Transition to ICD- 10

1. Transition to ICD-10 Presented by: Pat Schmitter CPC CPC-I Approved AAPC ICD-10-CM Trainer Approved AHIMA ICD-10-CM Trainer & Ambassador Sr Healthcare Consultant VEI Consulting www.Icdexpert.net Brace for Change!

2. Disclaimer This information was current at the time of publication and/or presentation.  Medicare, Medicaid and commercial payer policies change frequently so source documents have been provided within the presentation for your reference. This presentation was prepared as a tool to assist students and providers and is not intended to grant rights or impose obligations. Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services. VEI Consulting, ICDExpert.net, Indiana Medicaid Support, employees, agents, and staff make no guarantee that this information is error-free and bears no liability or responsibility for any results or consequences resulting from the use of this information. Medical Practitioners are responsible for the day to day implementation and compliance with applicable state and federal laws and regulations. Attendees should contact their own legal counsel or advisors for further legal opinion.

3. DISCLOSURE(S) • Financial Disclosure(s) • The presenter(s) has no financial interests or relationships relative to this live presentation/activity to disclose. • Continuing Education Unit(s) (CEU) • AAPC • AHIMA • Other • Certificate of Completion • Sign In • Completion of evaluation

4. Presenter(s) Pat Schmitter CPC CPC-I Sr Healthcare Consultant Certified Instructor-Professional Medical Coding Curriculum AAPC Approved ICD-10-CM Trainer AHIMA Approved ICD-10-CM Trainer & Ambassador VEI Consulting 6626 E. 75th St. Suite 500, Indianapolis, IN 46250 Phone: 317 621 7187 Fax: 317 355 8738 Email: info@icdexpert.net

5. Agenda • Delayed not cancelled • Analyze the impact • Documentation concepts • Examples • Top 5 myths • Preparing for ICD-10

6. Objectives • Expand your understanding of the current state of ICD-10, recent regulatory decisions and industry perspectives • Raise your awareness and understanding of the unique opportunities and challenges that the principles of ICD-10 brings to the entire health care industry including providers, payers and electronic trading partners. • Applying the principles of ICD10 documentation concepts to ICD9 documentation today to support severity, rick and quality reporting. • Review of steps to stay engaged

7. ICD-10 Delayed to 2015-Now What?

8. DELAYED NOT CANCELLED! • H.R. 4302 • Sec. 212 Delay in transition from ICD-9 to ICD-10 code sets “The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d-2(c)) and section 162.1002 of title 45, Code of Federal Regulations.”

9. H.R. 4302 • H.R. 4302 • Among other things…… • 0.5 percent thru December 31, 2014 • 0 - zero percent update to the 2015 Medicare Physician Fee Schedule (MPFS) through March 31, 2015. • 2014 conversion factor is $35.8228.

10. H.R. 4302 • Protecting Access to Medicare Act of 2014 • Among other things…… • Extension of Work GPCI Floor • Extension of Therapy Cap Exceptions Process • Extension of Ambulance Add-On Payments • Extension of Increased Inpatient Hospital Payment Adjustment for Certain Low-Volume Hospitals • Extension of the Medicare-Dependent Hospital (MDH) Program

11. Sustainable Growth Rate (SGR) • SGR is a budget cap to control physician spending • Short term patches since 2003 • H.R. 4302 is the 17th “patch” to SGR

12. Connection between ICD-10 and SGR • SGR set to expire March 31, 2014 • Many opposed another “patch” • American Medical Association • American College of Physicians • American College of Surgeons • American Osteopathic Association • American Academy of Family Physicians • ICD-10 added as a carrot to appease opposition

13. H.R. 4302 Protecting Access to Medicare Act 2014 Section 212 • Introduced by Rep. Joseph R Pitts (R-PA) • 1 – year “patch” for SGR • Section 212 included delay to ICD-10 • Bill placed on the Suspension Calendar

14. H.R. 4302 Voting Timeline

15. H.R. 4302 Moves to Senate

16. US Senate Considered H.R. 4302 • 3 hours of debate were allotted to the bill • Senator Wyden (OR) attempted to introduce an alternative bill to repair the SGR patch • At 6:30 PM EST H.R. 4302 passed. The final vote was 64-35

17. April 1, 2014 April 1, 2014…..

18. April 1, 2014 • 04/01/2014 Presented to President • Protecting Access to Medicare Act of 2014 • Sec. 212 Delay in Transition from ICD-9 to ICD-10 code sets “The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d-2(c)) and section 162.1002 of title 45, Code of Federal Regulations.”

19. Reaction to the Vote • No one had the chance to vote no; no one had a chance to vote yes. The maneuver came after a long delay amid opposition that threatened to kill the bill…… (Politico) • Rep. Louis Gohmert (R-Texas) on Thursday blasted a decision by House leaders to voice vote a controversial Medicare bill, and said he and other like-minded members would monitor the House floor at all times to ensure it can’t happen again….(The Hill)

20. Reaction to the Vote • The fast-track :doc fix” legislation was based on a bipartisan deal struck between House Speaker John Boehner and Senate Majority Leader Harry Reid…(Health and Data Management) • Members of both parties told the press that they were angry that leadership passed the “doc fix” by voice vote when it was clear that there not enough votes to pass it on a roll call….(Roll Call)

21. CMS Acknowledges ICD-10 Delay Posted at CMS ICD-10 main page: “With enactment of the Protecting Access to Medicare Act of 2014, CMS is examining the implications of the ICD-10 provision and will provide guidance to providers and stakeholders soon. This provision in the statute reads as follows: “The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard for codes sets under section 1173 (c) of the Social Security Act (42 U.S.C. 1320d-2 (c)) and section 162.1002 of title 45, Code of Federal Regulations.”

22. Coalition for ICD-10 Members • Advanced Medical Technology Association (AdvaMed) • American Health Information Association (AHIMA) • America’s Health Insurance Plans (AHIP) • American Hospital Association • American Medical Informatics Association (AMIA) • Blue Cross Blue Shield Association • College of Healthcare Information Management Executives (CHIME) • Health IT Now Coalition • Medical Device Manufacturers Association (MDMA) • 3M Health Information Systems • Roche Diagnostics Corporation • Siemens Health Services • Wellpoint • http://coalitionforicd10.wordpress.com?

23. Analyze the Impact Gap analysis • Top 25 ICD-9-CM used today Training • Is the ICD-9-CM supported today? • What will be needed additionally for ICD-10-CM? Documentation accuracy • Monitor

24. Documentation Concepts • Severity/status • Type • Anatomic Site • Laterality • Episode • Remission status • Due to • Complicated by • Secondary disease process • Significance of findings • Cause and effect relationship • Therapies • Substance • Symptoms/Manifestations • Contributory factors • Number of gestations • Outcome of delivery • BMI • Loss of consciousness • External Cause • Activity • Place of Occurrence

25. Convention(s) Use additional code where applicable to identify: • Exposure to environmental tobacco smoke (Z77.22) • Exposure to environmental tobacco smoke in the perinatal period (P96.81) • History of tobacco use (Z87.891) • Occupational exposure to environmental tobacco smoke (Z57.31) • Tobacco dependence (F17.-) • Tobacco use (Z72.0) • Example: J35 chronic diseases of tonsils and adenoids

26. Asthma Supporting documentation includes: • Identify type/severity of asthma • Mild (Intermittent or persistent) • Moderate persistent • Severe persistent • Other • Identify complications • Uncomplicated • With acute exacerbation • With status asthmaticus • Identify Symptoms • Identify family history

27. Otitis Media Supporting documentation includes: Severity • Mild • Moderate • Severe Duration • Acute • Subacute • Chronic

28. Hypertension Supporting documentation includes: • Type • Associated complications • Severity • Symptoms/Findings/Manifestations • Temporal factors • Contributing factors

29. Congestive Heart Failure Supporting documentation includes: • Type • Contributing factors • Temporal factors • Associated conditions

30. Osteoarthritis Supporting documentation includes: • Type • Contributing factors • Symptoms/Findings/Manifestations • Localization/Laterality • Anatomy

31. Headaches Supporting documentation includes: • Type • Severity • Contributing factors • Symptoms/Findings/Manifestations • Association • Temporal factors

32. Diabetes Mellitus Supporting documentation includes: • Type • Pregnancy-related • Complications • What body system is affected • Drug Induced?

33. Fracture • Contributing factor • Type of fracture • Underlying condition(s) • Anatomic location • Laterality/Localization • Complications • External Cause

34. What Now? • Organize the implementation effort • Contact system vendors • Contact trading partners • Implement system and/or software upgrades • Conduct internal testing • Conduct external testing • Monitor

35. ICD-10 Myths • The number of codes used by physicians will increase from 18,445 to 141,752 • Truth: 69,832 ICD-10-CM • Truth: 71,920 ICD-10-PCS

36. ICD-10 Myths • 2. More codes mean more complexity and difficulty of use • Physicians and other providers will only use the subset of ICD-10- that is relevant to their patient population

37. ICD-10 Myths • The increase in the number of codes requires the coding of clinically irrelevant detail that is a coding and reporting burden • Additional detail is at the request of specialty societies

38. ICD-10 Myths • Because of the isolated examples of ICD-10 codes that will rarely, if ever, be used, the entire system is riddled with unnecessary detail • Alligators -vs- Crocodiles • Injuries from burning water skis

39. ICD-10 Myths • ICD-10 was developed by “bureaucrats” who were “out of touch with the real world,” so the system is not relevant to physicians. • ICD-9-CM was created by scientists 4 decades ago!

40. Preparing for ICD-10 Planning Phase • Assign overall responsibility and decision-making authority for managing the transition • Ensure top leadership understands the breadth and significance of the ICD-10 change

41. Preparing for ICD-10 Planning Phase • Plan a comprehensive and realistic budget • Impact/GAP Analysis • Ensure involvement and commitment of all internal and external stakeholders • Adhere to a well-defined timeline

42. Preparing for ICD-10 Identify Current Systems and Work Processes Impact Assessment • Where are you using ICD-9? • Electronic or manual • Clinical documentation • Encounter Forms or Superbills • Practice Management System • Electronic Health Record (EHR/EMR) System • Quality Reporting • Public Health Reporting • Contracts

43. Preparing for ICD-10 Communicate with Practice Management System Vendor • Review your contract to determine if regulatory updates are included in your maintenance • Ask your vendor the following questions: • Can my current system accommodate the data format changes for the ICD-10 codes? • Will you be upgrading my current system to accommodate the ICD-10 codes? • Will there be a charge for the upgrade? • When will the upgrades be available for installation?

44. Preparing for ICD-10 Communicate with Your Billing Service, Clearinghouse and Payers Ask your billing service and clearinghouse the following questions: • Will you be upgrading your systems to accommodate the ICD-10 codes? • When will your upgrades be complete? • When can I send claims and other transactions with ICD-10 codes to you so you can test that they will be accepted?

45. Preparing for ICD-10 • Communicate with Your Payers About Your Contracts • Payers may modify the terms of their contracts for billing • Medical policies and local coverage determinations may require highest specificity be reported • Payment schedules may be altered and reimbursed differently for higher vs. less specific codes • More detailed ICD-10 may impact payer medical review, auditing, and coverage

46. Preparing for ICD-10 Identify Changes to Practice Work Flow and Business Processes • Clinical documentation • Encounter Forms or Superbills • Quality Reporting • Public Health Reporting

47. Preparing for ICD-10 Identify Staff Training Needs-Ask the following: • Which ICD-10 codes sets do we need to receive training: ICD-10-CM, ICD-10-PCS, or both? • Who needs to be trained? • How long will it take to train? • What training format will work best? • Where can we obtain training? • What is the cost of training? • What resources will be needed to support the staff after training? • When should training be completed?

48. Preparing for ICD-10 Test – Test – Test! • Trading partners • Organizations with which you exchange various transactions • Ask the following questions: • Which transactions should I test with ICD-10 codes? • Which trading partners should I test with? • When should I begin testing?

49. Preparing for ICD-10 Budget for Implementation Costs • Include expenses for: • System changes • Practice business process changes • Resource materials • Training • Continued education • ICD-9 focused review of current documentation • ICD-10 focused review of medical records

50. We can learn from Benjamin Franklin “If you fail to prepare, you are preparing to fail.”