A PORTION OF THESE MATERIALS WERE PRODUCED PURSUANT TO THE SHIP GRANT:Small Rural Hospital Improvement Grant Program

Countdown to ICD-10!

21 Days

15 Working Days

ABC’s of getting ready

Assess how ICD-10 will affect your practice and make a plan.

Be sure your systems are ready.

Contact your vendors.

What is CMS telling you to do NOW

You do not need to register. You can submit an unlimited number of

claims. You can submit directly or through a

clearinghouse or billing agency.

You must use: Current dates of service. The test indicator “T” in the Interchange

Control Structure (ISA) 15 field.

Acknowledgment Testing

If you think your systems won’t be ready:◦Free billing software available from every

MAC website.◦Part B claims submission by online

provider portal.◦Paper claims for providers who meet

Administrative Simplification Compliance Act Waiver requirements (rare exceptions).

◦However, you still must code in ICD-10.

Alternate Claims Submission Methods

www.roadto10.org/template-library

Vendor Readiness

There is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless otherwise mandated locally, chapter 20 is not required.

They do, however, provide valuable data.

Use of External Cause Codes

https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD-10MythsandFacts.pdf

You should code each encounter to the level of certainty known for that encounter.

When sufficient clinical information is not known or available about a particular health condition to assign a more specified code, it is acceptable to report the appropriate unspecified code.

It is inappropriate to select a specified code that is not supported by the documentation or to conduct medically unnecessary diagnostic testing to determine a more specific code.

Use of Unspecified Codes

https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD-10MythsandFacts.pdf

Refer to SE1408 & SE1325

Claims Processing Guidance

Medicare will not deny Part B claims based solely on the specificity of ICD-10 as long as the valid code is within the “right family”.

Family = Category◦“…the same as the ICD-10 three-

character category.”

CMS & AMA

ICD-10:

ICD-10:

ICD-9:ExtrinsicIntrinsicChronic

Obstructive

With status asthmaticus

With acute exacerbation

The coding specificity required by LCDs and NCDs will not change.

LCDs and NCDs will require no greater specificity in ICD-10 than was required in ICD-9, with the exception of laterality, which does not exist in ICD-9.◦LCDs and NCDs that contain ICD-10

codes for right, left, or bilateral do not allow for an unspecified side.

How does it apply to LCD/NCD

Valid code.Document as specific as possible.

Code as specific as possible.Continue educating yourself.

CMS/AMA Agreement Conclusion

ICD-10 Coordination Center Located in Baltimore & will begin operations

in late September. New ICD-10 Ombudsmand, William Rogers. Help receive & triage physician and provider

issues.

CMS Communication & Collaboration Center

2% of test claims were rejected due to invalid submission of ICD-10 diagnosis or procedure code.

less than 1% were rejected due to invalid submission of ICD-9 code

Other rejections were unrelated to ICD-10.

CMS: ICD-10 testing boasts 88% Acceptance Rate

Develop quick reference sheets for provider’s common diagnoses to assist with documentation.

Develop ICD-10 Query templates for your more common diagnoses.

Recommended

Example, quick reference sheet for asthma

http://bok.ahima.org/PdfView?oid=300621

Example, quick reference sheet for asthma

www.aapc.com/icd-10/icd-10-reference-guides.aspx

Example, Query template for asthma

www.CMS.gov 2015 ICD-10-CM and ICD-10-PCS GEMs Download file

In case you need to develop your own reference sheets:Know How to Use the GEMs

I9gem: crosswalks 9 to 10

I10gem: crosswalks 10 to 9

ICD-10-CM ICD-9-CM

I10, Essential hypertension

401.0, Malignant hypertension

401.1, Benign hypertension

401.9, Unspecified hypertension

Mapping

Minimize impact.Prioritize based on estimated financial impact.

Goal

Registration Charging Coding Billing Collections