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ICD-10 Transition: Q & A Session Beacon Health Options

ICD-10 Transition: Q & A Session - Beacon Health Optionsvalueoptions.com/.../ICD-10-Transition-QA-Session.pdf · Code Volume and Behavioral Health ICD-10 Transition 4 Clinical Area

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Page 1: ICD-10 Transition: Q & A Session - Beacon Health Optionsvalueoptions.com/.../ICD-10-Transition-QA-Session.pdf · Code Volume and Behavioral Health ICD-10 Transition 4 Clinical Area

ICD-10 Transition:

Q & A Session

Beacon Health Options

Page 2: ICD-10 Transition: Q & A Session - Beacon Health Optionsvalueoptions.com/.../ICD-10-Transition-QA-Session.pdf · Code Volume and Behavioral Health ICD-10 Transition 4 Clinical Area

Today’s Agenda

What’s Changing?

Preparedness

Dialogue

Resources

ICD-10 Transition 2

Page 3: ICD-10 Transition: Q & A Session - Beacon Health Optionsvalueoptions.com/.../ICD-10-Transition-QA-Session.pdf · Code Volume and Behavioral Health ICD-10 Transition 4 Clinical Area

What’s Changing?

ICD-10 Transition 3

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

3 to 5 digits 7 characters

Alpha “E” or “V” on first character Alpha or numeric for any character

Approximately 14,000 codes Approximately 69,000 codes

Terminology Similar

Severity parameters limited Extensive severity parameters

Source: Health Data Consulting

Page 4: ICD-10 Transition: Q & A Session - Beacon Health Optionsvalueoptions.com/.../ICD-10-Transition-QA-Session.pdf · Code Volume and Behavioral Health ICD-10 Transition 4 Clinical Area

Code Volume and Behavioral Health

ICD-10 Transition 4

Clinical Area ICD-9 ICD-10

Fractures 747 17099

Brain Injury 292 574

Anxiety Disorders 27 47

Mood Related

Disorders

75 71

Hypertensive

Disease

33 14

Source: Health Data Consulting

Impact not as large as anticipated

Page 5: ICD-10 Transition: Q & A Session - Beacon Health Optionsvalueoptions.com/.../ICD-10-Transition-QA-Session.pdf · Code Volume and Behavioral Health ICD-10 Transition 4 Clinical Area

How is ICD Changing?

5ICD-10 Transition

Diagnosis Code Change Examples:

• ICD-9 one ICD-10 code

• ICD-9 many ICD-10 codes

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

Page 6: ICD-10 Transition: Q & A Session - Beacon Health Optionsvalueoptions.com/.../ICD-10-Transition-QA-Session.pdf · Code Volume and Behavioral Health ICD-10 Transition 4 Clinical Area

A few examples…

ICD-10 Transition 6

Page 7: ICD-10 Transition: Q & A Session - Beacon Health Optionsvalueoptions.com/.../ICD-10-Transition-QA-Session.pdf · Code Volume and Behavioral Health ICD-10 Transition 4 Clinical Area

So what does this mean?

Same content will be in many places

Less than 5% of all ICD-9 and ICD-10 codes crosswalk 1:1

In some cases, a single ICD-9 code could be represented

by multiple ICD-10 codes or a cluster of ICD-10 codes may

be required to describe a single ICD-9 code

Some concepts will be lost when translating between ICD-

9 and ICD-10

• Substance Dependence concept has been removed from ICD-10

• Substance Use is now defined by specific substance

Overall, by using ICD-10, documentation will improve

7ICD-10 Transition

Page 8: ICD-10 Transition: Q & A Session - Beacon Health Optionsvalueoptions.com/.../ICD-10-Transition-QA-Session.pdf · Code Volume and Behavioral Health ICD-10 Transition 4 Clinical Area

Relationship with DSM-5

Both DSM and ICD codes are used for diagnosis

• Per HIPAA, ICD must be used for billing purposes

DSM-5 utilizes ICD-9-CM and ICD-10-CM coding

depending on the date of service

Authorization requests require the provider to supply the

DSM-5 diagnosis using the correct ICD format depending

on the requested start date

• Prior to October 1, 2015: ICD-9 coding accepted

• Beginning October 1, 2015: ICD-10 codes REQUIRED

ICD-10-CM codes can be found in the DSM-5 manual.

8ICD-10 Transition

Page 9: ICD-10 Transition: Q & A Session - Beacon Health Optionsvalueoptions.com/.../ICD-10-Transition-QA-Session.pdf · Code Volume and Behavioral Health ICD-10 Transition 4 Clinical Area

Are you Ready?

By now, you have most likely:

• Created a transition team or project manager

• Developed a conversion plan and communicated to staff

• Determined what the overall impact will be on your organization or

practice

• Determined documentation and record changes

• Spoke with your payers, billing and IT staff

• Reached out to trading partners about testing

• Began testing as soon as possible

9

It’s not too late!

Planning assistance is available

through CMS here:

http://www.cms.gov/Medicare/

Coding/ICD10/ProviderResources.

html

ICD-10 Transition

Page 10: ICD-10 Transition: Q & A Session - Beacon Health Optionsvalueoptions.com/.../ICD-10-Transition-QA-Session.pdf · Code Volume and Behavioral Health ICD-10 Transition 4 Clinical Area

Resources: ICD-10 Spotlight

Conversions – A Hot Topic:

• ValueOptions will use the CMS ICD-10 GEMs/crosswalks as the

standard for mapping ICD-9 to ICD-10. Additional information can

be located on the CMS website:

https://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-PCS-

and-GEMs.html.

CMS ICD-10 Code Lookup

Coding Conversion Tool

For more information, including webinar slide decks,

recordings, our FAQ and additional CMS resources, refer

to our ICD-10 Spotlight Page

Basic PowerPoint Template 10

Page 11: ICD-10 Transition: Q & A Session - Beacon Health Optionsvalueoptions.com/.../ICD-10-Transition-QA-Session.pdf · Code Volume and Behavioral Health ICD-10 Transition 4 Clinical Area

Time for Dialogue

At this time, we encourage you

to ask questions you have related

to the ICD-10 transition

Please enter questions via the

GoTo Question Box located in the

dropdown on your screen

If prompted, you may unmute your

phone line by pressing *6

• To minimize background noise,

please use your mute button or

press *6 to remain on mute if

you are not speaking

ICD-10 Transition 11

Page 12: ICD-10 Transition: Q & A Session - Beacon Health Optionsvalueoptions.com/.../ICD-10-Transition-QA-Session.pdf · Code Volume and Behavioral Health ICD-10 Transition 4 Clinical Area

Contact Us

Testing and Technical Questions

EDI Help Desk

Monday through Friday

8 a.m. to 6 p.m. ET

Phone: 888.247.9311

Email:

[email protected]

ICD-10 Transition 12

General Provider Questions

Provider Services Line

Monday through Friday

8 a.m. to 8 p.m. ET

Phone: 800.397.1630

Page 13: ICD-10 Transition: Q & A Session - Beacon Health Optionsvalueoptions.com/.../ICD-10-Transition-QA-Session.pdf · Code Volume and Behavioral Health ICD-10 Transition 4 Clinical Area

Thank you

13ICD-10 Transition

To help us continue to offer quality training opportunities,

please consider completing the survey when prompted to offer

feedback for today’s session