Indicators & Tooltip Orange ICD-10 bar displays for Encounter Dates October 1, 2015 and after
Red ICD-9 bar displays for Encounter Dates before October 1, 2015
ICD tooltip will also reflect which one applies to that PMH, encounter, or claim
Print Tags & Claim Labels CMS-1500 Printed Claim – cell 21
Track Status
I- button
Claim Labels & Tooltip
Once the payer is rebilled, this label will reflect ICD-10
accordingly on the rebill.
History Labels (EMR and Billing screens)
New columns added to display ICD-10 codes as well as ICD-9 codes
Appendix HL7 Interface Vendors
ICD-10 Certified Lab Vendors (Sept. 30, 2015)
Lab Vendors
LabCorp
Quest Diagnostics
Bio Reference (Gen Path)
PCLS
NorDx Lab
Med Labs Diagnostics
Pathology, Inc.
Empire City Labs
Millennium Labs
CLA-PAML
PathGroup
Theranos
Solstas
Ingalls
Atherotech
US Medical Scientific
(Vendition Partners)
Boston Heart Diagnostics
Vista Clinical Diagnostics
Note: This list includes those vendors who transact using HL7 Interfaces. Send inquiries to Interface Services Team at [email protected]
Accumen
ProGenity
Sentra Lab (4 Medica)
Sharp Labs
Ethos
AP Easy
Health Diagnostic Laboratory
Pathology Reference Lab
Drugscan (Atlas Medical)
ICD-10 Certified PMS Vendors (Sept. 30, 2015)
Note: This list includes those vendors who transact using HL7 Interfaces. Send inquiries to Interface Services Team at [email protected]
PMS
Benchmark
HealthPac
X-Link
MDSynergy
Medical Mastermind
SunRise
Athena Health PM
Avisena – Medusind
Orchard
Collaborate MD
MedFocus RCM
Medisys
Advanced MD
Web Practice (Health Nautica)
ClinicX PM
MedEvolve eCeno
Assertus/Proclaim
Doc-tor.com
ICD-10 Certified EDI Vendors (Sept. 30, 2015)
EDI Clearinghouses
Gateway
Office Ally
Navicure
Availity
Availity RCM (RealMed)
Emdeon
P2P Stone River
Inmediata
ZirMed
Emdeon One (Capario One)
Ability (MD Online)
Optum/ENS Health
Note: This list includes those vendors who transact using HL7 Interfaces. Send inquiries to Interface Services Team at [email protected]
All PrognoCIS Billing clients’ clearinghouses are certified for ICD-10
The End of the Curve Deployment
ASP/Cloud users do not have to wait for the upgrade.
Requires V3B2, Service Pack 163 or higher. (As of September 2015, all ASP Servers are current.)
Preparation
Analyze ICD-9 data from the ICD-specific Tabular Reports
Create ICD-10 crosswalk/superbill internally
Start using the new tools now
Or wait and do it “as you go” at the encounter -level
Note: You can verify your version under the Info icon in system tray in the upper right ( ).
If you are a Client Server user, please contact your local IT Administrator for details.
PrognoCIS Technical Support & Resources
How may I help you?
PrognoCIS Resource Center
Recorded version of this webinar
ICD-10 specific modular videos
Technical Support 24/7
New toll free number (800) 552-3301
Email: [email protected]
Live Chat
Implementation Manager (if applicable)
CMS Resources https://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/icd10
https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10ResourcesFlyer20150817.pdf
CMS Resources (cont’d)
Questions & Answers
Review Time!