Tommi Dukes, MIS, RHIA, CCS-P

AHIMA Approved ICD-10-CM Trainer

I U Health Southern Indiana Physicians

Pediatric Business Unit

Technology

Workflow Impact

Documentation

Reimbursement

Learning Methods to Manage

◦ Physician Education

◦ Practical Sessions with Staff

◦ User Group

AHIMA Role Based Model

X X X X

Category

.Etiology, anatomic

site, severity

Added code extensions (7th character) for obstetrics, injuries, and external causes of injury

3

X X XAMS 0 2 6. 5 x A

Additional Characters

Alpha (Except U)

2 Numeric3 - 7 Numeric or Alpha

3 – 7 Characters

1) true

2) false

3) neither

Assessment of current uses of ICD-9-CM that will be changed to ICD-10-CM

Review of all existing Information systems

Payers, Billing Services, Clearinghouses

◦ Check on their plan for ICD-10 changes

◦ Will documentation requirements change

◦ When will they begin to do testing on accepting the new codes

◦ Will claims be denied if laterality is not specified

Vendors◦ Upgrades necessary? (Do it sooner rather

than later)◦ Cost of Upgrades◦ Crosswalks (GEMs “general equivalent

mappings” are 50% correct)◦ Limited use of GEMs for physician

practices◦ Ability to maintain separate files for ICD-9

and ICD-10◦ Testing Timeframes

1) January 1, 2012

2) October 1, 2012

3) January 1, 2013

4) October 1, 2013

Support of Senior Practice Management and Physicians

Forms and Reports that need to be reformatted (Superbills, PA forms, Encounter notes)

Registry and other health care reporting

Management reports-changes that will need to be made

Requests for medical records to substantiate codes that are submitted

Tracing ICD-9-CM codes thru your practice to verify transition to ICD-10-CM codes

Increased documentation necessary to ensure correct coding with ICD-10-CM

Will extra training be necessary for billing staff as they prepare to learn ICD-10-CM

Does the current clinical documentation support the level of specificity

Audit documentation

Revise EHR forms if necessary

Educate providers on ICD-10-CM

Query providers if more information is needed

Develop list of diagnoses that require more documentation

Audit documentation AGAIN

Identify staff and providers who will benefit from more training on ICD-10-CM

Revise forms, if necessary, to maintain productivity of providers

1) patients

2) Senior practice management

3) Registration clerks

4) nurses

Include ICD-10-CM in Payer Contract Negotiations now to decrease risks of compliance errors and claims denials

Will there be greater payment for greater complexity and lesser payment for lesser complexity?

If a carrier is not ready to accept ICD-10 codes will claims be denied?

Professional services paid on CPT but diagnosis code supports the medical necessity

Will there be PA delays due to payer not accepting ICD-10 codes

Will there be a coding backlog during the timeframe

Prepare for decreased cash flow due to claim denials

Physician Education

◦ To the point!

◦ Allow for interaction

◦ Look for Webinars

◦ Train no more than six to nine months before compliance date of 10/1/13

◦ Train by specialty (not all codes pertain to all physicians)

Staff Sessions

◦ Separate staff to make training easier

◦ Clinical Staff needs vs. Billing Staff needs vs. Clerical Staff needs

◦ Start early with ICD-10 guidelines

◦ Make it fun!

◦ Know your audience

1) True

2) False

3) Both

Healthlinc has offered to host an ICD-10-CM user group

“Win-Win” attitude with HIM Director attending the meetings

Group working together to ease the transition from ICD-9-CM to ICD-10-CM

Day and time TBA

Hospital Sponsored CME on May 9th

Hospital-sponsored CME on ICD-10Guest Speaker: Danita Forgey, MIS, RHIA, CCS, CCS-PDate: Wednesday, May 9, 2012 Time: Noon to 1:30 pmLunch: Box lunches available beginning at noonPlace: Indiana University Health Bloomington Hospital Wegmiller Auditorium 601 W. Second St., Bloomington (attached to a free parking garage)

RSVP requested due to expected high attendance. Email pvaughn@iuhealth.org with a count for your office by April 11.

Physicians and practice managers will join IU Health for an informative overview of the coding upgrade, discuss documentation issues in ICD-10, and visualize the benefits and impact of ICD-10 to physician practices.Danita Forgey, MIS, RHIA, CCS, CCS-P brings 20 years of extensive coding and reimbursement experience to her executive presentations. She is the former Program Director for the Health Information Administration Program at Indiana University and has held state and national leadership positions in HIM professional associations. Forgey received her certification as an ICD-10-CM/PCS trainer in 2009.

Easy plan to follow in identifying your transition to ICD-10-CM

http://www.ahima.org/icd10/role.aspx