ICD-10 Transition GuidePreferred IPA

History of ICD-10

1994 ICD-10 Adopted by World Health

Organization (WHO)

2003 Health and Human Services

received recommendations to

adopt ICD-10

2008 US federal government

proposed ICD-10 adoption date of October 1, 2011

2009 – 2014 Six years of ICD-10

Compliance Date delays

October 1, 2015 ICD-10 Compliance

Date

2018 ICD-11 will be released

Worldwide ICD-10 Usage

ICD-10 has been translated into 43

languages and is being used by at least

117 countries around the world.

How is ICD-10 different from ICD-9?

ICD-9-CM Diagnosis Codes ICD-10-CM Diagnosis Codes

3-5 digits. 3-7 alphanumeric characters.

Based on outdated terminology. Reflects current use of medical

terminology.

Limited Severity Parameters. Extensive Severity Parameters.

Limited Combination Codes. Extensive Combination Codes to

better capture complexity.

Approximately 14,000 codes. Approximately 69,000 codes.

Where will you see ICD-10 changes?

How will ICD-10 change clinical

documentation?

Patient is seen in a [subsequent encounter] for a [non-union] of an [open] [fracture] of the [right] [distal] [radius] with [intra-articular extension] and a [minimal opening] with [minimal tissue damage]

Quick Tips

Date of service 10/1/2015 or later: use ICD-10 codes

Date of service 9/30/2015 or prior: use ICD-9 codes

Do not submit claims/encounters with both ICD-9 and ICD-10 codes on the same submission. Health plans require separate submission.

Clinical documentation- Make sure to document in detail so that the ICD code can be as specific as possible and is substantiated by the medical record.

Document comorbid conditions to capture the most accurate and complete picture of the patient.

Claims/encounters for date of service on or after 10/1/2015 submitted with ICD-9 codes will be rejected/returned for corrections.

Referrals with ICD-10 or ICD-9 codes are currently accepted. No referrals with ICD-9 codes will be accepted after 10/1/2015.

CPT and HCPCS codes are not impacted by ICD-10 changes.

ICD-10 transition will happen on October 1, 2015.

What Preferred IPA is doing to help:

Faxing bulletins since 2014

Provider readiness survey followed up by phone calls

Check stuffers with helpful hints

Phone call reminders

Webinars

Countdown on website and portal

What Preferred IPA is doing to help:

Office Ally Testing Steps

To submit your ICD-10 test file, prepare a claim as you normally do. Remember to include ICD-10 Diagnosis Codes.

Date of Service: Submit the test claim with current dates of service as Office Ally will be using a “fake” transition date of 10/01/2014

Submit your test file

For Upload Users Only: Submit a test file with the keyword OATESTICD in the name of the file, this keyword will prompt Office Ally’s system to process the file as an ICD-10 Test File

For OLE/PM Users Only: Submit test claims using OLE/PM and once they process (they will reject), send an email to Office Ally ICD10@officeally.com with the File ID. The claim will be recreated into an OATESTICD test file under your account.

Results: After the ICD-10 test file is processed, you will receive a Test File Summary showing the results of your ICD-10 test file.

If you have questions about Office Ally ICD-10 testing, contact Office Ally:

Phone: (360) 975-7000, Option 1

Email: ICD10@officeally.com

Implementation Guides

Build your action plan (very detailed):

http://www.roadto10.org/action-plan/get-started/

Quick Start Guide: 5 Step to be Ready for ICD-10 Compliance Deadline

https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10QuickStartGuide20150622.pdf

Implementation Timeline:

https://medicaidicd10.noblis.org/collaboration/

CMS Sponsored ICD-10 Teleconferences

https://www.cms.gov/Medicare/Coding/ICD10/CMS-Sponsored-ICD-10-Teleconferences.html

Physician Resources: Clinical

Documentation

Clinical Documentation: http://www.pathfinderadventure.com/sites/default/files/ICD-10%20Documentation%20for%20Common%20Comorbidities.pdf

Interactive case studies – to practice documentation for ICD-10 coding- http://www.roadto10.org/ics/

Medical case studies- http://www.roadto10.org/med-studies/

Primer for clinical documentation and clinical scenarios for different specialties- http://www.roadto10.org/specialty-references/

ICD-10 documentation- http://www.roadto10.org/webcasts/

Training Resources for Staff

CMS’ Provider Resources-

https://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html

ICD-10 overview and how to prepare for the transition-

http://www.roadto10.org/roadto10-webcasts/

ICD-10 basics for medical practices-https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10BasicsforPractices20140819.pdf

HHS ICD-10 Info-https://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD-10Overview.pdf

Coding Resources

Medical case studies- http://www.roadto10.org/med-studies/

Common codes for your specialty

http://www.roadto10.org/specialty-references/

General Equivalence Mapping – diagnosis codes and guidelines-

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_050190.hc

sp?dDocName=bok1_050190

https://www.cms.gov/Medicare/Coding/ICD10/2016-ICD-10-CM-and-GEMs.html

http://cdn.roadto10.org/wp-uploads/2014/08/2015-ICD-10-CM-Index-to-Diseases-

and-Injuries.pdf

ICD-10 code conversion

http://www.icd10data.com/Convert

https://www.aapc.com/icd-10/codes/

Questions?