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ICD-10 Transition Guide Preferred IPA

ICD-10 Transition Guide Presentation

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  • 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    Based on outdated terminology.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 Allys 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 [email protected] 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: [email protected]

    mailto:[email protected]

  • 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

    http://www.roadto10.org/action-plan/get-started/https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10QuickStartGuide20150622.pdfhttps://medicaidicd10.noblis.org/collaboration/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/

    http://www.pathfinderadventure.com/sites/default/files/ICD-10 Documentation for Common Comorbidities.pdfhttp://www.roadto10.org/ics/http://www.roadto10.org/med-studies/http://www.roadto10.org/specialty-references/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

    https://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.htmlhttp://www.roadto10.org/roadto10-webcasts/https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10BasicsforPractices20140819.pdfhttps://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/

    http://www.roadto10.org/med-studies/http://www.roadto10.org/specialty-references/http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_050190.hcsp?dDocName=bok1_050190https://www.cms.gov/Medicare/Coding/ICD10/2016-ICD-10-CM-and-GEMs.htmlhttp://cdn.roadto10.org/wp-uploads/2014/08/2015-ICD-10-CM-Index-to-Diseases-and-Injuries.pdfhttp://www.icd10data.com/Converthttps://www.aapc.com/icd-10/codes/

  • Questions?