Preparing for ICD-10 - HEALTHCAREfirst...2013/11/22 · HEALTHCAREfirst® 11/21/2013 2 ICD-10 Files • Tabular and index of ICD-10-CM • Addenda (Changes since the 2012 version)

HEALTHCAREfirst® 11/21/2013

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Preparing for ICD-10November 2013

Preparing for ICD-10

• Update on ICD-10 industry readiness

• ICD-10 files and documentation

• Cost of ICD-10 implementation

• ICD-10 budget considerations

• The importance of documentation

• Common diagnoses in home health

• Changes in documentation requirements

• Documentation preparation and training


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ICD-10 Files

• Tabular and index of ICD-10-CM

• Addenda (Changes since the 2012 version)• Complete list of ICD-10-CM code titles – long and

abbreviated

• General Equivalence Mappings

• Reimbursement Mappings

• Duplicate ICD-9-CM and ICD-10-CM codes

http://cms.hhs.gov/Medicare/Coding/ICD10/2013-ICD-10-PCS-GEMs.html

Will the Industry be Ready?

• Industry surveys show that Home Health providers are behind the curve

• Claims with ICD-10 cannot be sent until 10/1/2014 and Medicare is only doing internal testing

http://www.ngscedi.com/news/ngs_053113_Testing.htm

http://www.wedi.org/docs/comment-letters/2013-wedi-icd-10-survey-results-letter.pdf?sfvrsn=0

http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%2011%20Home%20Health%20and%20Hospice~Articles~ICD-10~987KA52644?open&navmenu=Articles||||


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Training and Preparedness Materials

Start preparing for ICD-10 NOW

http://apps.who.int/classifications/icd10/browse/2010/en

http://cms.hhs.gov/Medicare/Coding/ICD10/index.html

http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD-10Overview.pdf

Training and Preparedness Materials Cont.

The ICD-10 Transition (Introductory Document)

http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD

10_Introduction_060413%5B1%5D.pdf

Transition Basics (FAQ Document)http://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10FAQs2013.pdf

CMS Email Updates https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_608

http://blog.healthcarefirst.com/


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One of the Last Puzzle Pieces…

OASIS C-1

• Comments were due in August

• Final Rule still needs to be published

• In addition to ICD-10 support several items will be eliminated

http://www.gpo.gov/fdsys/pkg/FR-2013-06-21/pdf/2013-14878.pdf

http://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html

Cost of ICD-10 Implementation

One-Time Costs

• Trainingo Coderso Clinicianso Billerso Administration

• Software and technology updateso Billing and clinical systemso Physician portal/intake systemso Clearinghouse applications


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Other One-Time Costs

• New forms/ documentation systems

• Productivity loss during the learning curveo Internalo External – working with partners

• Workflow changes

• Financing costs for cash flow needso Get a line of credit approved nowo Have six months of money in the bank


Ongoing Costs

• Productivity losso It is predicted that an initial 54% decrease in

productivity will occur and will slowly decrease over the first 6 months

o A 20% decrease in productivity is what is to be expected to be ongoing

• Follow up training needso Continuing Education

• Coding Outsourcing costs


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ICD-10 Budget Considerations

Expenses

• Personnelo Staffing for lost productivity

� Overtime� Additional staff� Replacement costs during training

Training

• Training expenses• Travel expenses• Consultant fees

Coding Outsourcing

Importance of Documentation

CMS Requirements - CoPs

• Homebound status• Medically reasonable and necessary• Intermittent skilled care• Coordination of care

Reimbursement Support

• Support coding• ADRs• Denials

Legal Considerations


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CMS recently published “established recordkeeping principles” to provide further guidance regarding the timeliness of entries in medical records.

These principles apply to all Medicare contractors that review medical records.


Any medical record that contain amendments, corrections or addenda must:

1. Clearly and permanently identify any amendment, correction or delayed entry as such, and

2. Clearly indicate the date and author of any amendment, correction or delayed entry, and

3. Not delete, but instead, clearly identify all original content.


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Medicare contractors cannot consider entries in medical records that do not comply with these established recordkeeping principles; for example, we must disregard undated or unsigned entries handwritten in the margins of a document.

Consequences

• Compliance issues

• Payment issueso Upcodingo Downcoding

• Medical Review Issueso Lack of narrative

• Care Issue

• Survey Sanctions


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ICD-10 Documentation

ICD-10 is much more specific.

Very detailed information will be required by:

• Home Health clinicians• Referral sources• Hospitals• Physicians

ICD-10 Documentation

• ICD-10 transition team should include a documentation specialist.

• Perform a gap analysis on all clinicians.


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ICD-10 Gap Analysis

Your gap analysis should assess your employees’ knowledge of:

• Anatomy

• Physiology

• Pathophysiology

• Pharmacology

• Medical Terminology

Clinician Training

• Six months prior to implementation date

• Canada’s experience for clinical training

o 30 hours training plus 8 hours knowledge gap training

• Initial assessment/audits

• E-learning/webinars

• Practice tools

• Discussion forums

• Classroom education

• Live events


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Documentation Training

• Get to know your top 25 diagnoses in your agency.

• Learn the documentation requirements of these diagnoses first.

Common Diagnoses

• Ulcers

• Diabetes Mellitus

• Fractures

• Osteoporosis

• Myocardial Infarction

• CVA

• Hypertension

• Heart Failure


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Statis Ulcer Documentation Requirements

• Clinical Documentation

• Severity

o Bone necrosis

o Exposed fat layer

o Skin breakdown only

• Laterality

o Left

o Right

o Bilateral

Diabetes Mellitus

Five Categories of Diabetes Mellitus

• Due to underlying condition

• Due to chemical induced

• Type 1 Diabetes

• Type 2 Diabetes

• Other specified diabetes

Many are combination codes with specific manifestation information.


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Fractures

• Laterality

• Displaced

• Non-displaced

• Closed

• Open

Osteoporosis

Osteoporosis Due to:

• Age-related with/without current fracture

• Involutional

• Lequesne

• Localized

• Post-menopausal with/without current fracture

• Senile

• Specified type with/without fracture


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Myocardial Infarction

• Clinical documentation

o ST elevation anterior wall

o Left main coronary artery

o Left anterior descending coronary artery

o Other coronary artery of anterior wall

o ST myocardial infarction of inferior wall

o ST myocardial infarction of left circumflex coronary artery

• Length of time (4 weeks or less)

• History of tobacco use

Hypertension

• Unspecified, benign and malignant are all the same code

• Tobacco use, history, exposure, dependence will need to be coded as an additional code


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Cerebral Infarction

Should the affected side be documented, but not the specified dominant or non-dominant and the classification system does no indicate a default, code selection as follows:

• For ambidextrous patients, the default should be dominant.

• If the left side is affected, the default is non dominant.

• If the right side is affected, the default is dominant.

Heart Failure

CHF is a non-specified code in ICD-10:

• Specify systolic, diastolic or combined

• Specify acute or chronic


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Foot Ulcer

A 75-year-old woman is admitted to home care after developing an ulcer on the plantar surface of her left foot. The fat layer is exposed. This condition is a residual problem occurring after a stroke and due to a loss of sensation.

Skilled nursing services are ordered to care for the wound and teach patient self-care.

CVA and Hypertension

The patient was discharged from the hospital after an acute CVA resulting in right-sided spastic hemiplegia (right dominant). He also has HTN and diabetes.

He will receive nursing services as well as PT and OT.


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Conclusion

• Make clinical documentation training a priority

• Invest in adequate staffing

• Focus on accurate code assignments

• Hold staff accountable for productivity and accuracy

• Prioritize chart reviews for maximum impact

• Know your top 25 diagnoses

• Identify documentation improvement opportunities

• Develop coder and clinical interactions

For more information

HEALTHCAREfirst

[email protected]

Documents

Preparing for ICD-10 - HEALTHCAREfirst...2013/11/22 · HEALTHCAREfirst® 11/21/2013 2 ICD-10 Files • Tabular and index of ICD-10-CM • Addenda (Changes since the 2012 version)