ICD-10: A Coders Perspective

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© 2 0 1 2 Cl ift o n L a rso n A ll e n LLP

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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Perspective

• 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

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Perspective

• 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

KNOW

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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?

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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?

Reimbursement

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Workflow

• 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

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Workflow

• 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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Coding

• 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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Coding

• 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

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Coding

• ICD-10-CM

 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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Coding

• What the coder sees today when coding ICD-9 diagnosis codes:

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Coding

• 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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Coding

What the coder sees today when billing ICD-9-PC codes:

ICD-9-PC

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Coding

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

operation:

Excision/Head and Facial Bones

Drainage/Head and Facial Bones

Drainage/Ear, Nose, Sinus

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Compliance

• 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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Compliance

• 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

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Compliance

• 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 Us

twitter.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

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