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ICD-10 Transition GuidePreferred IPA
History of ICD-10
1994 ICD-10 Adopted by World Health
Organization (WHO)
2003 Health and Human Services
received recommendations to
adopt ICD-10
2008 US federal government
proposed ICD-10 adoption date of October 1, 2011
2009 – 2014 Six years of ICD-10
Compliance Date delays
October 1, 2015 ICD-10 Compliance
Date
2018 ICD-11 will be released
Worldwide ICD-10 Usage
ICD-10 has been translated into 43
languages and is being used by at least
117 countries around the world.
How is ICD-10 different from ICD-9?
ICD-9-CM Diagnosis Codes ICD-10-CM Diagnosis Codes
3-5 digits. 3-7 alphanumeric characters.
Based on outdated terminology. Reflects current use of medical
terminology.
Limited Severity Parameters. Extensive Severity Parameters.
Limited Combination Codes. Extensive Combination Codes to
better capture complexity.
Approximately 14,000 codes. Approximately 69,000 codes.
Where will you see ICD-10 changes?
How will ICD-10 change clinical
documentation?
Patient is seen in a [subsequent encounter] for a [non-union] of an [open] [fracture] of the [right] [distal] [radius] with [intra-articular extension] and a [minimal opening] with [minimal tissue damage]
Quick Tips
Date of service 10/1/2015 or later: use ICD-10 codes
Date of service 9/30/2015 or prior: use ICD-9 codes
Do not submit claims/encounters with both ICD-9 and ICD-10 codes on the same submission. Health plans require separate submission.
Clinical documentation- Make sure to document in detail so that the ICD code can be as specific as possible and is substantiated by the medical record.
Document comorbid conditions to capture the most accurate and complete picture of the patient.
Claims/encounters for date of service on or after 10/1/2015 submitted with ICD-9 codes will be rejected/returned for corrections.
Referrals with ICD-10 or ICD-9 codes are currently accepted. No referrals with ICD-9 codes will be accepted after 10/1/2015.
CPT and HCPCS codes are not impacted by ICD-10 changes.
ICD-10 transition will happen on October 1, 2015.
What Preferred IPA is doing to help:
Faxing bulletins since 2014
Provider readiness survey followed up by phone calls
Check stuffers with helpful hints
Phone call reminders
Webinars
Countdown on website and portal
What Preferred IPA is doing to help:
Office Ally Testing Steps
To submit your ICD-10 test file, prepare a claim as you normally do. Remember to include ICD-10 Diagnosis Codes.
Date of Service: Submit the test claim with current dates of service as Office Ally will be using a “fake” transition date of 10/01/2014
Submit your test file
For Upload Users Only: Submit a test file with the keyword OATESTICD in the name of the file, this keyword will prompt Office Ally’s system to process the file as an ICD-10 Test File
For OLE/PM Users Only: Submit test claims using OLE/PM and once they process (they will reject), send an email to Office Ally [email protected] with the File ID. The claim will be recreated into an OATESTICD test file under your account.
Results: After the ICD-10 test file is processed, you will receive a Test File Summary showing the results of your ICD-10 test file.
If you have questions about Office Ally ICD-10 testing, contact Office Ally:
Phone: (360) 975-7000, Option 1
Email: [email protected]
Implementation Guides
Build your action plan (very detailed):
http://www.roadto10.org/action-plan/get-started/
Quick Start Guide: 5 Step to be Ready for ICD-10 Compliance Deadline
https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10QuickStartGuide20150622.pdf
Implementation Timeline:
https://medicaidicd10.noblis.org/collaboration/
CMS Sponsored ICD-10 Teleconferences
https://www.cms.gov/Medicare/Coding/ICD10/CMS-Sponsored-ICD-10-Teleconferences.html
Physician Resources: Clinical
Documentation
Clinical Documentation: http://www.pathfinderadventure.com/sites/default/files/ICD-10%20Documentation%20for%20Common%20Comorbidities.pdf
Interactive case studies – to practice documentation for ICD-10 coding- http://www.roadto10.org/ics/
Medical case studies- http://www.roadto10.org/med-studies/
Primer for clinical documentation and clinical scenarios for different specialties- http://www.roadto10.org/specialty-references/
ICD-10 documentation- http://www.roadto10.org/webcasts/
Training Resources for Staff
CMS’ Provider Resources-
https://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html
ICD-10 overview and how to prepare for the transition-
http://www.roadto10.org/roadto10-webcasts/
ICD-10 basics for medical practices-https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10BasicsforPractices20140819.pdf
HHS ICD-10 Info-https://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD-10Overview.pdf
Coding Resources
Medical case studies- http://www.roadto10.org/med-studies/
Common codes for your specialty
http://www.roadto10.org/specialty-references/
General Equivalence Mapping – diagnosis codes and guidelines-
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_050190.hc
sp?dDocName=bok1_050190
https://www.cms.gov/Medicare/Coding/ICD10/2016-ICD-10-CM-and-GEMs.html
http://cdn.roadto10.org/wp-uploads/2014/08/2015-ICD-10-CM-Index-to-Diseases-
and-Injuries.pdf
ICD-10 code conversion
http://www.icd10data.com/Convert
https://www.aapc.com/icd-10/codes/
Questions?