Transcription
ICD-10» Introduction to ICD-10: A Guide for ProvidersCenters for Medicare& Medicaid Services
Compliance Date: October 1, 2015TABLE OF CONTENTSWhat is ICD-10?Why ICD-10 mattersWhy transition to ICD-10Getting ready for ICD-10CMS resourcesThis guide is intended to provide health care professionals with an overview of ICD-10. Hyperlinks to the CMSwebsite are included in the guide to direct you to more information and resources.WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES2
What is ICD-10?3WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
What is ICD-10?In 1990, the World Health Organization (WHO) approved the 10th Revision of the InternationalClassification of Diseases (ICD), known as ICD-10.WhatWhenWhy A method of coding:» The patient’s state ofhealth and» Institutional procedures In the U.S., ICD-10 includes:» ICD-10-CM : clinicalmodification of WHOstandard for diagnoses thatis maintained by NCHS andis for specific use in theU.S.» ICD-10-PCS: inpatientprocedures developed andmaintained by CMS ICD-10-CM and PCS arecomplete revisions of their U.S.developed ICD-9 counterparts,which were adopted in 1979» More information per code» Better support for caremanagement, qualitymeasurement, and analytics» Improved ability tounderstand risk and severity Compliance Date: 10/1/15» Outpatient services arebased on the Date ofService» Inpatient services arebased on the Date ofDischargeWho All HIPAA-covered entitiesmust use ICD-104WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Why ICD-10 Matters5WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Why ICD-10 MattersICD-10 replaces the ICD-9 code sets and includes updated medicalterminology and classification of diseasesICD-10 CM/PCS consists of two parts: ICD-10-CM for diagnosis coding in all health care settingsICD-10-PCS for inpatient procedure coding in hospital settingsCPT coding for outpatient and office procedures is notaffected by the ICD-10 transition6WHAT IS ICD-10?WHYWHY ICD-10ICD-10MATTERSMATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Why ICD-10 MattersICD-10-CM replaces ICD-9-CM fordiagnosis coding: ICD-9-CM diagnosis codes 3 to 5 digitsICD-10-CM codes 3 to 7 digitsOverall format of ICD-10 diagnosis codes similar to ICD-97WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Why ICD-10 MattersICD-10-PCS replaces ICD-9-CM for inpatientprocedure coding: ICD-9-CM procedure codes 3 to 4 numeric digitsICD-10-PCS codes 7 alphanumeric digitsICD-10-PCS code format substantially different from ICD-9Unlike ICD-9, ICD-10 expands details for many conditions8WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Why Transition to ICD-10WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Why Transition to ICD-10Better reflects current medical practiceCaptures more specific data from clinicaldocumentation than ICD-9 ICD-10-CM: For fractures, for example, captures left vs. right side ofbody, initial vs. subsequent encounter, routine vs. delayed healing, andnonunion vs. malunionICD-10-PCS: Provides detailed information on procedures anddistinct codes for all types of devices10WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Why Transition to ICD-10Detail captured by ICD-10 can: Facilitate patient care coordination across settingsImprove public health reporting and trackingICD-10 structure accommodates new codes ICD-9 is running out of capacity and cannot continue toaccommodate addition of codes to reflect new diagnosesand procedures11WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Compliance DateBy October 1, 2015, your practice must start usingICD-10 codes for services provided on or afterOctober 1, 201513WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Monitor Your ProgressMonitor your progress against your ICD-10project plan, which should identify: Each task to be completedWhen tasks should begin and endWho is responsible for each task14WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Check Your PlanCheck that your ICD-10 project plan: Ensures senior leadership understands breadth and significanceof ICD-10 changeAssigns overall responsibility and decision-making authority formanaging the transitionIncludes a comprehensive, realistic budgetEnsures involvement of all stakeholders, ranging from physiciansto clearinghouses and software vendors15WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Check Your PlanCheck that your ICD-10 project plan also covers: Software/hardware testingStaff training and sharing best practicesUpdating internal policies to support the transitionAdhering to a well-defined timeline16WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Key StepsEssential tasks to cover in project plan: Identify commonly used ICD-9 codes and explore related ICD-10codesIdentify paper and electronic forms to accommodate the ICD-10code structureSchedule ICD-10 training for clinicians, office managers, billers,coders, and other key staff17WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Analyze How You Use CodesIdentify how ICD-10 will affect your practice,specifically use of codes for: Billing and submitting claimsOther functions, like eligibility queries, registration, and referrals18WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Questions for Your AnalysisQuestions to inform your analysis: Will I be able to submit claims? You will need a billing system that is compliant withHIPAA Version 5010 transaction standards Verify that your existing billing system can submit and receiveICD-10 codesHow does ICD-10 work with my EHR systems? Verify whether your EHR captures ICD-10 codes as needed forbilling purposes19WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Questions for Your AnalysisHow do I become familiar with ICD-10 codes? Obtain ICD-10 code books if you use ICD-9 books for codelook-upCompare ICD-9 codes commonly used in your office tocorresponding ICD-10 codesCheck your software for an ICD-10 look up functionAcquire ICD-10 code trainingObtain new ICD-10 forms if you use ICD-9 forms today20WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Look for EfficienciesConsider opportunities to make codingmore efficient: List your most commonly used ICD-9 codes and look at theICD-10 codes you will use in their placeThen think about how front-office staff can help capture newinformation required under ICD-10 (e.g., trimester of pregnancyfor obstetric coding)21WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Changes to Your PracticeIdentify changes you might need to makeLook at: Business processesClinical documentationPractice management and clinical softwareReadiness of your vendors (e.g., practice management, billing, andclearinghouse products and services)22WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Business ProcessesBusiness processes to consider include: ReferralsAuthorization/precertificationPatient registration and schedulingPhysician ordersContracts with payers, clearinghouses, and other businesspartnersFinancial operationsPublic health reporting23WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:DocumentationClinical documentation of key medicalconcepts is essential to selecting specificICD-10 codes.As part of patient care, clinicians already document mostconcepts needed for ICD-10 coding.24WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:DocumentationDoes your practice’s documentation capturenecessary detail? Use documentation from recent patient encounters to tryselecting ICD-10 codesNote any changes needed to documentation for ICD-10 coding25WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:CommunicationConfirm ICD-10 plans and readiness of lling services26WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Talk with Payers Ask payers if they are revisingcontracts or policies based onICD-10; if so, negotiate newcontractsAsk about testing plans27WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Talk with Clearinghouses and Billing ServicesIf you work with a clearinghouse or billing service, check ontheir ICD-10 preparation and readinessFigure out how you can work together so yourclaims can be processed using ICD-10 Note: Clearinghouses cannot help identify which ICD-10 codesto use unless they offer coding services28WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Talk with Software/Systems VendorsTalk to your EHR and/or practicemanagement system vendors to seewhen they plan to upgrade your systemfor ICD-10Vendors will need to have productsready as soon as possible so you cantest them; if they don’t, you may needto find a new vendor who has ICD-10 ready products29WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Vendor Evaluation Identify your current vendorsContact vendors to confirm they areICD-10-ready and how they will helpyou get readyAssess whether you want or need todevelop new vendor relationshipsEvaluate your current vendor or newvendor by asking key questions30WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Key Vendor QuestionsAsk your vendors: Will you install products well before the October 1, 2015,compliance date, so I can begin testing?Will you support my products after October 1, 2015?Will you update my products and applications for ICD-10?Will you keep my products updated? Will there be a charge?Will I need new hardware to accommodate ICD-10-relatedsoftware changes?31WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:Key Vendor QuestionsMore questions for your vendors: What costs are involved with maintaining new products?Will you offer product support for the transition? If so, forhow long?How do I report issues and how quickly will you respond?Will you provide training on your software?Will you offer support during internal ICD-10 testing?Will you help me test my system with payers and othertrading partners?32WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:TestingOnce your system is ICD-10-ready, test it Try systems that send and receive codes to ensure they processICD-10 codes correctly Test transactions that affect your practice most, such as: Claims submission Eligibility verification Quality reporting33WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:TestingLook at processes for collecting and reporting diagnosis codes(e.g., superbills and patient encounter forms)Try handling processes with ICD-10: If I had to select an ICD-10 code for the last patient, whatwould it be? If I had to prepare a claim with an ICD-10 code, how wouldI do that?34WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:TestingTest with payers and other business partners Work with your vendors and other business partners to developa testing plan and schedule for ICD-10 transactionsTest how well your systems work together to send and receivecodes—focus on transactions that affect your practice most35WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:ImplementationPrepare and monitor for ICD-10’spotential impact on: Coding productivityCoding accuracyReimbursementVendor responsiveness36WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Getting Ready for ICD-10:ImplementationSample steps to minimize ICD-10-relatedchallenges: Eliminate coding backlogs before ICD-10 transitionPrioritize medical records for codingProvide refresher training to address productivity andaccuracy issuesDevelop a process for managing errors and resolvingvendor issues37WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
CMS ICD-10 ResourcesWHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
ResourcesCMS website:www.cms.gov/icd10 Features fact sheets,FAQs, andimplementationguides, timelines, andchecklists39WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
ResourcesCMS ICD-10 EmailUpdates providetimely informationTo sign up for updates:1. Go to cms.gov/icd102. Select “CMS ICD-10 IndustryEmail Updates” from leftnavigation bar3. Click on “Sign up for updatemessages”40WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
ResourcesFact sheets on ICD-10for providers, payers,and vendors Available on the Provider,Payer, and VendorResources pages of theCMS ICD-10 website41WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
ResourcesICD-10 MedscapeModules Expert Column: Preparing forICD-10: Now Is the TimeVideo: ICD-10: Getting FromHere to ThereVideo: ICD-10 and ClinicalDocumentationFree continuing medical education (CME) and continuing education (CE)credits available to physicians and nurses who complete ta brief post-test.Accessible from CMS ICD-10 website: www.cms.gov/icd1042WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
ResourcesRoad to 10 Tool: on Provider Resources page, cms.gov/ICD-10The Road to10 can help you: Understand the basics ofICD-10 Build an ICD-10 actionplan to map out yourtransition Answer frequently askedquestions43WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
ResourcesFollow us on Twitter: @CMSgovJoin the conversation: Use #ICD10 to tweet about ICD-1044WHAT IS ICD-10?WHY ICD-10MATTERSWHY TRANSITION TOICD-10GETTING READY FORICD-10CMS RESOURCES
Why transition to ICD-10 . Getting ready for ICD-10 . CMS resources . This guide is intended to provide health care professionals with an overview of ICD-10. Hyperlinks to the CMS 2 website are included in the guide to direct you to more information and resources. WHAT IS ICD-10? WHY ICD-10 MATTERS WHY TRANSITION TO ICD-10 GETTING READY FOR ICD-10
