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ICD‐10HOW eIVF HANDLES ICD‐10 CONVERSION
If I had it my way…
What is ICD‐10?• First, there is an increase in the number of billing codes, from 14,000 to 69,000.
• Take effect on October 1, 2015
• All healthcare providers are required to comply with the new regulations or they may have trouble with insurance reimbursement
What changed?Code structure grew
What changed?Categories grew from 19 to 21
What changed?2ND section (Ethology…) grew from 2 to 3
What changed?There is a new tricky character at the end• Only used in certain ICD‐10 chapters • Defines the characteristics of encounter for injuries and fractures
Value Description
A Initial encounter
D Subsequent encounter
S Sequela
How it may effect you?• The new ICD‐10 codes mean changes in patient coverage• Requires coders to have a more detailed knowledge of human anatomy and physiology
• Requires doctors to be more specific in their documentation and code observations
• The new ICD‐10 codes include more payment limitations for services
• Practices can expect a slow down in A/R and cash flow• Billing departments can expect an increase in call volume for confusing or rejected claims; the number of billing audits may also increase
How it may effect you?Some ICD‐9 codes are completely obsolete• V72.3 Gynecological examination• 790.9 Abnormal blood results• 256.3 Primary ovarian failure• 279.4 Autoimmune disease • 631 Spontaneous abortion• 632 Missed abortion
Some codes are expanded (more specific)
One ICD‐9 to many ICD‐10’s
How it may effect you?
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How it may effect you?Some codes are collapsed (more generalized)
Multiple ICD‐9’s to one ICD‐10
V23.2 Pregnancy with history of abortion OØ9.291 V23.4 Pregnancy with other poor obstetric historyV23.49 Pregnancy with other poor obstetric history V23.5 Pregnancy with other poor reproductive history
Supervision of pregnancy with other poor reproductive or obstetric history, first trimester
ICD‐9 Code(s) Corresponding ICD‐10 Code
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US Patent: US3285228 A
Granted: 1966
Anti‐gravity pen: is a pen that can write upside‐down, in frigid or roasting conditions (from minus 50 degrees Fahrenheit to up to 400 degrees F), and even underwateror in other liquids. If too hot, though, the ink turned green instead of its normal blue.
US Patent: # 2 (probably)
Created 1500’s
Pencil: requires no definition required
Our analysis of eIVF Dx workflowFirst, across all eIVF practices, we found:
Maximum # ICD‐9 on file: 390• # we could reference to ICD‐10: 331• Possible ICD‐10 References: 633 (192%)• Still had 60 or so codes that we could not find
# of Mappings: 419
Our analysis of eIVF Dx workflow2nd, thoroughly analyzed current workflow• Categories,
subcategories and Dx short name
• Dx Long Name• System Code / Dx
Code• Medication &
Requested labs• Start and Resolve
dates
Our challengeNot to much change…• Try to keep workflow/screens similar AND Provide visual references between ICD‐9 & ICD‐10 code
Our challengeNot to much change…
Our challengeNot to much change…
Our challengeNot to much change…
Our challengeNot to much change…
How did we tackle the issue? 1. Load “referenced” ICD‐10 Codes
Provide all ICD‐10 codes that have references to existing ICD‐9 codes in your eIVF
System Setup Diagnosis Diagnosis
ICD‐10 codes are placed in the respective categories of the original ICD‐9’s
http://ftp.cdc.gov/pub/health_Statistics/nchs/Publications/ICD10CM/2015/
How did we tackle the issue?2. Map existing ICD‐9 to ICD‐10
Placed them back in your respective category/subcategory
Mapping Rules (obsolete ICD‐9 codes)If we could not find a “referenced” ICD‐10 to ICD‐9 (i.e. V91.9), we left as Unmatched ICD‐9 Codes
Mapping Rules (expanded ICD‐10 codes)For ICD‐9 codes that have multiple ICD‐10 references, we ordered them by code #
How did we tackle the issue?3. Changed DxScreen (Build 60)• Categories,
subcategories and ICD‐9 Dx short name
• ICD‐9 code• Referenced ICD‐10
code• Referenced ICD‐10
description• Medication &
Requested labs• Start and Resolve
dates
What you should do today…You must review all ICD‐9 to ICD‐10 mapping and correct
To correct reference codes:1. Double click on entry
OR2. Setup Diagnosis Diagnosis
If ICD‐10 does not exist in your system1. Add ICD‐10 code in ICD‐10 Category 2. and then map
What you should do today…You must review all ICD‐9 to ICD‐10 mapping and correct• For example, eIVF references 752.0 to Q50.01• But if you feel 752.0’s reference code should be Q50.39, move it up
What you should do today …Then all codes in Unmatched ICD‐9 must be referenced / reviewed / Attended to
Setup Diagnosis Diagnosis
(ICD‐10 category)
What happens on October 1, 2015?
What happens on October 1, 2015?First, the selection columns flip.
You will no longer be able to select ICD‐9 code
What happens on October 1, 2015?
All possible ICD‐10 codes become available for selection
What happens on October 1, 2015?
When accessing Alert in patient chart to convert patient diagnosis codes
What happens on October 1, 2015?Click on Show Current Diagnosis and map
This will resolve ICD‐9 codes with Today’s date and create new ICD‐10 code
What happens on October 1, 2015?
All patient’s Dx codes must be converted before checkout, claim or reference lab submission
A friendly reminder from your support team1. We are not certified ICD‐10 trainers / consultants 2. PracticeHwy does not convert ICD‐9 codes– just mapping to
reference codes based on CMS suggestions:http://ftp.cdc.gov/pub/health_Statistics/nchs/Publications/ICD10CM/2015/
3. It is practice’s responsibility to:1. Review all codes and correctly map all Dx codes in Setup 2. On and after October 1, 2015 review all patient diagnosis
codes and correctly convert3. Review all claims for appropriate coding before submission4. Review all laboratory orders prior to requisitioning
eIVF & PracticeHwyMust not be held responsible for any discomfort due to ICD‐10 conversion / use / implementation, including• Completeness of code list• Coding method• Changes in patient coverage• Payment limitations for services• Slow down in A/R and cash flow • Increase in call volume • Confusing or rejected claims• Billing audits
Rest assured, eIVF has all the tools
QUESTIONS
We don’t use eIVF billing, do I still need to do worry about this?
Does this effect my flowsheet compliance?
Does this effect my lab orders and results?
Everyone has to take part
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Questions?Comments?
Observations?
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