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Robert Janowitz, MD
Medical Director, Illinois Local Markets
BCBSIL
July 17, 2015
Illinois Public Health Association
Preparing for ICD-10 What you need to know
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.
Agenda
What is ICD-10?
Why does ICD-10 Matter?
What is Changing?
How do I get ready for ICD-10?
How are we helping you prepare for ICD-10?
ICD-9 ICD-10
2
What is ICD-10?
• ICD works with other code sets to
create information in health care
• Healthcare services are defined by
ICD + other coding attributes
• Most payers like Medicare and
BCBSIL have systems that derive
(1) benefits, (2) medical policies,
and (3) pricing from a combination
of codes, including ICD
What is ICD-10?
Regulatory mandate from the US Dept. of Health & Human Services beginning 2009
• Applies to all health care organizations
• Implementation date postponed 3 times, most recently in 2014 due to
Congressional action
• Current compliance date is 10/1/2015 – all indications say this date will
hold
ICD is an important building block for health data
4
ICD-10 Patient
Attributes
Revenue
Codes
Treatment
Settings
What is ICD-10?
5
Diagnoses: ICD-10-CM
Procedures/Treatments: ICD-10-PCS
• Will be used by all providers
• Replaces ICD-9-CM Volumes 1 & 2
• Distributed by CDC and CMS
• No license fees, free to use
• >5 x increase in volume of codes
69,823 codes You will use a fraction of these!
• For inpatient facility billing only
• Replaces ICD-9-CM Volume 3
• Distributed by CMS
• No license fees, free to use
• >8 x increase in volume of codes
71,974 codes Hospitals only!
What is ICD-10?
6
ICD-10-CM Structure:
3- to 6-position code with leading alpha (+ extension)
Note: ICD-9-CM diagnosis was 3- to 5-position numeric except V and E
.X X X X X X X
Category
Etiology, anatomic
site, severity
Extension
ICD-10-PCS Structure:
7-position alphanumeric code
Note: ICD-9-CM procedure code was 2- to 4-position numeric
1 2 3 4 5 6 7
Section
Body System
Root Operation
Body System
Approach
Device
Qualifier
ICD-10-PCS Structure:
7-position alphanumeric code
Note: ICD-9-CM procedure code was 2- to 4-position numeric
1 2 3 4 5 6 7
Section
Body System
Root Operation
Body System
Approach
Device
Qualifier
1 2 3 4 5 6 71 2 3 4 5 6 7
Section
Body System
Root Operation
Body System
Approach
Device
Qualifier
ICD-10-CM Structure ICD-10-PCS Structure
Up to seven characters – all alphanumeric
Part
Hospitals Only!
Why does ICD-10 Matter?
ICD-10: Why does it matter?
It’s a Federal Mandate!
• DHHS final rule under HIPAA – new ICD standard
• Becomes effective 10/1/2015 – required for all HIPAA-covered
transactions nationally
• Effective date or Implementation date means date of service or date
of discharge
• No opting out – There are no provisions allowing opt out (e.g. paper
claims, small practices, etc.)
• Same implementation date for everyone:
Prior authorizations, referrals, orders, and prescriptions written before 10/1/15 for services to be
provided on 10/1/15 and later should contain ICD-10 where ICD is required
8
Use ICD-9* Use ICD-10*
O/P and Professional - Date of service 9/30/15 or earlier
For E/R and O/P Observation – treatment starts 23:59 or
earlier on 9/30/15
O/P and Professional - Date of service 10/1/15 or later
For E/R and O/P Observation – treatment starts 00:00 or
later on 10/1/15
O/P and Professional with from-through dates that cross 10/1/15 – split the record, request, or claim
For I/P Institutional – Date of Discharge 9/30/15 or earlier For I/P Institutional – Date of Discharge 10/1/15 or later
ICD-10: Why does it matter?
Industry Benefits of the transition to ICD-10
Makes richer data sets available
Helps research and public health surveillance – information on subsets of patients
can be more easily aggregated for large-scale population health analysis
New payment methodologies more practical
The ability to capture greater detail and differentiation in acuity/severity
will make complex outcome-based and risk-adjusted payment
models more mainstream
Drives health systems innovation
Innovations will better reflect the intensity of patient needs
than is currently possible
9
ICD-10 will provide better information to accelerate the meaningful use of health data
ICD-10: Why does it matter?
Benefits to You
More specific coding – Detail often lost with ICD-9, physicians
had a hard time conveying to payers how sick their patients really are
Finding a diagnosis gets easier – Physicians and coders will find it
easier to look up unusual diagnoses, signs, and symptoms. New AHIMA study
shows conversion costs range from $1,960 to $5,900 for small practices
Avoid audits and future payment delays – Claims are often
suspended for review or denied due to non-specific information, which the
detail in ICD-10 can help eliminate
Makes ICD-9 limitations a thing of the past – ICD-9 increasingly
fragmented and contained archaic medical terminology, contributed to coding
errors and delayed/inaccurate payments
More meaningful management of physician patient populations – Are you currently tracking a population of diabetic or asthmatic patients in your
practice?
ICD-10 will provide better information about patients’ overall health, aiding in clinical decision support
10
Link to Video – Internet connection required
02:46 min - Right click on link, select “Open Hyperlink”
A new browser window will open, maximize window for best viewing, click “Play” button
11
Let’s Hear From A Physician Champion at CMS
As a practicing physician, Dr. Martinez offers his insights about the benefits of
ICD-10 and four key points to help physicians with their transition to ICD-10.
What is Changing?
ICD-10-CM New and Different Diagnoses
Major Areas of Change
• Abnormal Test Findings & Borderline Diagnoses
• Acute Myocardial Infarction
• Adverse Effects, Dosing, & Poisoning
• Atherosclerosis, Angina & Hypertension
• Coma
• Diabetes Mellitus
• Kidney Disease & Urosepsis
• OB, Pregnancy, & Newborns
• Oncology & Neoplasms
• Orthopedics, Musculoskeletal, Injuries & Fractures
• Routine Exams / Screening Tests
• Vaccines / Immunizations
13
Focus of today’s presentation
New Terminology and Concepts, some examples: • STEMI and Non-STEMI instead of “Heart Attack” or “AMI”
• Underdosing and more Borderline conditions can be coded
• New scales for Asthma (4 levels), Diabetes (5 levels), Coma, and other conditions
• Episode of care indicators
• Pregnancy coded in trimesters
• Only 1 code to use for vaccinations
• Routine exams split into “with” and “without findings” categories
Data will behave differently, some examples: • Fewer heart attacks (coded for 4 weeks following infarct instead of 8 in ICD-9)
• More cancer cases (anemia coded 2nd in ICD-10 after cancer, ICD-9 rule was opposite) when looking
at primary Dx
• No V codes for rehab visits, instead this is part of the episode of care digit
• Pregnancies include new code for weeks gestation
• More combination codes will cause some conditions harder to locate in queries (e.g. kidney failure due
to diabetes)
• Abnormal test findings will appear in more records
• Smokers and patients exposed to tobacco smoke will appear more often
14
ICD-10-CM New and Different Diagnoses
ICD-10 Diagnosis Changes
Asthma ICD-10 requires the following scales into documentation:
Mild intermittent
Mild persistent
Moderate persistent
Severe persistent
More instructions to code tobacco
use/exposure
15
Risk Stratification – The varying degrees of asthma severity will make it easier to identify high risk
populations in health care data sets; more identification of patients who smoke/exposed to tobacco smoke
ICD-9-CM ICD-10-CM
493.22 chronic
obstructive asthma, with
status asthmaticus
J44.1 Chronic obstructive
pulmonary disease with
(acute) exacerbation
J45.42 Moderate
persistent asthma with
status asthmaticus
Z72.0 Tobacco use
ICD-10 Diagnosis Changes
16
Health Status Factors & “History of” condition codes are moderately to
highly impacted by the switch to ICD-10 depending on the type of encounter
Health Status Factors and & “History of” codes represent a wide range of reasons for
healthcare encounters for circumstances other than a current disease or injury, and can
include contraindications to care
ICD-9-CM ICD-10-CM
Often referred to as
“V" codes, because
most of them started
with the letter “V”
Equivalent and more
detailed codes have
been dispersed
throughout section
“Z"
V = Z
Example of
Health Status Factor:
Post heart surgery
ICD-10 Diagnosis Changes
17
Screening Exams and Preventive Care…
Annual physical exams and
entrance exams for school,
work, or sports participation
Inoculations and vaccinations
Routine exams to measure
developmental progress in
children
Routine hearing, vision and dental
exams
Routine screenings when no symptoms are present, such as:
• Cancer (neoplasm) screenings, like mammograms and pap
smears
• Infectious and parasitic disease screenings, such as tuberculosis
Observation of a suspected condition that has been ruled out (no
symptoms are present), such as
• ingestion of a toxic substance or exposure to a harmful substance
with no harmful effects
• potential complications following an accident or abuse incident
Contact/Exposure with a
communicable disease or other
health hazard (but showing no
symptoms)
Counseling for purposes such as
genetic counseling, childcare
instruction, and victim services
Disease and condition
screenings, for at-risk patients
such as diabetes, heart disease,
anemia, & genetic disorders
Donor screenings of blood, tissues,
or organs (but not-self donations
such as autologous blood)
ICD-9-CM Examples ICD-10-CM Examples
V71.31 Routine gynecological examination visit
V73.81 Special screening examination for Human papillomavirus
(HPV)
V76.47 Special screening for malignant neoplasms of vagina
V04.81 Vaccination and inoculation; influenza
Note: there is no ICD-9 code to indicate if the exam was normal
or abnormal
Z01.419 Encounter for gynecological examination (general)
(routine) without abnormal findings
Z11.51 Screening for human papillomavirus
Z12.72 Screening vaginal pap smear
Z23 Encounter for Vaccination (prophylactic)
Note: the vaccine code does not indicate the type of vaccine
administered, this information can be found in the procedure
coded for this service
V70.3 Other general medical examination for administrative
purposes
Z02.0 Encounter for examination for admission to educational
institution (Note added specificity available for reason for exam)
V71.82 Observation and evaluation for suspected exposure to
anthrax
Z03.810 Encounter for observation for suspected exposure to anthrax
ruled out
ICD-10 Diagnosis Changes
Routine and Administrative Exams New information needed in ICD-10 for Exams by physician
which are not well documented in many physician office
records today:
3 categories of routine exams, divided further by nature of
findings
• Z00.00-Z00.01 General adult medical exam
• Z00.121-Z00.129 Routine child health exam
• Z01.411-Z01.419 Routine gynecological exam
• With abnormal findings
• Without abnormal findings
Specific reasons needed for administrative exams
(e.g. “screening physicals”)
• School exam
• Admission to residential institution
• Pre-employment
• Sports participation
• And more…..
18
Risk Stratification – Can better identify abnormal vs normal screening exams in a population of patients
ICD-9-CM ICD-10-CM
V20.2 Routine infant
or child health check
794.15 Nonspecific
abnormal auditory
function studies
Z00.121 Encounter
for routine child health
examination with
abnormal findings
R94.120 Abnormal
auditory function
study
ICD-10 Diagnosis Changes
Screening Tests Visits for screening tests are coded similarly as they were in
ICD-9, but with more specificity
19
Risk Stratification – Use ICD-10 to track screening exams in a population of patients
ICD-9-CM ICD-10-CM
V72.42 Pregnancy examination or test, positive result Z32.01 Encounter for pregnancy test, result positive
V74.5 Screening examination for venereal disease
Z11.3* Encounter for screening for infections with a predominantly
sexual mode of transmission
Excludes:
Encounter for screening for human immunodeficiency virus [HIV] (Z11.4)
Encounter for screening for human papillomavirus (Z11.51)
V77.1 Screening examination; diabetes mellitus Z13.1* Encounter for screening for diabetes mellitus
*Z00-Z13 Notes: Nonspecific abnormal findings disclosed at the time of these examinations are
classified to categories R70-R94
• Encounters for diagnostic examinations – should code to sign or symptom, either R00-
R99, or signs and symptoms classified in the body system chapters
• Encounters related to pregnancy and reproduction, use sections Z30-Z39
ICD-10 Diagnosis Changes
Vaccines & Immunizations An example of where ICD-10-CM is less specific than ICD-9
• ICD-10: One code, Z23 used as diagnosis for all types of immunizations
• ICD-9: Several codes depending on type of immunization
Procedure code (rather than diagnosis) identifies
• Administration of the injection
• Type of immunization given
20
Risk Stratification – Can no longer rely on Dx to identify type of vaccine given, must look to CPT/HCPCS
code for most records
CPT Procedure ICD-9-CM
Diagnosis
ICD-10-CM
Diagnosis
90700
DTaP (6 weeks - 6
years old)
V06.1 Vaccination;
diphtheria-tetanus-
pertussis, combined
[DTP] [DTaP]
Z23 Encounter for
immunization
Code First: any
routine childhood
examination
90649
GARDASIL (9 years
old - 26 years old)
V04.89 Vaccination
and inoculation;
other viral diseases
Z23 Encounter for
immunization
Code First: any
routine childhood
examination
ICD-10 Diagnosis Changes
Vaccines & Immunizations Is your patient underimmunized? Yes – code it:
What if you can’t administer a vaccine using Z23, can you bill for the visit?
Yes - use one of these codes:
21
Risk Stratification – Use ICD to help manage immunization status of your patient populations
Z28.01 Immunization not carried out because of acute illness of patient
Z28.02 Immunization not carried out because chronic illness or condition of patient
Z28.03 Immunization not carried out because immune compromised state of patient
Z28.04 Immunization not carried out because patient allergy to vaccine or component
Z28.09 Immunization not carried out because of other contraindication
Z28.1 Immunization not carried out because of patient belief or group pressure
Z28.20 Immunization not carried out because patient decision for unspecified reason
Z28.21 Immunization not carried out because of patient refusal
Z28.29 Immunization not carried out because patient decision for other reason
Z28.81 Immunization not carried out due to patient having had the disease
Z28.82 Immunization not carried out because of caregiver refusal
Z28.89 Immunization not carried out for other reason
Z28.3 UnderImmunization status
ICD-10 Diagnosis Changes
Obstetrics, Pregnancy, & Newborns Mom and Baby records must be coded separately, not
combined
Maternal Records
• Many conditions must be coded to a trimester of pregnancy
• Concepts of "delivered" and "not delivered" are no longer
part of ICD-10-CM (but this information is captured in ICD-
10-PCS for OB procedures)
• OB conditions (Pregnancy, childbirth and the puerperium
O00-O9A) are never for use on the newborn record.
• Conditions present in a fetus can be coded to a specific
fetus in multiple pregnancies
• If a condition occurs during a specific week during
pregnancy, the week can be coded in ICD-10
• Normal deliveries coded similarly to ICD-9
• 5th digits for "episode of care" have been eliminated
22
Risk Stratification – new ability to track conditions by trimester, weeks of pregnancy, and fetus affected in
multiple pregnancies
ICD-9 ICD-10
650 Normal delivery
V27.0 Outcome of
delivery, single liveborn
O80 Encounter for full-
term uncomplicated
delivery
Z37.0 - Single live birth
ICD-10 Diagnosis Changes
ICD-9
Persons Encountering Health Services in
Circumstances related to reproduction/development
(V20-V29)
V23 Supervision of high-risk pregnancy (section heading)
V23.4 Supervision of; pregnancy with other poor
obstetric history
V23.41 - Supervision of high-risk; pregnancy with
history of pre-term labor
Vague condition in ICD-9:
• No indication of trimester
• No indication of weeks gestation
• Lack of excludes notes
23
ICD-10
Pregnancy, childbirth and the puerperium (O00-O9A)
• Excludes1: supervision of normal pregnancy (Z34.-)
• Excludes2: mental and behavioral disorders associated with
the puerperium (F53), obstetrical tetanus (A34), postpartum
necrosis of pituitary gland, (E23.0) puerperal osteomalacia
(M83.0)
• Use additional code from category Z3A, Weeks of
gestation, to identify the specific week of the pregnancy
O09 Supervision of high risk pregnancy (Section heading)
O09.2 Supervision of pregnancy with other poor
reproductive or obstetric history
• Excludes2: pregnancy care for patient with hx of recurrent
pregnancy loss (O26.2-)
O09.21 Supervision of pregnancy with history of
pre-term labor
O09.211 Supervision of pregnancy with
history of pre-term labor, 1st trimester
O09.212 Supervision of pregnancy with
history of pre-term labor, 2nd trimester
O09.213 Supervision of pregnancy with
history of pre-term labor, 3rd trimester
O09.219 Supervision of pregnancy with
history of pre-term labor, unsp trimester
Another example
+ Z3A.38 - 38 weeks gestation
?
ICD-10-CM
ICD-9-CM
ICD-10 Diagnosis Changes
Obstetrics, Pregnancy, & Newborns Infant Records
• Normal births coded separately from mother’s record
• Newborn conditions (Certain Conditions Originating
in the Perinatal Period - P00-P96) are never for use
on the maternal record
• Distinction between fetus and newborn in more
diagnoses:
Congenital Defects
• These codes may be used throughout the life of the
patient if the condition is still present
24
Risk Stratification – congenital defect conditions may appear on more records in a population of patients due
to the new guideline to code conditions throughout the life of the patient
ICD-9 ICD-10
V30.00 Single liveborn,
born in hospital,
delivered without
mention of cesarean
section
*Z38.0 Single liveborn
infant, delivered
vaginally, born in
birthing center or other
health care facility
*New note - Not to be
used on the mother’s
record
ICD-9 ICD-10 760.75 Cocaine affecting fetus or
newborn via placenta or breast milk
P04.41 - Newborn (suspected to be)
affected by maternal use of cocaine
'Crack baby‘
Can only be used on newborn record
Link to Video – Internet connection required
05:24 min - Right click on link, select “Open Hyperlink”
A new browser window will open, maximize window for best viewing, click “Play” button
25
Another Physician Perspective “The current transfer of information is still way too dependent on electronic means that were
good 30 years ago… we need to start looking at how we’re going to get better information
and data transfer to providers to get back to taking care of our patients better.”
ICD-10 Procedure Changes (Facility Inpatient only)
Procedures Built with Tables, not Lists
16 Sections
Medical/Surgical
Obstetrics
Placement
Administration
Measurement & Monitoring
Extracorporeal Assist
Extracorporeal Therapy
Osteopathic
Other Procedures
Chiropractic
Imaging
Nuclear Medicine
Radiation Oncology
Phys Rehab & Diag Audiology
Mental Health
Substance Abuse Tx
Over 35 Body
Systems
Central nervous system
Peripheral nervous system
Heart and Great vessels
Upper arteries
Lower arteries
Upper veins
Lower veins
Lymphatic and Hemic system
Eye
Ear, Nose, Sinus
Respiratory System
Mouth and Throat
Gastrointestinal system Hepatobiliary System &
Pancreas Endocrine system
Skin and Breast
Subcutaneous tissue
Muscles
Tendons
Bursae and Ligaments
Head and Facial bones
Upper bones
Lower bones
Upper joints
Lower joints
Urinary system
Female reproductive system
Male reproductive system
Anatomical regions, General Anatomical regions, Upper
extremities Anatomical regions, Lower extremities Pregnancy
Anatomical Orifices
Indwelling Device
31 Root Operations
Excision Resection
Destruction Extraction Drainage
Extirpation Fragmentation
Division Release
Transplantation Reattachment
Transfer Reposition Restriction Occlusion Dilation Bypass Insertion
Replacement Supplement
Change Removal Revision
Inspection Map
Repair Control Fusion
Alteration Creation
Thousands of Body Parts
(Examples)
Abdominal Sympathetic Nerve
Anterior Tibial Artery, Left
Cephalic Vein, Right
Cerebral Meninges
Esophagus, Lower
External Carotid Artery, Right
Internal Mammary Artery, Left
Lumbar Plexus
Phrenic nerve
Scapula, Left
Shoulder Bursa
Spleen
Subcutaneous Tissue and Fascia, Left Lower Arm
Ventricle, Right
Upper Leg Muscle, Right
Uterine Supporting Structure
Six Approaches
Open
Percutaneous
Percutaneous endoscopic
Via Natural or artificial opening
Via Natural or artificial opening endoscopic
Via Natural or artificial opening with
percutaneous endoscopic assistance
External
Hundreds of Devices (Examples)
Graft (e.g. synthetic, autologous,
nonautologous)
Prosthesis
Intraluminal
Leads
Implants
Fixation Devices
Mechanical appliances
Electronic appliances
Z = NONE
Intermittent Qualifiers
(Examples)
Diagnostic
Temporary
Cemented
Allogeneic
Zooplastic
Multiple
Type of Substance
Source of tissue used for bypass or graft
Z = NONE
26
Values for each position are not interchangeable among sections, body systems, and root operations
Only valid combinations can be coded using carefully organized tables
1 2 3 4 5 6 7
Medical/Surgical Section
ICD-10-PCS - OB Procedure Coding Example
Operation: Cesarean section delivery of twins
One procedure, coded as follows:
Rationale:
Note that the diagnosis, not procedure, will explain the number of newborns, outcome of
delivery, trimester of delivery, number of weeks gestation (if premature), birth weight, any
complications in one of the newborns, and which newborn had each complication
No diagnostic information is included in ICD-10-PCS
27
Section Obstetrics 1
Body System Pregnancy 0
Root Operation Extraction D
Body Part Products of Conception 0
Approach Open 0
Device No Device Z
Qualifier Low Cervical 1
10D00Z1 Extraction of Products of
Conception, Low Cervical, Open
Approach
How do I get ready for ICD-10?
29
Readiness Survey Results*
How do I get ready for ICD-10?
VENDORS
When do you plan to have
your ICD-10 Services /
Software available to
customers?
From the Workgroup for Electronic Data Interchange (WEDI), largest industry ICD-10 surveyor with support from
CMS, Feb 2015 Survey – 1,174 participants (68% providers, 17% health plans, 15% vendors)
HEALTH PLANS
What is your estimated
date to begin external
testing?
PROVIDERS
What is your expected
date to begin external
testing?
Available Now 60%
By Q2/Q3 2015 25%
Unknown15%
Have Started
50%
By Q1/Q2 2015 40%
Unknown10%
Have Started
30%
By Q2/Q3 2015 30%
Unknown40%
30
Know your 15 to 30 most frequently used diagnoses
How do I get ready for ICD-10?
Acute Respiratory Infections Acute Serous Otitis Media
ICD-9 ICD-10 ICD-9 ICD-10
462 Acute
pharyngitis
465.9 Acute upper
respiratory infection,
unspecified
466.0 Acute
bronchitis
J02.0 - Streptococcal pharyngitis
J02.8 Acute pharyngitis due to other
specified organisms
J02.9 Acute pharyngitis, unspecified
J06.9 Acute upper respiratory infection,
unspecified
J20.0 Acute bronchitis due to Mycoplasma
pneumoniae
J20.1 due to Hemophilus influenzae
J20.2 due to streptococcus
J20.3 due to coxsackievirus
J20.4 due to parainfluenza virus
J20.5 due to respiratory syncytial virus
J20.6 due to rhinovirus
J20.7 due to echovirus
J20.8 due to other specified organisms
381.01 Acute
serous otitis media
H65.01 Acute serous otitis media, right ear
H65.02 left ear
H65.03 bilateral
H65.04 recurrent, right ear
H65.05 recurrent, left ear
H65.06 recurrent, bilateral
Find your common
diagnoses in ICD-9, look
them up in ICD-10
Notice that many, but
not all, have more
specific variations in
ICD-10 than existed in
ICD-9 You will use a fraction of ICD-10 codes, just like you use a fraction of ICD-9 today
How do I get ready for ICD-10?
31
Know Your Workflow
Orders/Referrals: Labs
Imaging Rx Billing &
Practice Management
Medical Coding
Front Desk
Scheduling
Exam Rooms
EMR or Chart
Scheduling & Front Desk: • Forms and Systems, Recognize new
alpha/numeric format
• Ask about new requirements for prior
authorizations
Exam Rooms: • Consider impacts to forms & ABNs
(advance beneficiary notices)
• Clinical staff training
EMR or Chart: • System drop downs & forms
• System reports
Medical coding: • Requires more documentation
• More codes per record
• Training & Productivity impacts
Billing & Practice Management: • Review/adjust contracts
• Update policies/procedures
associated with a disease/condition
• Review Budgets
Orders/Referrals: • Make sure providers who fulfill orders
have the right Dx for future dates of
service (consider standing orders)
How do I get ready for ICD-10?
32
Plan & Assess
Remediate
Test & Validate
Educate
Create a Project Team
Baseline Budget Formulation
Internal Impact Assessment – talk to your staff
External Impact Assessment – talk to your vendors
Internal system changes
Vendor system changes
Business Process Changes
Internal Testing & Validation
External Testing & Validation
Medical Coder Training
Physician Training
Office staff, Report writers, & Analytics staff
Key Metrics Review
Comparison Studies Review & Assess
Your Roadmap
How are we helping you prepare for ICD-10?
How are we helping you get ready for ICD-10?
34
Visit bcbsil.com/provider
78
helps identify possible issues -- and
allows time to fix them -- well before
the compliance deadline
offers you and your staff the
opportunity to "practice" coding with
ICD-10, without any risk to your
revenue
35
Test with us:
Attend a Webinar for More Information
BCBSIL is hosting ICD-10 Testing Readiness Webinars through July!
Visit the ICD-10 page in the Standards and Requirements section of the
BCBSIL Provider website at bcbsil.com/provider for details on upcoming
webinars, as well as other educational resources.
How are we helping you get ready for ICD-10?
• Within 3 - 5 days after your request is received, BCBSIL will send
you an enrollment kit via email (brief survey, testing agreement,
instructions)
• Upon approval, you will receive a welcome letter with confirmation
and next steps
36
Send an email to
or
Contact your Provider
Network Consultant
How are we helping you get ready for ICD-10?
Interested in testing with BCBSIL?
How are we helping you get ready for ICD-10?
37
Read the Blue Review
How are we helping you get ready for ICD-10?
38
Industry Resources
CMS Centers for Medicare
& Medicaid Services
CMS regulates ICD-10. Not just for Medicare, CMS oversees ICD-10 for
the entire US, including all covered entities like health plans, clearinghouses, vendors
and providers. Part of HIPAA regulations.
CMS ICD-10
Main Page
http://www.cms.gov/Medicare/Coding/ICD10/index.html
Available at this site:
• Implementation guides by health care entity type: www.roadto10.org
• "ICD 10: Getting from Here to There--Navigating the Road Ahead":
http://www.medscape.org/viewarticle/820612_2 - 21 minutes, 0.5 CMEs
• ICD-10-CM & ICD-10-PCS code set downloads; ICD-10 coding manual downloads
• GEMs downloads (forward and backward maps)
• Link to subscribe to CMS news & updates about ICD-10
• CMS testing initiatives through local MACs
• ICD-10 Final Rule language
• ICD-10 Maintenance Committee minutes
• MS-DRG conversion project & backward reimbursement maps
• Links to other organizations with stake in ICD-10
BCBS ICD-10
Resource Page
http://www.bcbsil.com/provider/standards/icd_10.html
On our Provider Portal
• Hear free webinars
• Links to these resources and more
Start Here
Start Here
How are we helping you get ready for ICD-10?
39
Other Key Industry Associations
AHIMA American Health
Information Management
Association
• Medical Coder certifying organization, emphasis on facility coding
• CMS advisor – Helps guide CMS policy about ICD-10
• Good training provider, multiple training formats available
• AHIMA ICD-10 Home page: http://www.ahima.org/icd10/default.aspx
• Links to online training, implementation guides, regulatory news
HIMSS Healthcare Information
Management Systems
Society
• Integrator for many health information technology topics, including standards like ICD-10
• Developed ICD-10 cost calculator for providers
• ICD-10 Playbook: http://www.himss.org/library/icd-10/playbook?navItemNumber=13480
• National Pilot Testing Program: http://www.himss.org/library/icd-10/national-pilot-program?navItemNumber=13477 Note: program is co-sponsored by WEDI
WEDI Workgroup for Electronic Data Interchange
• Integrator for many electronic data interchange (EDI) topics, including standards like ICD-10
• Developed original recommended ICD-10 timeline with NCHICA
• Largest regular ICD-10 surveyor of health care entities
• WEDI ICD-10 Home page: http://www.wedi.org/topics/icd-10
AAPC American Association of
Professional Coders
• Medical Coder certifying organization, emphasis on professional coding
• More commercially oriented, good training provider
• AAPC ICD-10 Home page: http://www.aapc.com/icd-10/index.aspx
Thank You!
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