WELCOME

1. WELCOME!

2. ICD-10 Implementation Project Management Getting ready for ICD-10 transition By Julie E Larish My name is Julie Larish. I have been working in the coding for over 20 years with 17 of them in Mental Health and Substance Abuse. I have been through the AAPC boot camp for the ICD-10 Transition, trained in both outpatient and inpatient changes, ICD-10-CM & PCS coding. I'd like to mention two of my partners, Herbert Westermann and Clayton McMillan. Herbert specializes in project management,�specifically in getting time critical projects back on track, and Clayton specializes in IT, particularly in automated translation, which we believe will be a key issue in the ICD-10 transition for mental health organizations. Clayton was not able to join us today, but I'll ask Herbert to say a little more about himself. Herbert..."My name is Julie Larish. I have been working in the coding for over 20 years with 17 of them in Mental Health and Substance Abuse. I have been through the AAPC boot camp for the ICD-10 Transition, trained in both outpatient and inpatient changes, ICD-10-CM & PCS coding. I'd like to mention two of my partners, Herbert Westermann and Clayton McMillan. Herbert specializes in project management,�specifically in getting time critical projects back on track, and Clayton specializes in IT, particularly in automated translation, which we believe will be a key issue in the ICD-10 transition for mental health organizations. Clayton was not able to join us today, but I'll ask Herbert to say a little more about himself. Herbert..."

3. ICD-10-CM and ICD-10-PCS coding systems will replace the current ICD-9-CM coding system on October 1, 2013. This includes all inpatient and outpatient facility visits as well as freestanding providers and ancillary services ICD-10-CM will replace the ICD-9-CM diagnosis codes rendered in all settings Key Highlights of ICD-10 Final Rule

4. ICD-10-PCS will replace the ICD-9-PCS procedures codes rendered within the hospital inpatient setting Current Procedural Terminology (CPT) and the Healthcare Common Procedural Coding Systems (HCPCS Level II) will remain the official coding systems for outpatient reporting for procedures and services After the implementation of ICD-10 code set, general acute care inpatient reimbursement for Medicare patients will be based on Medicare severity-based diagnosis-related groups (MS-DRGs) using the ICD-10 classification system and not ICD-9 Reimbursement rates for the DRG system will be affected in a big way for inpatient units. This is why hospitals need to be ready BEFORE October 1! If there is a delay on the provider�s side, reimbursements will be delayed!Reimbursement rates for the DRG system will be affected in a big way for inpatient units. This is why hospitals need to be ready BEFORE October 1! If there is a delay on the provider�s side, reimbursements will be delayed!

5. Key Changes in CM Coding Systems ICD-10-CM has 69,000 codes whereas ICD-9-CM has 14,000 codes. That�s an increase of nearly 55,000 codes ICD-9-CM lacks detail whereas ICD-10-CM has very specific details. This will cause greater detail in documentation and a patient/client may end up with more diagnosis codes per visit ICD-10-CM has 69,000 codes whereas ICD-9-CM has 14,000 codes. That�s an increase of nearly 55,000 codes ICD-9-CM lacks detail whereas ICD-10-CM has very specific details. This will cause greater detail in documentation and a patient/client may end up with more diagnosis codes per visit

6. Key Changes in PCS Coding Systems ICD-10-PCS has 87,000 codes whereas ICD-9-PCS has only 3,000 codes. That�s an increase of nearly 84,000 new codes! ICD-9-PCS uses generic terms for body parts whereas ICD-10-PCS uses detailed description for body parts. ICD-9-PCS lacks the description of the approach to a procedure whereas ICD-10-PCS provides the detailed descriptions of methodology/approach for procedures. ICD-9-PCS uses generic terms for body parts whereas ICD-10-PCS uses detailed description for body parts. This is why when assessing the needs of your organization, you will need to budget the possibility of anatomy and physiology classes for coders or medical record techs. You can also purchase those cheat sheets that you can buy in WalGreens that show the different terminology based on the system of review. The details of procedure notes is going to need to increase. ICD-10-PCS has 87,000 codes whereas ICD-9-PCS has only 3,000 codes. That�s an increase of nearly 84,000 new codes! ICD-9-PCS uses generic terms for body parts whereas ICD-10-PCS uses detailed description for body parts. ICD-9-PCS lacks the description of the approach to a procedure whereas ICD-10-PCS provides the detailed descriptions of methodology/approach for procedures. ICD-9-PCS uses generic terms for body parts whereas ICD-10-PCS uses detailed description for body parts. This is why when assessing the needs of your organization, you will need to budget the possibility of anatomy and physiology classes for coders or medical record techs. You can also purchase those cheat sheets that you can buy in WalGreens that show the different terminology based on the system of review. The details of procedure notes is going to need to increase.

7. ICD-9-PCS limits DRG assignment whereas ICD-10-PCS allows DRG definitions for recognition of new technology and devices ICD-10-PCS precisely defines procedures with detail regarding body part, approach, device used, and qualifying information. ICD-10-PCS increases code length to up to 7 characters. PCS Code Consists of the following: Section Medical Practice/body system/root operation/body part/approach/device The PCS coding structure is made up of a defined code. The first digit is the section of medical practice such as surgery, administration, measuring and monitoring. The digits that follow are for the body system, the root operation, the body part within the body system involved, the approach and the device(s) used. The PCS coding structure is made up of a defined code. The first digit is the section of medical practice such as surgery, administration, measuring and monitoring. The digits that follow are for the body system, the root operation, the body part within the body system involved, the approach and the device(s) used.

8. We can keep our heads above water by working on this together! Keeping our heads above water!

9. How does this affect my practice or organization? Overview for all disciplines #1 Myth � This is JUST a coding change! Our software vendor will train us on the new coding system!

10. CHANGES

11. Manager�s Office/Fiscal Department New policy and procedures Vendor/Payer contracts will need to be revisited Budgets will need to be evaluated (expect delays in payments and influx of denials to be appealed) Implementation budget will need to be established Front Desk/Waiting Rooms All new HIPAA forms to be signed System changes Coding Changes to code set Have to know more anatomy & physiology More details in documentation to sort through Inpatient has over 156,000 more codes between CM & PCS Outpatient has 55,000 more codes CHANGES

14. Integration between systems will change. This is an important part of the analysis that will need to happen. Electronic Health records will change as well as the documentation requirements at the federal level. The federal government will eventually require state documentation reporting to change. Billing systems will need to be revamped. System Changes

15. How? How much? How long? How do I get started?

16. Biggest cost � delay in payments on and after October 1, 2013 (or new date approved my HHS). But you can minimize this by being proactive and go-live prior to the big day! A broad range of organizations (The American Academy of Dermatology, American Academy of Professional Coders, American Association of Neurological Surgeons, American Association of Orthopaedic Surgeons, American Clinical Laboratory Association, American College of Physicians, American Medical Association, American Optometric Association, American Physical Therapy Association, American Society of Anesthesiologists, and the Medical Group Management Association) retained Nachimson Advisors to assess the cost impact of the Administration�s proposed ICD-10 rule on the provider community. How Much?

17. # Memberships Total Cost Small (<1M Members) 2,635,000 $99 Million Medium (1-5 M Member) 23,400,000 $293 Million Large (>5M Members) 113,162,000 $1.3 Billion Cost alone is a reason for payors to not be ready for the conversion. Considering the costs, there may be delays or errors in denials causing providers additional concern about reimbursement disruption. Estimated Cost by Size of Insurance Company

18. Nachimson Advisors estimated the cost-impact of an ICD-10 mandate on three different provider practices: A �typical� small practice, comprised of three physicians and two administrative staff. A �typical� medium practice, comprised of 10 providers, one full-time coder, and six administrative staff. A �typical� large practice, comprised of 100 providers, with 64 coding staff comprised of 10-full time coders and 54 medical records staff. Nachimsom�s Findings

19. Provider Costs These are approximate figures. If you are not ready on time and accurate coding is not done, then the cash flow disruption will increase dramatically. Also, if you are not communicating with payor sources, reviewing policy changes and authorization processes, there will be a delay in payments. We cannot control what the payor sources do or how fast they are in compliance, but we can stay informed so that we are able to plan for the disruptions. These are approximate figures. If you are not ready on time and accurate coding is not done, then the cash flow disruption will increase dramatically. Also, if you are not communicating with payor sources, reviewing policy changes and authorization processes, there will be a delay in payments. We cannot control what the payor sources do or how fast they are in compliance, but we can stay informed so that we are able to plan for the disruptions.

20. The preliminary estimate of training costs if training is conducted by private consultants are as follows: Additional Costs � Training

21. This timeline was recommended by the American Hospital Association. The time may vary according to the size of your facility. Regardless of the size of your facility, plan ahead, give yourself time for delays, and be ready to go-live before October 1, 2013 How long will it take for the implementation process?

22. Define Analyze Plan Implement Follow-up Before you can plan, you need to know what you are planning. Steps to Success

23. Before you can start anything, you have to have MANAGEMENT APPROVAL AND SUPPORT!

24. Steering Committee � decision makers Project Team � subject matter experts (may change over time) Sub-committees � Clinical & Billing Communication Plans Identify:

25. To be completed by the end of 2009 Education on what is ICD-10 and how it will affect your organization Develop plan for assessing implementation impact Develop tools to assess impact on affected functional areas Develop implementation goals Develop implementation strategy Identify steering committee�s required tasks Develop timelines Assign responsibility for tasks Educate IT staff on code sets Organizing the Implementation EffortTo be completed by the end of 2009

26. Changing to ICD-10 will impact departments differently. Every department should have an internal assessment of how it will be affected. From this assessment, a master to-do list can be developed to assist with the planning of the implementation. This leads into a full project plan including resources and budget. Planning & Impact AnalysisTo Be Completed By Spring 2010

27. Conduct IS Inventory � what systems will need enhanced? Assess Vendor readiness � IS, Insurances, Software etc Conduct Staff Awareness Sessions Assess/plan for staff training needs � may require coding, documentation and anatomy/physiology training (and maybe new systems) Identify necessary tools Identify areas requiring operational/policy changes Evaluate health plan contract implications Budge planning Identify gaps in health record documentation Impact Analysis

28. System Analysis Example

29. Sample: System Assessment Your IT assessment of systems might include: Application Name Vendor Application Maintainer Frequency of Regular Updates Under Maintenance Contract Diagnosis � DSM � ICD-10, Procedure code changes? Codes entered directly or downloaded from other systems? Lead PersonYour IT assessment of systems might include: Application Name Vendor Application Maintainer Frequency of Regular Updates Under Maintenance Contract Diagnosis � DSM � ICD-10, Procedure code changes? Codes entered directly or downloaded from other systems? Lead Person

30. Vendor Readiness & Support

31. Health Plan Awareness

32. Once you do the assessment of needs, you can then put together a plan of action � a project plan Project plans do the following Outline tasks in order of priority, precedence Monitor due dates Monitor where the plan is slipping Monitor where you can make up time Monitor for derailments Add resources � accountability Management tool for knowing if you need to hire temporary staff Outline shortages Document Budget Monitor for shortage of funds Project plan budget for the tasks will not include the productivity losses Project plan budget will not include delay in reimbursement Plan

33. Budgeting

34. Assistance with Mappings and Conversions

35. General Equivalency Mappings Free from CSM Is not a complete set of mappings Gives you generalizations of code mappings Comes in a text file to be used in systems Does not incorporate DSM codes Maps forwards and backwards ICD-9 to ICD 10 ICD-10 to 9 GEMs

36. Basic training: During the initial phase, all departments should receive awareness training to ensure general awareness of the magnitude of the change Advance Training: Moderate level training should be conducted, beginning in FY 2010 Expert Training: In-depth, detailed training of coding professionals should be conducted six to nine months prior to October 1, 2013. However, it is not too early for them to become familiar with ICD-10 concepts and guidelines earlier in order to ease the transition and allay any potential fears. It is estimated that expert training will require 40 hours for both diagnosis (3 days) and procedure (2 days) coding. Per AHA, AMA, APA

37. Your vendor is not ready to answer your questions. Then you find out that the system you interface most with is having difficulties and may not be ready on time. Once your vendor is ready to talk, you find out your system can not handle the changes and must be replaced. In the mean time, your interface system has to be replaced also. Then the state informs you that their system is not ready but Medicare is demanding testing and is ready on time. Now you must find a system, interface with another new system, and get testing with Medicare and other insurances. Then you find out that the state still will not be ready for possibly a year delay. You new system may or may not be able to bill two different ways and require you to use both ICD-9 & 10 for a while. Worst Case Scenario

38. Decision needs to be made to use DSM V instead of ICD-10. However, DSM V is delayed. Then it is announced that it will be released 5 months before the deadline. Now you need to set up your new system with the diagnosis coding based on???? DSM IV, DSM V, ICD-9 or ICD-10. The crosswalk for all need to be done for purposes of back billing and historical diagnosis�. ???????DSM IV to ICD-9, DSM IV to ICD-10, DSM V to ICD-10?????? When talking to the largest insurance company you contract with, you find out they are not ready to give you new guidelines or authorization procedures yet; they are ready to start testing. The contract negotiations are slow, as everyone has to do it. Now you don�t have a contract nor the guidelines to bill electronically�

39. Forms! Forms! Where are you with any and all the forms that need to be changed? The print shop is backed up with hospital forms: superbills, ABN notifications, policies and procedures. If you are required to get a new system, for data integrity, you now need new registration forms that follow the flow of the data input. Then there�s the diagnosis form that needs to be revamped. Training is a nightmare. Physicians are complaining about how much time they will need away from their clients. The billers are behind and don�t have time to attend trainings, either. You do not have an adequate training facility to house everyone and all off site locations are booked with other facilities trying to get their training done. And in the middle of it all------ staff have quit, retired, transferred and hit the lottery!

40. You are overworked, overwhelmed, and underpaid!

41. Plan ahead Put together contingency plans Stay in communication with all vendors (systems, insurances, printers, etc) Watch your budget Keep staff informed STAY CALM! Don�t get stuck!

43. Public Health

44. More defined coding system for all Lab, Radiology & Injury, Symptoms are extensive Need to start coding with external causes OB changes are extensive (family planning) Will need to be able to code both ICD 9 & 10 for historical purposes Documentation requirements change extensively Contracts/prior authorizations Policy & Procedural changes with insurance billing Changes

45. R78 Findings of drugs and other substances , not normally found in blood R78.0 � Finding alcohol in blood (Use additional external cause code (Y90), for detail regarding alcohol level Y90 � Evidence of alcohol involvement determined by blood alcohol level Y90.0 � Blood alcohol level of less than 20mg/100ml Y90.1 � Blood alcohol level of 20-39mg/100ml Y90.2 - Blood alcohol level of 40-59mg/100ml Y90.3 - Blood alcohol level of 60-79mg/100ml Y90.4 - Blood alcohol level of 80-99mg/100ml Y90.5 - Blood alcohol level of 100-119mg/100ml Y90.6 - Blood alcohol level of 120-199mg/100ml This goes up to Y90.9 Example: 790.3 � Excessive Blood Level of Alcohol

46. R78.0 � Finding of alcohol in blood R78.1 � Finding of opiate drug in blood R78.2 � Finding of cocaine in blood R78.3 � Finding of Hallucinogen in blood R78.4 � Finding of other drugs of addictive potential in blood R78.5 � Finding of other psychotropic drug in blood R78.6 � Finding of steroid agent in blood R78 Findings of drugs and other substances , not normally found in blood The category use to be only looking alcohol. The Category now asks about other substances found in the blood but these do not have the requirement of an additional coding such as the Y codes.The category use to be only looking alcohol. The Category now asks about other substances found in the blood but these do not have the requirement of an additional coding such as the Y codes.

47. 813.15 � Fracture of radius & ulna, head of radius S52.123B � Displaced fracture of head of unspecified radius � initial encounter for open fracture type I or II with initial encounter for open fracture NOS S52.123C - Displaced fracture of head of unspecified radius � initial encounter for open fracture type IIIA, IIIB, IIIC S52.126B � Nondisplaced fracture of head of unspecified radius - initial encounter for open fracture type I or II with initial encounter for open fracture NOS S52.123C - Nondisplaced fracture of head of unspecified radius � initial encounter for open fracture type IIIA, IIIB, IIIC GEMs Mapping

48. S52.121X � Displaced fracture of head of right radius - X S52.122X � Displaced fracture of head of left radius � X S52.123X - Displaced fracture of head of unspecified radius - X S52.124X - Nondisplaced fracture of head of right radius - X S52.125X - Nondisplaced fracture of head of left radius � X S52.126X - Nondisplaced fracture of head of unspecified radius � X Real Mapping

49. X = A � initial encounter for closed fracture B � initial encounter for open fracture type I or II C � initial encounter for open fracture type IIIA, IIIB, or IIIC D - Subsequent encounter for closed fracture with routine healing E � Subsequent encounter for open fracture type I or II with routine healing F � subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing G - Subsequent encounter for closed fracture with delayed healing H� Subsequent encounter for open fracture type I or II with delayed healing J � subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing. K � subsequent encounter for closed fracture with nonunion M - Subsequent encounter for open fracture type I or II with nonunion N� subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion P � subsequent encounter for closed fracture with malunion Q - Subsequent encounter for open fracture type I or II with malunion R� subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion S - Sequela

50. So the real mapping of 813.15 is 6 codes x 16 modifiers = 96 codes Codes are based on type of fracture (Displaced, Nondisplaced ), location (right, left, unspecified) Modifiers is type of encounter (initial, subsequent, sequela), type of fracture (closed, open type I or II, Open type IIIA, IIIB, or IIIC) & way of healing (routine, delayed, nonunion, & malunion) Auditors will expect to see this documented in the notes!!

51. Mental Health & Substance Abuse

52. Good thing! Delay expected to be for providers IF there is a delay it will most likely not be more than 1 year delay Larger organizations are well into implementation (such as Mayo Clinic, St Jude�s, large scaled Hospitals) Payers are already well into the implementation Federal Government is well into the implementation DO NOT EXPECT A DELAY! HHS announces a possible delay in implementation of ICD-10 Don�t expect a delay as many of the larger facilities have stressed the cost and potential damage that could rise from the delay with their plans that are already in process. Most very large organizations are already � through their planning and implementation. Don�t expect a delay as many of the larger facilities have stressed the cost and potential damage that could rise from the delay with their plans that are already in process. Most very large organizations are already � through their planning and implementation.

53. Allows Mental Health & Substance Abuse agencies time for the DSM V release! Scheduled to be released May 2013 Does not map one to one with ICD-10 (follows ICD-11 more closely) DSM V is more sophisticated than DSM IV TR Delaying is GOOD!

54. for MH & ADP � this is four coding systems:DSM IV to ICD-9DSM V to ICD-10 There is a two year period where both coding systems will need to be accessed for historical data and billing.

55. Ordering lab tests for medication support services will change E-prescribing will change Medical records that you will be reviewing from any hospital or outside medical facility will change. ABN�s will change Interactions with insurance companies will change Medicare policy and procedures will change Documentation requirements will change My organization is Mental Health and Substance Abuse � why would I need to know general medicine?

56. DSM V is scheduled to be released May 2013 � only 5 months before the October 2013 deadline. If the government goes through with a delay�.. This will help with the crosswalk between DSM v and ICD-10 Mental Health and Substance Abuse has an additional coding system change that no other discipline has�..

57. Because of the delay in releasing DSM V � the ICD-10-CM was modeled after DSM IV TRAPA & WHO are working together to get ICD-11 & DSM V closely linked � ICD-11 will not in the US for another 10 to 20 years.APA is working to get a better crosswalk between ICD-10 & DSM V Myth: ICD-10-CM and DSM V match!

58. Numerous disorders contain updated criteria. For example, nearly all of the Bipolar and Related Disorders contain updates. There are several newly proposed disorders, such as Premenstrual Dysphoric Disorder. Added many diagnostic-specific severity measures, including the Anxiety, Obsessive-Compulsive-Related, and Trauma-Related Disorders. Personality disorders have new criteria added. Changes to DSM V

59. Neurodevelopmental Disorders Schizophrenia Spectrum and Other Psychotic Disorders Bipolar and Related Disorders Depressive Disorders Anxiety Disorders Obsessive-Compulsive and Related Disorders Trauma- and Stressor-Related Disorders Dissociative Disorders Somatic Symptom Disorders Feeding and Eating Disorders Elimination Disorders Sleep-Wake Disorders Sexual Dysfunctions Gender Dysphoria Disruptive, Impulse Control, and Conduct Disorders Substance Use and Addictive Disorders Neurocognitive Disorders Personality Disorders Paraphilias Other Disorders NEW! Proposed DSM-5 Organizational Structure

60. Schizophrenia DSM IV DSM V 295.10 � Disorganized Type 295.20 � Catatonic Type 295.30 � Paranoid Type 295 60 � Residual Type 295.90 � Undifferentiated Type B00 � Schizophrenia No Sub-types

61. ICD-9-CM ICD-10-CM 295.0X� Simple Type 295.1X � Disorganized Type 295.2X � Catatonic Type 295.3X � Paranoid Type 295.5X � Latent 295.6X � Residual Type 295.9X � Unspecified type 0- Unspecified 1� Subchronic 2� Chronic 3� Subchronic with acute exacerbation 4 - Chronic w/acute exacerbation 5 - in remission Total - 42 possible codes F20.0 � Paranoid Schizophrenia F20.1 � Disorganized Schizophrenia F20.2 � Catatonic Schizophrenia F20.3 � Undifferentiated Schizophrenia F20.5 � Residual Schizophrenia Total - 5 possible codes

62. Something Doesn�t Look Right!

63. DSM IV 295.10 � Disorganized Type 295.20 � Catatonic Type 295.30 � Paranoid Type 295 60 � Residual Type 295.90 � Undifferentiated Type

64. F10.159 Alcohol abuse with alcohol-induced psychotic disorder, unspecified F10.180 Alcohol abuse with alcohol-induced anxiety disorder F10.181 Alcohol abuse with alcohol-induced sexual dysfunction F10.188 Alcohol abuse with other alcohol-induced disorder F10.259 Alcohol dependence with alcohol-induced psychotic disorder, unspecified F10.280 Alcohol dependence with alcohol-induced anxiety disorder F10.281 Alcohol dependence with alcohol-induced sexual dysfunction F10.288 Alcohol dependence with other alcohol-induced disorder F10.921 Alcohol Use , Unspecified with intoxication delirium F10.94 Alcohol use, unspecified with alcohol-induced mood disorder F10.950 Alcohol use, unspecified with alcohol-induced psychotic disorder with delusions F10.951 Alcohol use, unspecified with alcohol-induced psychotic disorder with hallucinations F10.959 Alcohol use unspecified with alcohol-induced psychotic disorder, unspecified F10.96 Alcohol use, unspecified with alcohol-induced persisting amnestic disorder F10.97 Alcohol use, unspecified with alcohol-induced persisting dementia F10.980 Alcohol use, Unspecified with alcohol-induced anxiety disorder 292.89 � Other specified drug induced disorders

65. F10.981 Alcohol use, Unspecified with alcohol-induced sexual dysfunction F10.982 Alcohol use, Unspecified with alcohol-induced sleep disorder F10.988 Alcohol use, Unspecified with other alcohol-induced disorder F10.99 Alcohol use, Unspecified with unspecified alcohol-induced disorder F11.121 Opioid Abuse with intoxication delirium F11.122 Opioid Abuse with intoxication perceptual disturbance F11.14 Opioid abuse with opioid-induced mood disorder F11.150 Opioid abuse with opioid-induced psychotic disorder with delusions F11.151 Opioid abuse with opioid-induced psychotic disorder with hallucinations F11.159 Opioid abuse with opioid-induced psychotic disorder, unspecified F11.181 Opioid abuse with opioid-induced sexual dysfunction F11.182 Opioid abuse with opioid-induced sleep disorder F11.188 Opioid abuse with other opioid-induced disorder F11.19 Opioid abuse with unspecified opioid-induced disorder F11.221 Opioid dependence with intoxication delirium F11.222 Opioid dependence with intoxication with perceptual disturbance F11.24 Opioid dependence with opioid-induced mood disorder F11.250 Opioid dependence with opioid-induced psychotic disorder with delusions F11.251 Opioid dependence with opioid-induced psychotic disorder with hallucinations

66. F11.259 Opioid dependence with opioid-induced psychotic disorder, unspecified F11.281 Opioid dependence with opioid-induced sexual dysfunction F11.282 Opioid dependence with opioid-induced sleep disorder F11.288 Opioid dependence with other opioid-induced disorder F11.29 Opioid dependence with unspecified opioid-induced disorder F11.921 Opioid use with intoxication delirium F11.922 Opioid use with intoxication with perceptual disturbance F11.94 Opioid use with opioid-induced mood disorder F11.950 Opioid use with opioid-induced psychotic disorder with delusions F11.951 Opioid use with opioid-induced psychotic disorder with hallucinations F11.959 Opioid use with opioid-induced psychotic disorder, unspecified F11.981 Opioid use with opioid-induced sexual dysfunction F11.982 Opioid use with opioid-induced sleep disorder F11.988 Opioid use, unspecified with other opioid-induced disorder F11.99 Opioid use, unspecified with unspecified opioid-induced disorder F12.121 Cannabis Abuse with intoxication delirium F12.122 Cannabis Abuse with intoxication perceptual disturbance F12.150 Cannabis abuse with Cannabis-induced psychotic disorder with delusions F12.151 Cannabis abuse with Cannabis-induced psychotic disorder with hallucinations F12.159 Cannabis abuse with Cannabis-induced psychotic disorder, unspecified F12.180 Cannabis abuse with Cannabis-induced anxiety disorder

67. F12.188 Cannabis abuse with other Cannabis-induced disorder F12.19 Cannabis abuse with unspecified Cannabis-induced disorder F12.221 Cannabis dependence with intoxication delirium F12.222 Cannabis dependence with intoxication with perceptual disturbance F12.250 Cannabis dependence with Cannabis-induced psychotic disorder with delusions F12.251 Cannabis dependence with Cannabis-induced psychotic disorder with hallucinations F12.259 Opioid dependence with Cannabis-induced psychotic disorder, unspecified F12.280 Cannabis dependence with Cannabis-induced anxiety disorder F12.288 Cannabis dependence with other Cannabis-induced disorder F12.29 Cannabis dependence with unspecified Cannabis-induced disorder F12.921 Cannabis use with intoxication delirium F12.922 Cannabis use with intoxication with perceptual disturbance F12.950 Cannabis use with Cannabis-induced psychotic disorder with delusions F12.951 Cannabis use with Cannabis-induced psychotic disorder with hallucinations F12.959 Opioid use with Cannabis-induced psychotic disorder, unspecified F12.980 Cannabis use with Cannabis-induced anxiety Disorder F12.988 Cannabis use with other Cannabis-induced disorder F12.99 Cannabis use with unspecified Cannabis-induced disorder F13.121 Sedative, hypnotic or anxiolytic abuse with intoxication delirium F13.14 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced mood disorder F13.150 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions

68. F13.151 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations F13.159 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder unspecified F13.181 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced sexual dysfunction F13.182 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced Sleep disorder F13.19 Sedative, hypnotic or anxiolytic abuse with unspecified sedative, hypnotic or anxiolytic-induced disorder F13.221 Sedative, hypnotic or anxiolytic dependence with intoxication delirium F13.232 Sedative, hypnotic or anxiolytic dependence with withdrawal with perceptual disturbance F13.24 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced mood disorder F13.250 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions F13.251 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations F13.259 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder unspecified F13.26 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder F13.27 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting dementia This continues for a total of 265 codes

69. Hypnotic, or Anxiolytic-Induced Sleep Disorder (Amphetamine-Induced Anxiety Disorder Amphetamine-Induced Sexual Dysfunction� Amphetamine-Induced Sleep Disorder Amphetamine Intoxication� Caffeine-Induced Anxiety Disorder� Caffeine-Induced Sleep Disorder Cannabis-Induced Anxiety Disorder� Cannabis Intoxication� Cocaine-Induced Anxiety Disorder� Cocaine-Induced Sexual Dysfunction�� Cocaine-Induced Sleep Disorder� Cocaine Intoxication� Hallucinogen-Induced Anxiety Disorder� Hallucinogen Intoxication Hallucinogen Persisting Perception Disorder� Inhalant-Induced Anxiety Disorder Inhalant Intoxication Opioid-Induced Sexual Dysfunction� Opioid-Induced Sleep Disorder Opioid Intoxication Other (or Unknown) Substance-Induced Anxiety Disorder Other (or Unknown) Substance-Induced Sexual Dysfunction� Other (or Unknown) Substance-Induced Sleep Disorder Other (or Unknown) Substance Intoxication� Phencyclidine-Induced Anxiety Disorder Phencyclidine Intoxication Sedative, Hypnotic, or Anxiolytic-Induced Anxiety Disorder Sedative, Hypnotic, or Anxiolytic-Induced Sexual Dysfunction Sedative, Hypnotic, or Anxiolytic-Induced Sleep Disorder� Sedative, Hypnotic, or Anxiolytic Intoxication DSM IV TR = 292.89

70. Substance-Induced Psychotic Disorder - B07- B14 Substance-Induced Bipolar Disorder - C03 Substance-Induced Depressive Disorder - D06 Substance-Induced Anxiety Disorder � E06-E11 Substance-Induced Obsessive-Compulsive or Related Disorders � F05-06 Substance-Induced Dissociative Disorder � H03 Substance-Induced Sleep-Wake Disorder � M12-M18 Substance-Induced Sexual Dysfunction � N07 Substance-Induced Delirium � S01-S10 Mild Neurocognitive Disorder Associated with Substance Use � S20 Major Neurocognitive Disorder Associated with Substance Use � S32 DSM V

71. R 00-10 Substance Use Disorders R Substance Use Disorder R 00 Alcohol Use Disorder R 01 Amphetamine Use Disorder R 02 Cannabis Use Disorder R 03 Cocaine Use Disorder R 04 Hallucinogen Use Disorder R 05 Inhalant Use Disorder R 06 Opioid Use Disorder R 07 Phencyclidine Use Disorder R 08 Sedative, Hypnotic, or Anxiolytic Use Disorder R 09 Tobacco Use Disorder R 10 Other (or Unknown) Substance Use Disorder R 11-21 Substance Intoxication R 11 Alcohol Intoxication R 12 Amphetamine Intoxication R 13 Caffeine Intoxication R 14 Cannabis Intoxication R 15 Cocaine Intoxication R 16 Hallucinogen Intoxication R 17 Inhalant Intoxication R 18 Opioid Intoxication R 19 Phencyclidine Intoxication R 20 Sedative, Hypnotic, or Anxiolytic Intoxication R 21 Other (or Unknown) Substance Intoxication DSM V

72. R 22-30 Substance Withdrawal R 22 Alcohol Withdrawal R 23 Amphetamine Withdrawal R 24 Caffeine Withdrawal R 25 Cannabis Withdrawal R 26 Cocaine Withdrawal R 27 Opioid Withdrawal R 28 Sedative, Hypnotic, or Anxiolytic Withdrawal R 29 Tobacco Withdrawal R 30 Other (or Unknown) Substance Withdrawal DSM V

73. As if we have a choice!

74. THIS IS NEW TO EVERYONE! There is no one in the United States that has done it yet! ICD-10-CM is going to be time consuming and difficult to implement for everyone The implementation is MORE than a coding change Due to the additional release of the DSM V the same year (within 5 months), there is an additional issue for Mental Health & Substance Abuse. Clinical staff need to learn the additional requirements of diagnosis and combine it with coding from ICD-10 (as it is the national standard) Conclusion

75. This is going to be a very complex implementation regardless of the specialty you work in. Substance Abuse and Mental Health have an additional hurdle with DSM V being released so close to ICD-10 mandates Everyone you talk to in healthcare is going to have a change: Pharmacy X-ray(Radiology) Laboratory Insurance Companies Systems/Billing/Medical Records

76. ICD-10 Implementation is like the game JENGA

77. For those who have a strong project team on site, we offer on-line project management (once a week meetings) Inexpensive Share ideas with a group Learn from each other Have templates to help No long-term contact - Sign up and pay for only the sessions you feel you need Can get more assistance for low cost Good way to second check on things you�ve already completed Usually good for smaller organizations **** Training not included but can be purchased under contract What can we do to help you?Option 1

78. Contract with us (usually for larger groups or groups who have lack of support staff) More one on one help On-site only when you need us More allocated time A little more expensive You know what your budget is before starting Can contract for all or part of implementation Training Development of crosswalks System integrations Develop application program for crosswalks Project Management Option 2

79. Contract for specialty areas Training Training documentation development Translation application Translation (manual) System Analysis Project Management Option 3

80. Online sessions for MH & SA will start Tuesday, March 13, 2012 at 1:00 CST (2:00 pm EST, 12:00 pm PST). Online sessions for Public Health will start Monday, March 12, 2012 at 1:00 CST (2:00 pm EST, 12:00 pm PST) Each session is $59 payable by check or credit card You can sign up by going to: www.icd10consultants.net and click on Register for Webinars . ON LINE PROJECT MANAGEMENT

81. We can be reached at: mbp@saber.net 763-878-2108 208-484-6227 www.icd10consultants.net Contracting

82. Thank you for coming!