© 2015 Axxess. Unauthorized use is prohibited.engage.axxess.com/rs/axxess/images/ICD-10_WebinarVideo_2-3-15.pdf · Preparation and training is the key to successful ... ICD-9 Current

© 2015 Axxess. Unauthorized use is prohibited.

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Axxess Leads the Industry

Our Mission is to empower healthcare organizations with the world’s best technology solutions


Your Certified, Experienced Presenter

Empowering You with the Knowledge to Grow Your Business We Learn. We Teach. We Grow.

Jennifer Gibson is a Registered Nurse with over 20 years of home health industry

experience. She is a certified OASIS and Coding Specialist. She regularly trains on

ICD-9 and ICD-10 coding. She has held several leadership roles in the

administration of home health agencies and as a Director of Nursing. Jennifer

consults widely for home health agencies nationwide and is a sought after

contributor to industry blogs and publications.

Jennifer is committed to the success of the home care industry and currently

serves on several committees for the National Alliance for Home Health Quality

and Innovation (AHHQI) as well as the Texas Association for Home Care &

Hospice. Jennifer has the heart of a teacher, and her passion is to support others in

the home care industry.

Jennifer Gibson, RN, HCS-D ICD-9, HCS-D ICD-10, COS-C


Introduction

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• 2013

– CMS’s 2013 final rule indicated that ICD-10-CM implementation will proceed

beginning October 1, 2014

– CMS stated that there would be NO further delays*

• 2014

– Protecting Access to Medicare Act (PAMA) Passed: April 1, 2014 • ICD-10-CM Postponed

• 2015

– ICD-10 Implementation date October 1, 2015

– No further delays are anticipated

*CMS’s MLN Webinar 08/22/2013

Preparation and training is the key to successful implementation


Objectives

• To learn WHY implementation of ICD-10-CM is occurring

• To learn HOW it will effect us

• To learn the differences between ICD-9-CM and ICD-10-CM

• To learn about expected issues of implementation

• To learn what we can do to minimize the effects of

implementation

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Why ICD-10-CM?

• ICD-9-CM is Outdated

– First used in the US in 1979 on all Medicare claims

– Terminology is outdated

– Does not include new technology

– Many categories in ICD-9-CM are full

• There is no more space to add codes for new diseases and procedures

– No laterality (side of body affected)

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ICD-9-CM Compared to ICD-10-CM

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ICD-10-CM is MUCH more specific

ICD-9-CM

•14,315 diagnosis codes •No Laterality (side of body) •Procedure Coding Required

-3,838 Procedure Codes

•69,099 diagnosis codes •Includes Laterality (side of body) •Procedure Coding NOT Required

- 75,795 Procedure Codes

ICD-10-CM


ICD-10-CM Goals

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Enhance accurate

payment for services

rendered

Facilitate evaluation of

medical processes

and outcomes

Incorporate emerging diagnosis

and procedures

Identify diagnoses

and procedures

precisely

Assist in tracking

public health and risks

Recognize advances in

medical technology and allow room to

add these codes


What you need to know: ICD-10-CM

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• Agencies will be maintaining two coding systems for a period of time – up to 14 months

• CPT codes and HCPCS codes will not be affected

• ICD-10-CM codes will be used for all providers who use ICD-9-CM

Start

October 1, 2015


ICD Comparison

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ICD-9-CM codes ICD-10-CM codes

3-5 characters in length 3-7 characters in length

First character can be numeric or alpha (V or E codes)

First character is alpha (all letters except U)

Characters 2-5 are NUMERIC Character 2 is NUMERIC; Character 3-7 may be ALPHA or NUMERIC

Use of decimal required after 3 characters

Use of decimal required after 3 characters

No Placeholders Use of dummy placeholder ‘X’

Alpha characters are case sensitive (matters on bill in ICD-9)

Alpha characters are NOT case sensitive

Incomplete code titles Complete code titles

14, 315 diagnosis codes 69,099 diagnosis

3,838 procedure codes 71,957 procedure codes

No Laterality (side of body) Laterality

Injuries grouped by type Injuries grouped by anatomical site


ICD-10-PCS & OASIS

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Information on MO1012 was no longer used to calculate risk adjustment or outcomes

• M1012 is the OASIS-C question that used codes for inpatient procedures

Agencies were required to answer this M question, but could mark ‘N/A,’ ‘Unknown’,

or list a procedure

We do NOT use procedure codes in OASIS –C1; therefore, we do not use ICD-10-PCS (procedure codes)


More Combination Codes in ICD-10

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I25.110

Atherosclerotic heart disease of native coronary

vessel with unstable angina

pectoris

E11.311 Type 2 diabetes

mellitus with unspecified

diabetic retinopathy

with macular edema

K71.51 Toxic liver disease with chronic

active hepatitis with ascites

K50.012 Chron’s disease of small intestine with

intestinal obstruction

EXAMPLES


ICD-10-CM 7th Character

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• ICD-10-CM has a 7th character feature for some codes

• If 7th character is required and is not added, the code is invalid

• 7th character helps to indicate which encounter is being treated

– Initial treatment (ER or hospital, usually)

– Subsequent treatment (most often for home care)

– Sequela (complication arising from a condition such as contractures due to burns)

– Special 7th character classifications for fractures


Placeholder ‘X’

• Dummy Placeholder ‘X’ is used in certain codes – X Allows for future expansion

– Fill out empty characters when a code contains fewer than 6 characters and requires a 7th character

• When placeholder character applies, it MUST BE USED in order for the code to be valid

• ‘X’ is not case sensitive – EX: T46.1x5A or T46.1X5A (adverse effect of calcium-channel blockers, initial

encounter)

– T15.02xD or T15.02XD (foreign body in cornea, left eye, subsequent encounter)

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More Specific

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ICD-10-CM: S72.044G Non-displaced fracture of base of neck of right femur, subsequent encounter

for closed fracture with delayed healing

•ICD-9-CM: V54.9 Unspecified Orthopedic Aftercare

•With M1024b buddy code of 820.03 Fracture of neck of femur, base of neck


More Specific

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ICD-10-CM: I69.351

Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side

•ICD-9-CM: 438.21 Hemiplegia/Hemiparesis affecting dominant side (this is a late effect code, but as you can see is very non-specific)


HIPAA 5010

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• HIPAA 5010 was created in anticipation of ICD-10-CM

– Increased the field size for characters from 5 to 7 characters on the bill

– Increased the number of diagnosis codes allowed from 9 to 25

– MACs will see up to 25 codes

– Clarifies why home care is being provided


Industry Readiness

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80%+ No designated transition team

75%+ believe ICD-10

compliance date will be delayed again*

75%+ believe their agency

will be ready for October 1, 2015

changes

*Source: Decision Health

CMS webinar 8/22/13 stated NO FURTHER DELAYS


Home Health Coders

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44%

single coder

25%

2 person team

31%

3+ person team

Do your coders also QA the OASIS forms?

•Coders are a mix of clinical and

non-clinical staff

•Some agencies outsource coding

responsibilities


ICD-9-CM Productivity

• Coders who ONLY assign codes

– 25 assessments daily

• Coders who assign codes AND QA OASIS

– 15 assessments daily

• Internal quarterly audit results

– 90% > accuracy rating

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ICD-10-CM Coder Productivity

1st 12 Months of Implementation

70% longer to code claims

21 *Data collected from Canadian implementation

54%

decrease in

productivity

20%

decrease in

productivity

Long- term (after 12 mos.)

Maintain a 90% > accuracy

rating when audited


Productivity Comparison

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ICD-9 Current ICD-10 First 12 Months ICD-10 Long Term

CODING: CODING: CODING:

25 assessments daily 11.5 assessments daily

20 assessments daily

Coding and OASIS Review: Coding and OASIS Review: Coding and OASIS Review:

15 assessments daily 6.9 assessments daily 12 assessments daily

Internal Audit Review: Internal Audit Review: Internal Audit Review:

90% > accuracy rating 90% > accuracy rating 90% > accuracy rating


Coding Specialist Training

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• CMS calculations for FULL TIME CODING SPECIALISTS

training (not agency staff overall such as senior management,

accounting, QA staff and clinicians)

– CMS estimated Cost: $644 per coder

– Canadian data reports 50+ hours to train

Coders Training Hours

Coding Specialists 16 Hours

Gap Knowledge Deficit 8 Additional Hours

Total 24 Hours


Anticipated Issues

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Implementation will increase coding errors resulting in rejected claims

Medicare EXPECTS a spike in rejection of claims 3-6 months following introduction of code set,

peaking at 10% of all claims submitted

Productivity will be directly affected (decreased) because of knowledge deficit with new codes and definitions


Top 10 Anticipated Issues

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1. Coding clinic guidance for ICD-9-CM will not translate over to ICD-10

2. Will have to ‘unlearn’ rules for ICD-9 and learn new rules for ICD-10

3. $9.77 million loss in coder productivity*

4. Overall transition cost from ICD-9 to ICD-10 of $16.58 million**

5. Increased delay processing OASIS/Coding

6. Increase delay processing claims

7. Increased rejections and denials

8. Improper payment

9. Coding backlog

10.Decreased cash flow

*CMS estimate In 2015, if each assessment takes 1.7 more minutes to complete

**CMS estimate for home health industry


Documentation Requirements

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Referral sources

Hospitals

Physicians

Home health

clinicians

ICD-10-CM is much more specific. Accurate and thorough documentation required


Clinician Training

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• Start Training a Minimum of 6 months prior to implementation date

– No later than April 1, 2015

• Tools available

– Initial assessment audits

– E-learning

– Practice tools

– Webinars, discussion forums

– Classroom education

• Canadian data shows

– 30 hours training plus 8 hours of knowledge gap training

Start Training Now


Agency Transition

• Agencies will not bill claims with services provided ON or After

October 1, 2015 with ICD-9-CM

• Agencies will have to access both ICD-9 and ICD-10 to submit or

revise any claims associated with services actually provided on or

before September 30, 2015

• M0090 will be the determining factor

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Home Health Agency Billing

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• MACs to “allow HHAs to use the payment group code derived from ICD-9 codes on RAPs for episodes that span October 1, 2015, but require EOE claims to be submitted using ICD-10 codes”

• Part B claims that are billed on a monthly basis will split claims based on dates of service and use ICD-9 before October 1, 2015

– Examples:

• Hospice/Home Health billing

• Outpatient therapy/Outpatient billing

• Most of OUR clients will be billing traditional Medicare clients under part A and therefore will be billing episodes that begin before October 1, 2015 and end after October 1, 2015 as follows – RAP for episode started before October 1, 2015 bill using ICD-9-CM

– EOE for episode starting before October 1, 2015 and ending after 10/01/2015 using ICD-10-CM


Home Health Agency Billing

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• Most of OUR clients will be billing traditional Medicare clients under part A and therefore will be billing episodes that begin before October 1, 2015 and end after October 1, 2015 as follows

– RAP for episode started before 10/01/2015-bill using ICD-9-CM

– EOE for episode starting before October 1, 2015 and ending after October 1, 2015 using ICD-10-CM


Agency Steps to Success

• Evaluate financial resources

– 3-6 month productivity lag and claim payment delay

• Consider establishing a line of credit to proactively deal with potential cash flow interruptions

• Assess clinician knowledge deficits and role in coding

• Analyze documentation NOW on top 25 diagnoses for the agency

• Monitor Vendor Readiness – Software

– External coders

– External billers or clearing houses

– Payers

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Steps To Take Today

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Establish a transition team NOW

Develop an educational plan and timeline

Train clinicians, coders, management, QAPI and Clinical Supervisors on ICD-10-CM as well as anatomy and physiology

Reinforce ICD-9-CM coding fundamentals, OASIS completion guidelines, and documentation standards NOW to get staff accustomed to the level of documentation ICD-10-CM will require

Begin ‘Dual Coding’ a sample of patients (code in ICD-9 and ICD-10)


More Steps To Take Today

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• CMS recommends dual coding beginning January - March 2015 and continue until full implementation in October 2015

– Consider manually coding and progress to testing within informational system by April 2015

• Assess accuracy of coding – HCS-D certified in ICD-10 coding reviews

– Internal audits

– External auditor review of portion of records to verify accuracy and completeness of coding

– Look for consistency between OASIS, Plan of Care, claim and documentation of the record


Are Agencies Ready?

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Z56.1 Change of Job

Z56.3 Stressful Work Schedule

Z56.5 Uncongenial Work Environment

Z56.4 Discord with Boss and Workmates

Z71.89 Other Specified Counseling

Z56.0 Unemployment, Unspecified

T73.2xxD Exhaustion due to exposure


Is Support Ready??

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R45.0 Nervousness

R45.82 Worries

R45.2 Unhappiness

R45.5 Hostility

R46.7 Verbosity and circumstantial detail obscuring reason for contact

W17.2 Fall into hole

Q17.4 Misplaced ear

Z46.5 Malingerer

F10.10 Alcohol abuse


Questions & Answers

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http://www.axxess.com/icd-10

Decision Health: www.decisionhealth.com

https://www.optumcoding.com/




http://www.decisionhealth.com/

http://www.decisionhealth.com/

https://www.optumcoding.com/


Empowering You with the Knowledge to Grow Your Business

Thank You for Attending

Jennifer Gibson, RN, HCS-D ICD-9, HCS-D ICD-10, COS-C

[email protected]

214-575-7711, extension 3917

mailto:[email protected]







Documents

© 2015 Axxess. Unauthorized use is prohibited.engage.axxess.com/rs/axxess/images/ICD-10_WebinarVideo_2-3-15.pdf · Preparation and training is the key to successful ... ICD-9 Current