icd-10 & friends sampler - apma.org icd-10 update.pdf · blame the american podiatric medicine...
TRANSCRIPT
11/11/2014
1
ICD-10 & Friends Sampler
Resistance is futile
Disclaimer
This presentation is brought to you by Harry Goldsmith, DPM who is solely responsible for its content and delivery so don’t complain to or blame the American Podiatric Medicine Association for any demonstrated insensitivity, poor judgment, unfunny jokes, puns that aren’t punny, or lack of taste.
* Always check with individual payers for their policies and guidelines
11/11/2014
2
Disclaimer
The APMA Coding Resource Center is wholly owned and operated by the American Podiatric Medical Association. It is partially sponsored by Mertz North America. Part of the proceeds from each subscription is contributed to the APMA Educational Foundation Student Scholarship Fund. I do not receive any payment for promoting the CRC. Nor am I on scholarship…
APMA Coding Resource Center
www.apmacodingrc.org
11/11/2014
3
“59” Modifier Question
Distinct Procedural Service
• Modifier of last resort (i.e., use more specific modifiers if you can)
• Identifies the procedure(s) as being distinct and separate from other procedures performed the same date
11/11/2014
4
“59” Modifier
• This modifier unbundles CCI or other global bundling edits
• The documentation must clearly evidence that the procedure or service was comprehensive, and not a component of another billed procedure
Introducing January 1, 2015
XE - Separate Encounter, a service that is distinct because it occurred during a separate encounter.
XS - Separate structure, a service that is distinct because it was performed on a separate organ/structure.
XP - Separate Practitioner, a service that is distinct because it was performed by a different practitioner.
XU - Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap usual components of the main service.
11/11/2014
5
The ICD-10 “Why” Question
ICD-9 has been used by the US for 35 years
ICD-9 has outgrown its intended level of specificity
ICD-9 cannot reasonably accommodate new codes
HIPAA regulations mandate the move to ICD-10
CMS announced it will no longer support ICD-9
The rest of the world is moving toward ICD-11
11/11/2014
6
The “Why” Question
is no longer important
Timing
Less than 1 year away (again)
11/11/2014
7
Transitioning Your Members
1. Someone in the office/group needs to be designated the ICD-10 “project manager”
2. Primary vendors need to be contacted and asked how ready they are for ICD-10
3. Practice major payers need to be contacted about signing up for ICD-10 “testing”
Transitioning Your Members
4. Your state should plan to put on (or contacting APMA for) ICD-10 workshops and learning sessions
5. Members need to begin (and complete) the crosswalking of existing ICD-9 codes used by the practice to ICD-10 codes
11/11/2014
8
Crosswalking ICD-9 to ICD-10
Crosswalking ICD-9 to ICD-10
#1
11/11/2014
9
Crosswalking ICD-9 to ICD-10
Crosswalking ICD-9 to ICD-10
11/11/2014
10
Crosswalking ICD-9 to ICD-10
Crosswalking ICD-9 to ICD-10
Abrasion ankle, left
What’s the main term?
11/11/2014
11
Crosswalking ICD-9 to ICD-10
Abrasion ankle, left
What’s the main term?
Crosswalking ICD-9 to ICD-10
1. Go to the ICD-10 Index to “Diseases & Injuries”
11/11/2014
12
Crosswalking ICD-9 to ICD-10
1. Go to the ICD-10 Index to “Diseases & Injuries”
2. Look under “A” for “Abrasion”
Crosswalking ICD-9 to ICD-10
1. Search for “Abrasion”
11/11/2014
13
Crosswalking ICD-9 to ICD-10
Crosswalking ICD-9 to ICD-10
11/11/2014
14
Crosswalking ICD-9 to ICD-10
The Hyphen (or Dash)Educational Moment
A hyphen at the end of an ICD-10 indicates that additional characters are required
You will only see the hyphen on a code in the alphabetic index
11/11/2014
15
Crosswalking ICD-9 to ICD-10
Underscore = Hyperlink
Crosswalking ICD-9 to ICD-10
Moving to the Tabular List
S90.51
11/11/2014
16
Crosswalking ICD-9 to ICD-10
S90.51
Crosswalking ICD-9 to ICD-10
S90.51
Let the abrasion be on the right ankle
category
subcategorysubcategorysubcategory
11/11/2014
17
Crosswalking ICD-9 to ICD-10
S90.511
Let the abrasion be on the right ankle
Crosswalking ICD-9 to ICD-10
S90.511
Let the abrasion be on the right ankle
11/11/2014
18
Crosswalking ICD-9 to ICD-10
The “additional character indicator” box located in front of a code is a “hint” that you need one or more additional characters at the end to get to the code of highest specificity
5+ 6+ 7+
Crosswalking ICD-9 to ICD-10
S90.511
Scr
oll u
p
11/11/2014
19
Crosswalking ICD-9 to ICD-10
S90.511
Crosswalking ICD-9 to ICD-10
S90.511
11/11/2014
20
“A” – Initial Encounter
S90.511A
Don’t think “encounter”
Think “episode of care” or “active treatment” or “phase of treatment”
“A” – Initial Encounter
S90.511A
Used while the patient is receiving activetreatment for a condition.
11/11/2014
21
“A” – Initial Encounter
“Used while the patient is receiving active treatment for a condition.”
How is “active treatment” defined?
“A” – Initial Encounter
S90.511A
Examples of active treatment are: surgical treatment, emergency department encounter, &evaluation and treatment by a new physician.
11/11/2014
22
“A” – Initial Encounter
S90.511A
Examples of active treatment are: surgical treatment, emergency department encounter, & evaluation and continued treatment by the same or a different physician.
Huh?
“A” – Initial Encounter
There can only be one “initial” episode of careper doctor per condition
So, what is an initial episode of care?
In a hospital, an episode of care is from admission to discharge
11/11/2014
23
“A” – Initial Encounter
Can more than one provider code a 7th character “A” during an episode of care?
A patient goes to the emergency department and the ED physician sees the patient, orders x-rays, has both an infectious disease specialist and a foot and ankle specialist do a consult in the ED, how many physicians get “A”s?
…at least 4…
“D” – Subsequent Encounter
S90.511D
11/11/2014
24
“D” – Subsequent Encounter
“Used after the patient has received activetreatment for the condition during the healingor recovery phase.”
When does active treatment end?
How do you define “healing phase”?
“D” – Subsequent Encounter
S90.511D
Examples of subsequent care are: cast change or removal, an x-ray to check healing status of fracture, removal of external or internal fixation device, medication adjustment, other aftercare and follow-up visits following treatment of the injury.
11/11/2014
25
“A” & “D” – A Fly in the Ointment
Disclaimer – Best Current Interpretation
1. If you see a patient in the ED for the first time, it’s an “A”
2. If the patient is admitted and you round 3 times during the admission, it’s an “A” each time
3. If the patient is discharged from the hospital to your care and you see them in the office, it’s a “D”
4. If you reappoint and see the patient for follow-up care, it’s a “D”
“A” & “D” – A Fly in the Ointment
Disclaimer – Best Current Interpretation
5. If the patient was seen by a primary care physician in their office for an injury and then was referred to you for follow-up, the 1st time you see that patient for that condition, it’s an “A”
6. If there is no referral, but instead a patient calls your office and tells you they just twisted their ankle. You tell the patient to come to your office and you see them for the 1st time for that condition, it’s an “A”
7. When the patient returns for follow-up care, it’s a “D”
11/11/2014
26
“A” & “D” – A Fly in the Ointment
Unanswered Questions
1. The “initial encounter” description is definite for “physician”, what about NPs, PAs, PTs, OTs, etc.?
2. If you belong to a podiatry supergroup (7 docs), and one of your partner’s patients with an established condition sees you because you are available, is that an “A” or “D” for you?
3. What if you happened to be a podiatrist in a small orthopedic group (65 docs), same scenario, is that an “A” or “D” for you?
4. Why did CDC/CMS make this so confusing?
“S” – Sequela
11/11/2014
27
Sequela
Some Other Time
Crosswalking ICD-9 to ICD-10
ICD-9 916.0 crosswalks to
ICD-10 S90.511A (initial encounter)
11/11/2014
28
Tada
Crosswalking ICD-9 to ICD-10
#2
11/11/2014
29
Crosswalking ICD-9 to ICD-10
Crosswalking ICD-9 to ICD-10
11/11/2014
30
Crosswalking ICD-9 to ICD-10
Crosswalking ICD-9 to ICD-10
11/11/2014
31
Crosswalking ICD-9 to ICD-10
Crosswalking ICD-9 to ICD-10
11/11/2014
32
Crosswalking ICD-9 to ICD-10
Crosswalking ICD-9 to ICD-10
ICD-9 355.6 crosswalks to
ICD-10 G57.62 (neuroma, left “lower limb”)
11/11/2014
33
Tada
Crosswalking ICD-9 to ICD-10
11/11/2014
34
Crosswalking ICD-9 to ICD-10
#3
Crosswalking ICD-9 to ICD-10
11/11/2014
35
Crosswalking ICD-9 to ICD-10
Crosswalking ICD-9 to ICD-10
11/11/2014
36
Crosswalking ICD-9 to ICD-10
Crosswalking ICD-9 to ICD-10
11/11/2014
37
Crosswalking ICD-9 to ICD-10
Crosswalking ICD-9 to ICD-10
ICD-9 728.71 crosswalks to
ICD-10 M72.2
11/11/2014
38
Tada
Crosswalking ICD-9 to ICD-10
11/11/2014
39
Crosswalking ICD-9 to ICD-10
#4
Crosswalking ICD-9 to ICD-10
11/11/2014
40
Crosswalking ICD-9 to ICD-10
Crosswalking ICD-9 to ICD-10
11/11/2014
41
Crosswalking ICD-9 to ICD-10
Crosswalking ICD-9 to ICD-10
11/11/2014
42
Crosswalking ICD-9 to ICD-10
Tada
11/11/2014
43
ICD-10 Educational Moment
“Not coded here” - mutually exclusive; can never occur at the same site along with the
primary condition
ICD-10 Educational Moment
New Terms: Excludes1
Excludes2
11/11/2014
44
Excludes1
“Not coded here” - mutually exclusive; can never occur at the same site along with the primary condition
Excludes1
“Not coded here” - mutually exclusive; can never occur at the same site along with the primary condition
11/11/2014
45
Excludes2
Degenerative joint disease 1st metatarsal-phalangeal joint
“Not included here” – the excluded condition is not part of the condition represented in the primary code. An Excludes2 code can be coded with the primary code as long as it is occurring elsewhere.
Whew
11/11/2014
46
Workflow
How are you going to manage your workflow?
11/11/2014
47
Workflow• 273 codes for fractures of the calcaneus
• 252 codes for fractures of the talus
• 21 codes for unspecified tarsal bones
• 42 codes for fractures of the cuboid
• 42 codes for fractures of the lateral cuneiform
• 42 codes for fractures of the intermediate cuneiform
• 42 codes for fractures of the medial cuneiform
• 42 codes for fractures of the navicular of the foot
• 231 codes for fractures of the metatarsals
• 147 codes for fractures of the great toe
• 189 codes for fractures of the lesser toes
• 42 codes for unspecified fractures of the foot and toe
That’s 1365 codes for just fractures in the foot.
Workflow
The updated Diagnosis Section (superbill)
ICD-9 crosswalked to ICD-10
can be found on APMA Coding Resource Center (Library, ICD-10
Documents)
and
Codingline (The Library – for Gold subscribers
11/11/2014
48
Workflow
Link (R) and (L) to a specific
diagnosis
Change this section to denote specifics such as fracture information
Change to read initial condition or established condition
Rest of the space can be for misc. info
11/11/2014
49
Back to Transitioning
6. Members should prepare because…
…it’s gonna cost something
to implement ICD-10
Bottom Line Preparation Costs?
11/11/2014
50
Bottom Line Preparation Costs?
AAPC Survey of 220 Members (vendor costs, education, consultants – but not including staff time training/education)
• Small practices (fewer than 10 providers) = $750 per provider
• Medium practices (10 – 49 providers) = $575 per provider
• Large practices (50 or more providers) = $3,500 per provider
PMNews ICD-10 Poll (06-30-14)
11/11/2014
51
Failing to Be Prepared
Is not an option
Back to Transitioning
7. Get to know the ICD-10 guidelines, conventions, and definitions now, not later…
11/11/2014
52
APMA Coding Resource Center
www.apmacodingrc.org
October 1, 2015
Thank you.