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ICD-10: A Coders Perspective
Karla VonEschen, CPC
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What is ICD-10?
• ICD-10 is the new coding system that will take the place of our current system, ICD-9.
• ICD-10 is broken in 2 classifications:
ICD-10-CM: diagnosis coding for all claims; inpatient or outpatient
ICD-10-PCS: procedure coding system for
inpatient physician procedures only
• The implementation of ICD-10 does not impact CPT or HCPC codes
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Who is impacted?
• Any organization covered under HIPAA is impacted by ICD-10. This includes but is not limited to:
Physicians Facilities Payers
Skilled Nursing Facilities Home Health Providers
• ICD-10 is effective 10/1/2014. Transitioning is not an option!
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• There are many personalities among physicians, coders, billers and office staff
• No two practice environments are the same • An eclectic mix of personalities
• A broad variety of specialties
• ICD-10 as a whole is overwhelming • One solution does not fit all
• A belief that the transition to ICD-10 should be tailored to the specific clinic
• For a successful transition, we need to take in to account the organization specialty (hospital, senior living, clinic, DME, home health, etc.), organization size, population served, motivation of staff and
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WHAT ORGANIZATIONS WANT TO
What Coders Want to Know
• Will current 9 codes crosswalk to the same ICD-10 code?
• Will I have to go back to the provider for clarification?
• Will it take me longer to code with ICD-10? • Will I have a loss of productivity?
• When do I need to learn the new codes?
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What Physicians Want to Know
• How will this impact my reimbursement? • Will my work flow change?
What Administrators Want to Know• How will this impact productivity?
• What changes need to occur?
• How many areas of my organization are impacted? • How much will the transition cost?
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What The Consultant Hears• Do you see any common themes?
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• Provider impact is limited on the front end
• Bigger changes behind the scenes or the back end • A successful transition is dependent on how well the
• Don’t procrastinate!
• Now is a great time to evaluate your front end and back end
• Make a list of what will impact workflow within your organization
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• This change will be painful, but helpful in the long run
• We need to be able to code more accurately • ICD-10-CM codes tell a story
• Use of unlisted diagnosis and procedure codes • Physician payment
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• The biggest job falls on the coder
• Look at most commonly billed ICD-9 codes now • Not all ICD-9 codes crosswalk to 1 ICD-10 code
• Increased knowledge of Anatomy and Physiology is a must
The basic structure of the ICD-10 manual is the same as ICD-9
The number of available diagnosis codes will change
Not all diagnosis codes apply to all specialties Organizations can focus on those diagnosis
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• What the coder sees today when coding ICD-9 diagnosis codes:
• What the coder will see on 10/1/2014 when billing ICD-10 diagnosis codes:
S52.121A- Displaced fracture of head of right radius, initial encounter for closed fracture
S52.122A- Displaced fracture of head of left radius, initial encounter for closed fracture
S52.123A- Displaced fracture of head of right radius, initial encounter for closed fracture
S52.124A- Nondisplaced fracture of head of right radius, initial encounter for closed fracture
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What the coder sees today when billing ICD-9-PC codes:
What the coder will see when coding ICD-10-PCS: ICD-10-PCS
9-PC 21.22 crosswalks to 31 different ICD-10-PCS codes depending on the root
Excision/Head and Facial Bones
Drainage/Head and Facial Bones
Drainage/Ear, Nose, Sinus
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• This change is not an option!
• A change this large does carry risks that could lead to non-compliance:
Risk due to failure of billing or EMR systems Risk due to lack of education
Risk due to insufficient review and training of revised carrier documentation and policies & procedures for ICD-10
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• There are many impacts of reporting incorrect ICD-10 codes:
Code reported is not supported by documentation
Payment for an incorrect ICD-10 code when the correct code may not pay
Underpayment or payment delay
• Limiting compliance risk is important
Perform an internal review of your business processes
Test your systems! Staff training
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What You Can Do Now!
• Begin the conversation about ICD-10 • Create an inventory
• Have a cushion
• Physician involvement • EMR templates
• Keep in contact with your software vendor
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Contact Ustwitter.com/CLA_CPAs www.facebook.co m/CliftonLarsonAll en www.linkedin.com/compan y/cliftonlarsonallen
• Thank you for attending! If you have questions around ICD-10 please feel free to contact me!
Karla VonEschen, CPC
AHIMA Approved ICD-10 Trainer 612-376-4603