Transitioning to ICD-10-CM Deena Wojtkowski, CPC, CEMC, CCP-P Speaker April 3, 2014

1. Transitioning to ICD-10-CM Deena Wojtkowski, CPC, CEMC, CCP-P Speaker April 3, 2014

2. Good Afternoon everyone, I would like to take this time to thank everyone for joining us for this lunch time learning webinar today. This webinar is provided to you by Independent Physician Advisors . I am Deena Wojtkowski and I will be your presenter for today's seminar. I have over 25 years of billing expertise. I have my credentials as a Certified Professional Coder (CPC), an Evaluation and Management Specialist (CEMC) and a Certified Compliance Professional (CCP-P). I am currently the Assoc. VP of Client Services for ebix, Incorporated. At ebix, we work in partnership with you to ensure that your practices revenue cycle is being managed effectively. We currently provide revenue cycle management services to many clients through out the midwestern united states.

3. Disclaimer The information contained in this webinar is for general information purposes only. The information is provided by Independent Physician Advisory Group and while we endeavor to keep the information up to date and correct, we make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the information contained in this webinar for any purpose. In no event will we be liable for any loss or damage including without limitation, indirect or consequential loss or damage, or any loss or damage whatsoever arising from the use of this information. Every effort is made to keep the information we share with you as accurate and complete as the time it was released.

4. As you know, today's seminar was created to assist you with understanding and implementing ICD-10-CM to your practice.

5. ICD-10 Delayed On Monday, the U.S. Senate voted to pass the Protecting Access to Medicare Act of 2014, which both pushes back the compliance deadline for ICD-10 and perseveres the pay rate for doctors treating Medicare patients. Before this officially could take hold, President Barack Obama needed to sign the bill into law. President Obama formally approved the bill on April 1, 2014.

6. ICD-10 Delayed • The measure states, “The Secretary of Health and Human Service may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard for code sets.” • CMS estimates that a one-year delay of ICD-10 could cost between $1 billion and $6.6 billion (according to AHIMA, which strongly opposes the bill) [iHealthBeat 3/28]

7. ICD-10 Delayed • There are other groups that are also deeply disappointed. College of Healthcare Information Management (CHIME) and the American Medical Association among others. • However, other health care providers welcome the ICD-10 delay. • Medical Group Management Association policy advisor Robert Tennant said that the proposed delay is “recognition that the industry is simply not ready for the transition.” [iHealthBeat, 3/28]

8. ICD-10 Delayed • In January MGMA released survey results that showed less than 10% of 570 responding practices reported making significant progress in overall ICD-10 transition readiness. • So we all know that the transition to ICD-10 is delayed. Without addressing the reason for the delay, we may very well be back in the same place next year.

9. ICD-10 Delayed • This delay means that you will have more time to make the transition more smoothly. • Implementation will not be easy unless you are prepared. • It does not matter where you see patients, what specialty you are in, or whether you bill Medicare or not. In order to get paid, you are going to need to know how to use ICD-10 correctly, whether it is October 2014 or October 2015.

10. ICD-10 Delayed • So what does this mean to you and your practice? • Prior to the senate vote we at Independent Physician Advisors had prepared this ICD-10 training webinar in order to provide you with information you will need to successfully implement the proper use of ICD-10 in your practice.

11. ICD-10 Delayed • We suggest you take full advantage of this delay by dual coding now in order to maintain coder productivity. • Wherever possible you should do IT Testing with insurance companies and your clearing houses. One of the downfalls of this years implementation delay is CMS lack of response to requests that providers and clearinghouses had related to claims submission testing.

12. It is recommended that during your preparation that you follow one claim per payer, from start to finish, or end to end testing, to see how many areas it touches, and who will need to be educated on their particular process related to ICD-10 transitioning

13. How To Prepare • Create a ICD-10 Committee • Choose a representative from each area of your practice to participate • Create an impact analysis based on your results • Develop a set of clear, consistent, and concise messages concerning the ICD-10 implementation project to ensure that everyone is speaking with “one voice”

14. ICD-10 Delayed • Is this an opportunity or a diversion? • Regardless of where you were in the implementation process, the delay must be viewed as an opportunity. • Successful implementation of ICD-10, at either the hospital or physician practice level, is a test of foundational revenue cycle functionality. • What is your current revenue cycle state? • Be honest. Are you having problems now?

15. ICD-10 Delayed • Lets look at what the foundational revenue cycle components are: • Chargemaster • Revenue Capture • Compliance Protocols • Coding • Business office • Each of these areas impact financial viability, growth and compensation.

16. ICD-10 Delayed • How do we focus on these components to facilitate increased gross, maximum net, compliance mitigation and successful ICD-10 implementation? • You must go back to the basics

17. ICD-10 Delayed • Chargemaster Functionality • Why is the chargemaster important? • Identification of steps to ensure best practices The chargemaster is the electronic brain of your practice

18. ICD-10 Delayed • The chargemaster relates all services that are performed in a language that facilitates payment. • The chargemaster is a living breathing entity. Changing all of the time. It needs the right people to take care of it and update it as needed. • The chargemaster requires ongoing attention especially when this form leads to provider revenue.

19. ICD-10 Delayed • If your chargemaster is done properly, it facilitates clean, compliant claims that ensure proper, timely reimbursement. • If your chargmaster is done improperly, it increases compliance risk, increased the cost per claim and slows reimbursement. • It also increases customer satisfaction. Patients are more savvy now and when they receive their EOB they review and will question the EOB vs. what services were actually provided to them and included on the chargemaster from their visit.

20. ICD-10 Delayed • In the majority of hospitals and physician practices, the chargemaster is: • Treated as an afterthought • Not treated as a active, living, vibrant living entity. • Treated as a static mechanism that has minimal impact on financial viability

21. ICD-10 Delayed • Your chargemaster review should focus on: • Review of newly added codes • Deletion of codes where necessary • Descriptions • Alternate code assignment • Some CPT/HCPCS codes overlap and payers determine which code is required for processing

22. ICD-10 Delayed • The chargemaster must maintain all CPT and HCPCS used within your organization, and provide accurate differentation between codes for proper identification. • Example: 22 CPT codes representing upper GI endoscopy from esophagus to jejunum. As numbers change in CPT, they get more specific and detailed. If you do not maintain and review your chargemaster you could be loosing money.

23. ICD-10 Delayed • Certified Coders and/or someone who is knowledgeable in Anatomy and Physiology should be reviewing the CPT Codes. • For example: • 43250 Upper GI Endoscopy • Description fits over 40 CPT codes What are you doing from a revenue standpoint to be certain you are billing out the correct CPT codes in order to maximize your revenue?

24. Next Steps for ICD-10 – GAP Analysis • Why should you perform a gap analysis? • Tells you where you are, what you need to do and creates the timetable for successful implementation. • Use the delay as a opportunity • If you were on course, allows for better preparation • If you were behind, allows you to catch up • ICD-10 will happen so take action!

25. The Transition to ICD-10-CM • There are two code sets for ICD-10 • ICD-10-CM – Fee for service code set • ICD-10-PCS – Facility Code sets • Workers Compensation, auto and personal liability insurance are currently exempt from ICD-10 ICD-10 is already in use in the United States but only for mortality coding done for the CDC

26. Who is impacted by this transition? Consider who is your target audience? • Management • Coding Staff • Billing Staff • Information Technology • Providers • Business Associates

27. How To Prepare – Develop your ICD-10 Strategy • Identify actions, persons responsible, and deadlines for the tasks required to complete the transition. • Assess needed training and education • Schedule Training • Budget Resources • Develop a communication plan

28. How To Prepare • Conduct regularly scheduled standing meetings of the committee to ensure communication between key individuals • Establish ongoing communication with all affected personnel • Appoint and recognize external communication liaisons to manage communication with business associates and other external entities.

29. Analysis and Education • Coder Training: Recommendations for coder training range anywhere from 15-100 hours or more with a refresher in anatomy and physiology. • Provider feedback: provide regular, real time feedback to your providers. Code in ICD-9 and also in ICD-10 so you can share things such as specificity, laterality and other requirements related to ICD-10. Documentation is the key. • Decide if you will need to hire temporary staffing or if you will choose to offer overtime.

30. Education: GEM Crosswalk ICD-9 Bridge to ICD-10-CM Crosswalk Codes ICD-9: 357.2 Polyneuropathy in diabetes (one to five) ICD-10-CM-GEM Crosswalk: E08.42 Diabetes mellitus due to underlying condition with diabetic polyneuropathy E09.42 Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy E13.42 other specified diabetes mellitus with diabetic polyneuropathy

31. What do you code first? • Code First • Poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4 or 6) • Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5) • Use additional code to identify any insulin use (Z79.4)

32. Scenario Today lets look at the female 26-year-old patient who presents to her physicians office with ankle sprain. No other information is offered about the injury or how it happened. In ICD-9CM we code this Medical Record statement as: 845.00 sprains and strains of ankle, unspecified site

33. Scenario crosswalk ICD-10 ICD-10CM: S93.4- Sprain of ankle This block instructs us to use a fifth, sixth, and seventh digit: S93.4- Sprain of ankle S93.401- Sprain of unspecified ligament of right ankle S93.402- Sprain of unspecified ligament of left ankle S93.409- Sprain of unspecified ligament of unspecified ankle

34. Scenario Crosswalk ICD-10 In ICD–10 you are Required to use a 7th digit to identify the encounter: A- Initial D- Subsequent S- Sequela

35. Scenario Crosswalk ICD-10 • This documented statement in the medical record of ankle sprain will require a written inquiry to the physician for additional information: • Which ankle, right or left? • Is this the initial, subsequent or sequela encounter? • How did this injury happen? • Where did this injury happen?

36. Scenario Crosswalk ICD-10 The following week we receive the inquiry back from the physician with the information that is needed to select an ICD-10CM code for the encounter. The physician indicates that this is the first encounter for this right ankle sprain, leading us to use: S93.401A.

37. Scenario Crosswalk ICD-10 The physician also tells us that the patient slipped in the driveway on the ice while going to the mailbox. This is additionally coded in ICD-10CM as W00.0xxA - fall on same level due to ice and snow, initial encounter. The seventh character A indicates that this is the initial encounter. You may notice that code W00.0xxA describes how the injury happened and that this code includes two xx placeholders.

38. Lets Discuss the Placeholders and what they mean. • Not every ICD-10 code with a seventh character, has a sixth character, or even a fifth or fourth character for that matter. • This frequently occurs with poisonings and injuries. • The letter “x” serves as a placeholder when a code contains fewer than six characters and a seventh character applies. The “x” also allows for future expansion of the codes.

39. Placeholder for ICD-10 • When reporting ICD-10 codes, coders must add a placeholder so the seventh character is in the correct position. Without this placeholder to ensure characters appear in the correct positions, the codes are invalid. • For example:

40. Placeholder for ICD-10 A patient presents with an accidental poisoning by an anti-allergic drug. For the initial encounter, coders should report: ICD-10 - T45.0x1A In this case, the x in the fifth position serves as a placeholder so that the sixth and seventh characters are in the correct position. If a coder inadvertently omits the placeholder, the resulting code would be T45.01A, which is invalid

41. Placeholder for ICD-10 Please note that the location of the x within a code matters. When x is in the fourth, fifth and/or sixth character, it appears lowercase and is a placeholder. When X is at the beginning of the code, it is uppercase and indicates the chapter (i.e., codes X00-X99 Chapter 20: External Causes of Morbidity)

42. Something else to think about when we talk about crosswalking ICD-9-CM to ICD-10-CM. I will use Gout as an example: • In ICD-9 a physician/coder will choose category 274 and choose one of 15 Gout codes to describe the encounter. • In ICD-10 a physician/coder will choose from category M10 and select a code from 162 choices. In order to select the appropriate code, your documentation will need to reflect all of the following elements that most accurately describe the encounter:

43. anatomical area affected • laterality • idiopathic • lead-induced (also identify the toxic effects of lead and its compounds) • drug induced (also identify the drug) • renal impairment (also code the associated renal disease) • other secondary (coding first the associated condition) • an additional code to identify certain diseases and/or disorders classified elsewhere

44. The days of memorizing codes could be drawing to a close, the use of unspecified codes very likely may be restricted by payers. Take advantage of this delay in implementation to jump start your smooth transition to ICD-10. “At the end of the day, it all boils down to the documentation”

45. dwojtkowski@ebixinc.com Keep Calm and Code on . . . . QUESTIONS?