ICD-10 Boot Camp O n Behalf of: Oklahoma Chiropractors Association

1. ICD-10 Boot CampOn Behalf of:Oklahoma Chiropractors Association Presented by: David Klein CPC, CHC & Evan M. Gwilliam, MBA DC CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA Sponsored by:

2. Objectives • Gain a basic understanding of ICD-10 • Understand the reason for the transition • Identify the similarities and differences from ICD-9 • Get familiar with relevant guidelines • Learn how to select the right codes • Learn how to document properly • Know how to implement ICD-10 • Reduce ICD-10 related anxiety

3. Recommended Tools Inside you will find: • Comprehensive list of relevant ICD-10-CM codes for Chiropractic (~15,000 codes) • Tools to help you convert from ICD-9-CM to ICD-10-CM • GEMs code map • Commonly used codes • Alphabetic index • Complete guide to understanding ICD-10-CM coding • Other aids you need for a painless transition. ChiroCode’s Complete and Easy ICD-10 Coding for Chiropractic

4. Recommended Tools You could also use the complete code set (~68,000 codes), available from multiple publishers

5. Disclaimer Every attempt has been made to make this presentation as current as possible, but things change Be sure to check with your local carriers and Medicare for updates as the ICD-10 implementation date gets closer Subscribe to ChiroCode alerts or follow ChiroCode on Twitter for updates that pertain to DCs

6. The Landscape

7. The Landscape

8. CMS-1500 Claim form • Approved for official use 08/05 • www.nucc.org for official instructions

10. CMS-1500 Claim form • Revision 02/12 • Changed to match the electronic format (5010) and ICD-10 codes • Adds space for eight more diagnosis codes in box 21. • January 6th, 2014 - Health plans and clearinghouses must accept the form. • April 1st, 2014 – Providers must use the new form

11. Why do we have diagnosis codes? • HIPAA requirement • Establish medical necessity • Process claims • Translate written terminology into common language • Provide data for statistical analysis • Identify fraud, set healthcare policy, measure quality

12. Where did they come from? • ICD-9 was developed by the World Health Organization for public health and statistical analysis • First revision 1893, ninth revision 1979 • Shifted focus from mortality to morbidity • “ICD-9-CM” means Clinical Modification - for use with health care claims in the U.S. • ICD-9-CM was mandated in 1988 under the Medicare Catastrophic Coverage Act, then reaffirmed by HIPAA in 1996

13. How do I know which codes to use? Follow payer guidelines for code sequencing. Diagnosis code hierarchy: • Neurological • Structural • Functional • Soft tissue • For example, sciatica (724.3) and DDD (722.4) will carry more weight than spasm (728.85) or myalgia (729.1) • It is said that some software only looks at the first diagnosis when adjudicating a claim, so make it count!

14. How do I know which codes to use? Medicare Universal Diagnosis List: Short term (approximately 6-12 treatments) • 721 Spondylosis • 723-724 Back Pain Moderate term (approximately12-18 treatments) • 353 Root lesions • 722 Unspecified disc disorders • 724 Stenosis • 846-7 Sprains Long term (approximately18-24 treatments) • 722 Degeneration, displaced discs

15. How do I know which codes to use? Do not code the “kitchen sink”. Example: • 847.0Sprain of neck • 723.4Brachial neuritis or radiculitis NOS • 739.1Nonallopathic lesions, cervical region • 728.4Laxity of ligament (cervical) • 728.85Spasm of muscle (cervical) • 729.1Myalgia and myositis, unspecified • 847.1Sprain of thoracic • 724.4Thoracic or lumbosacral neuritis or radiculitis, unspecified • 739.2Nonallopathic lesions, thoracic region • 728.4Laxity of ligament (thoracic) • 728.85Spasm of muscle (thoracic) • 719.7Difficulty in walking • 784.0Headache • 780.5Sleep disturbances

16. How do I know which codes to use? • Are all of these codes medically indicated by the patient’s records? • Are any of the rendered codes merely symptoms of other codes? • Are the rendered codes as accurate and precise as possible, given the supporting medical documentation?

17. Why can’t we keep using ICD-9? • Too old • Many sections are full and cannot be expanded • Not descriptive enough • Not able to accurately reflect advances in medical knowledge or technology • Will not meet healthcare needs of the future

18. Why can’t we keep using ICD-9? • Requires excessive reliance on supporting paper documentation • Hampers the ability to compare costs and outcomes

19. Why can’t we keep using ICD-9? ICD-9 ~14,000 codes ICD-10 ~68,000 codes

21. Will Oct. 1, 2014 be the end of the world?

22. Where did ICD-10 come from? • The World Health Organization issued the tenth revision of the International Classification of Disease (ICD-10) in the early 90’s. • Each country is responsible for adapting ICD-10 to suit its needs • Australia uses ICD-10-AM • Germany uses ICD-10-GM • Canada uses ICD-10-CA • United States uses ICD-10-CM • U.S. has used ICD-10 since 1999 to report mortality data on death certificates

23. Where did ICD-10 come from? • ICD-10-CM (CM=Clinical Modification) was developed by the National Center for Health Statistics for reporting morbidity and mortality in the U.S. • Ready in 1994 • Public comments 1997-1998 • Tested in 2003 by AHA and AHIMA • Final rule for implementation published 2009 • Postponed in 2012 • Implementation October 1, 2014 (for sure, maybe)

24. Won’t they just postpose it again?

25. Won’t they just postpone it again? • Jan. 2013, the AMA asked CMS to abandon ICD-10 • Feb. 6, 2013, CMS Acting Administrator, Marilyn Tavenner said no • Too much work has already been done to turn back now • The old system won’t work with new technologies • That would penalize innovators • It is necessary for health care reform

26. Won’t they just postpone it again? ICD-10 does a better job than ICD-9 with: • Providing data for statistical analysis • Measuring quality and outcomes • Helping to set healthcare policy • Identifying public health threats • Identifying fraud and errors • Exchanging data among health care entities In other words, we need it to improve our health care system.

27. How are ICD-9 and ICD-10 similar? • Still a tabular list divided into chapters based on body system or condition • Similar hierarchy • Still an index with main terms and sub-terms • Must code to the highest level of specificity • ICD-10 is mandated under HIPAA

28. How are ICD-9 and ICD-10 similar? Conventions are mostly the same (page 467) NEC “Not elsewhere classified” Used when the information in the medical record provides detail for which a specific code does not exist NOS “Not otherwise specified” or “unspecified” Used when the information in the medical record is insufficient to assign a more specific code.

29. How are ICD-9 and ICD-10 similar? Conventions are mostly the same (page 467) [ ] Brackets are used in the tabular list to enclose synonyms, alternative wording or explanatory phrases. Brackets are used in the Index to identify manifestation codes ( ) Parentheses are used in both the Index and Tabular to enclose supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number to which it is assigned. The terms within the parentheses are referred to as nonessential modifiers

30. How are ICD-9 and ICD-10 similar? Conventions are mostly the same “Includes” This note appears immediately under a three-digit code title to further define, clarify, or give examples of the content of a code category. “And” The word “and” should be interpreted to mean either “and” or “or” when it appears in a title… “either or”

31. How are ICD-9 and ICD-10 similar? Conventions are mostly the same “Excludes” Excludes1 – is used when two conditions cannot occur together or “NOT CODED HERE!” Mutually exclusive codes; two conditions that cannot be reported together. Excludes2 – indicates “NOT INCLUDED HERE.” Although the excluded condition is not part of the condition, it is excluded from, a patient may have both conditions at the same time. The excluded code and the code above the excludes can be used together if the documentation supports them.

32. How are ICD-9 and ICD-10 similar? Conventions are mostly the same “Code First/Use additional code” Provides instructions on how to “sequence” the codes. Signals that that an additional code should be reported to provide a more complete picture of the diagnosis. “Code Also” Alerts the coder that more than one code may be required to fully describe the condition. The sequencing of the codes depends on the severity and/or the reason for the encounter.

33. How are ICD-9 and ICD-10 similar? ICD-9 • Official Guidelines (about 30 pages) • Indexes • Diseases and Injuries (300 pages) • Neoplasms (20 pages) • Drugs and Chemicals (30 pages) • External Causes (20 pages)

34. How are ICD-9 and ICD-10 similar? ICD-10 • Official Guidelines (about 30 pages) • Indexes • Diseases and Injuries (340 pages) • Neoplasms (20 pages) • Drugs and Chemicals (50 pages) • External Causes (35 pages)

35. How are ICD-9 and ICD-10 similar? • Tabular list (340 pages) • Infectious Diseases • Neoplasms • Endocrine • Blood • Mental • Nervous • Circulatory • Respiratory • Digestive • Genitourinary • Pregnancy • Skin • Musculoskeletal • Congenital malformations • Perinatal • Signs and Symptoms • Injuries and Poisoning • E-codes. External Causes • V-codes. Health Status ICD-9

36. How are ICD-9 and ICD-10 similar? • Tabular list (600 pages) • Infectious Diseases • Neoplasms • Blood • Endocrine • Mental • Nervous • Eye • Ear • Circulatory • Respiratory • Digestive • Skin • Musculoskeletal • Genitourinary • Pregnancy • Perinatal • Congenital malformations • Signs and Symptoms • Injuries and Poisoning • External Causes • Health Status ICD-10

37. How are ICD-9 and ICD-10 similar? • Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00 – M99) page 166 • M00 to M25, Arthropathies(diseases of the joints) • M40 to M43, Dorsopathies(diseases of the spine) • M45 to M49, Spondylopathies (diseases of the vertebrae) • M50 to M54, Other Dorsopathies • M60 to M63, Disorders of Muscles • M65 to M67, Disorders of synovium and tendons • M70 to M79, Other soft tissue disorders • M80 to M94, Osteopathiesand Chondropathies(diseases of bone and cartilage) • M99 Biomechanical Lesions, NEC (subluxations and others) • Codes assigned to each chapter are broken into blocks of one or more 3 digit codes each. Each block deals with a specific disease and associated symptoms.

38. How are ICD-9 and ICD-10 different? • The alphanumeric structure of ICD-10 allows for more specific information • Increased codes and categories allow for more accurate representation of the patient’s diagnoses

39. How are ICD-9 and ICD-10 different?

40. How are ICD-9 and ICD-10 different?

41. How are ICD-9 and ICD-10 different? ICD-10 ICD-9

42. How are ICD-9 and ICD-10 different?

43. How are ICD-9 and ICD-10 different? • Placeholder “x” character (guidelines, page 466) • ICD-10-CM utilizes a placeholder character “x” in positions 4, 5, and/or 6 in certain codes to allow for future expansion. • 7th Characters • Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder “x” must be used to fill in the empty characters.

44. ICD-10-CM code for chronic gout due to renal impairment, left shoulder, without tophus.Note: there are 11 gout codes in ICD-9 and 365 in ICD-10 What are some ICD-10 examples?

45. What are some ICD-10 examples? In ICD-9: E844.8 Sucked into a jet without damage to airplane; ground crew

46. What are some ICD-10 examples? In ICD-10: V97.2 :Sucked into a jet without damage to airplane;

47. What are some ICD-10 examples? In ICD-10: V97.29:Sucked into a jet without damage to airplane; luggage cart driver

48. What are some ICD-10 examples? In ICD-10: V97.29&:Sucked into a jet without damage to airplane; luggage cart driver; male

49. What are some ICD-10 examples? In ICD-10: V97.29&A:Sucked into a jet without damage to airplane; luggage cart driver; male; under 5’5” in height;

50. What are some ICD-10 examples? In ICD-10: V97.29&A#:Sucked into a jet without damage to airplane; luggage cart driver; male; under 5’5” in height; slightly bald;