Presenters

Resa Barbalich – Clinical Director

Patti Vanzuuk – Director of RCM

Compliance

The compliance date for implementation of ICD-10-CM/PCS is October 1, 2015, for all Health Insurance Portability and Accountability Act (HIPAA) – covered entities. ICD-10-CM will enhance accurate payment for services rendered and help evaluate medical processes and outcomes. A number of other countries have already moved to ICD-10, including:

• United Kingdom (1995)
• France (1997)
• Australia (1998)
• Germany (2000)
• Canada (2001)

ICD-9 Drawbacks

• It does not provide the necessary detail for patients’ medical conditions or the procedures and services performed on hospitalized patients
• It is 34 years old
• It uses outdated and obsolete terminology
• It uses outdated codes that produce inaccurate and limited data

ICD-10 Advantages

• ICD-10-CM/PCS consists of two parts:
• ICD-10-CM – The diagnosis classification system developed by the Centers for Disease Control and Prevention for use in all United States (U.S.) health care treatment settings. Diagnosis coding under this system uses 3–7 alpha and numeric digits and full code titles, but the format is very much the same as ICD9-CM
• ICD-10-PCS – The procedure classification system developed by the Centers for Medicare & Medicaid Services (CMS) for use in the U.S. for inpatient hospital settings only. The new procedure coding system uses 7 alpha or numeric digits while the ICD-9-CM coding system uses 3 or 4 numeric digits
• The new classification system provides significant improvements through greater detailed information and the ability to expand to capture additional advancements in clinical medicine. ICD-10-CM/PCS improvements include:
• Much greater detail and clinical information, which results in: Improved ability to measure health care services
• Increased sensitivity when refining grouping and reimbursement methodologies
• Decreased need to include supporting documentation

The Bottom Line

ICD-10 will allow for:

• Updated medical terminology and classification of diseases
• Codes that allow comparison of mortality and morbidity data
• Better data for: Measuring care furnished to patients
• Designing payment systems
• Better Processing of claims
• Making clinical decisions
• Tracking public health
• Identifying fraud and abuse
• Conducting research

Example

• ICD-9-CM Mechanical complication of other vascular device, implant and graft – 1 code (996.1)
• ICD-10-CM
• Mechanical complication of other vascular grafts 49 codes
• T82.311A – Breakdown (mechanical) of carotid arterial graft (bypass), initial encounter
• T82.312A – Breakdown (mechanical) of femoral arterial graft (bypass), initial encounter
• T82.329A – Displacement of unspecified vascular grafts, initial encounter
• T82.330A – Leakage of aortic (bifurcation) graft (replacement), initial encounter
• T82.331A – Leakage of carotid arterial graft (bypass), initial encounter
• T82.332A – Leakage of femoral arterial graft (bypass), initial encounter
• T82.524A – Displacement of infusion catheter, initial encounter
• T82.525A – Displacement of umbrella device, initial encounter

Structural Differences between ICD-9-CM and ICD-10-CM

ICD-9-CM Diagnoses Codes:

• 3–5 digits;
• First digit is alpha (E or V) or numeric
• Digits 2–5 are numeric
• Decimal is after third digit

ICD-10-CM Diagnoses Codes:

• 3–7 digits
• Digit 1 is alpha
• Digit 2 is numeric
• Digits 3–7 are alpha or numeric (alpha digits are not case sensitive)
• Decimal is after third digit

ICD-10 and WRS – Clinical Set Up

• Mapping has already been done within each WRS practice based on the current Superbill as populated/customized by each practice. This mapping was based on General Equivalency mapping (GEM) published by CMS. General Equivalence Mappings (GEMS) were developed over several years by the National Center for Health Statistics, Centers for Medicare and Medicaid Services, AHIMA, the American Hospital Association, and 3M Health Information Systems
• GEMS provide a temporary mechanism to link ICD-9 to ICD-10 and vice versa. It is important to keep in mind that in most cases, there are not exact matches between ICD-9 and ICD-10. Per CMS, “The purpose of GEMS is to create a useful, practical code to code translation reference dictionary for both code sets, and to offer acceptable
  translation alternatives wherever possible.” Not every ICD-9 code may translate “easily” to ICD-10. Similarly, when translating one language to another, there may not always be exact matches. Keeping in mind that currently there are approximately 14,500 ICD-9 codes and there are over 70,000 ICD-10 codes
• All practices are advised to review the current ICD-9 to ICD-10 within their practice mapping to ensure that the coding is complete and relevant

Clinical Set up

• To review, go to ADMINISTRATION → EMR SETUP → ICD SUPERBILL. For any codes not mapped to an ICD-10 code please add the correct ICD-10 code. Usually, the main reason for no mapping to a current ICD-9 code, is that the code will be deleted or replaced by more accurate, and concise ICD-10 codes
  
• Once you have verified the appropriate ICD-10 code, either as an equivalent or replacement code, add that code to your current Superbill compendium. If a code is added as a replacement for a deactivated code, there will not be an instance of both ICD-9 and ICD-10 for the diagnosis, the diagnoses will be different and listed as such
  

CMS1500

Box 21 of the CMS 1500 will switch from 9 to 10 October 1, 2015 indicating that ICD-10 is applied to the claim. In the event that you have to send ICD 9 codes on a claim you can just type in the 9 replacing the 0 and the codes will revert back to ICD 9

Resources through CMS

• CMS has a few documents that can be used as a resource for updating your ICD-10 codes. They can be accessed from the CMS.GOV website at
  http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM-and-GEMs.html

• One document is a tabular list of diseases, system specific, and by clicking the link of the required system, will take you to those pertinent codes.
• ICD-10-CM TABULAR LIST of DISEASES and INJURIES
  
• The other document will list diseases alphabetically and by clinking on the correct letter link, will take you to those pertinent codes
• ICD-10-CM INDEX TO DISEASES and INJURIES
  
• Another good source of ICD-10 information from CMS is their webpage: Road to 10: The Small Physician Practice’s Route to ICD-10 at address: http://www.roadto10.org/
  
• There is a SPECIALTY SECTION that addresses specialty specific coding, as well as application within that specialty
  

The Bottom Line

• You are not alone, this is all new to all of us, Providers and EHR’s; there will be a learning curve. WRS presents these webinars as a teaching aid and will provide you with a pdf worksheet that can be printed and distributed among staff
• Clinically, I would suggest, after updating your Superbill content, to print that new Superbill with all the coding as desk reference, and for quick access. In addition all billers should make themselves familiar with the codes and the CMS 1500 in WRS

Additional Resources

• ICD-10-CM/PCS:
  http://www.cms.gov/Medicare/Coding/ICD10/index.html (on the CMS website)

• ICD-10-CM/PCS Information for Medicare Fee-For-Service Providers:
  http://www.cms.gov/Medicare/Coding/ICD10/MedicareFee-For-Service-Provider-Resources.html (on the CMS website)

Questions

Any questions should be sent in via the support portal or directed to accountmanagement@wrshealth.com