4/7/2014. I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

Transcription

1 Disclosure I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation. Objectives: Educate and guide the pediatrician in the process of implementing ICD-10-CM. Develop a plan to implementation. Design a calendar to make the process reasonable in your practice. Reinforce the benefits of better documentation. 1

2 Agenda: Explain the major parts of the new system. Explain the process of changing over. Develop a comfort level that will make the process less stressful. Give references for review and guidance. What does this acronym stand for? If Contagious, Disinfect 10 Children Meaningfully Implement, Customize, Discard, 10 Current Methods Increase Cool Designs 10 Common Moves Infants, Children, Decisions, 10 Choice Mistakes International Classification of Diseases 10 th revision, Clinical Modification The purpose of ICD-10-CM is the same as it was with ICD-9-CM which is to collect epidemiologic data of illness and injuries; Not as a payment program. It is developed through the WHO and is based on Clinical Judgment of the clinician doing the work. 2

3 The ICD system has been in use in the U.S. since 1949 and is a collaboration of: National Center for Health Statistics / CDC Centers for Medicare/Medicaid Services (CMS) American Hospital Association American Health Information Management Association It is the HIPAA standard for Morbidity/Mortality reporting. ICD-10-CM was released in 1994 and been used in the rest of the world since then. ICD-9-CM is in effect until October 1, There have not been new codes in the last two years. When we reach October 1, 2015 use ICD-10- CM but realize that you will still be cleaning up claims from before that date so your billing system will need to have both systems (9 and 10) on it until you finish all of those claims. Benefits: More specificity Improves measurement of health care services Supports public health surveillance Reflects advances in medical technology and in medicine as a whole Uses current terminology Allows for expansion and flexibility in making new diagnoses 3

4 Has five times the number of codes as ICD- 9-CM. (About 13,500 codes to about 68,000) There are 21 chapters and no supplements A00-B99 Infectious and Parasitic diseases C00-D49 Neoplasms D50-D89 Diseases of blood and blood forming organs and disorders involving immune mechanisms E00-E89 Endocrine, nutritional and metabolic diseases F01-F99 Mental, Behavioral and Neurodevelopmental Disorders G00-G99 Diseases of the nervous system H00-H59 Diseases of the eye and adnexa H60-H95 Diseases of the ear and mastoid process I00-I99 Diseases of the circulatory system J00-J99 Diseases of the respiratory system K00-K95 Diseases of the digestive system L00-L99 Diseases of the skin and subq tissue M00-M99 Diseases of the musculoskeletal system and connective tissue N00-N99 Diseases of the genitourinary system O00-O9A Pregnancy, childbirth and the puerperium P00-P96 Conditions in the perinatal period Q00-Q99 Congenital malformations, deformations and chromosomal abnls. R00-R99 Symptoms, signs and abnormal clinical and lab findings, not elsewhere classified 4

5 S00-T88 Injury, poisoning and certain other consequences of external causes V00-Y99 External causes of morbidity Z00-Z99 Factors influencing health status and contact with health services ICD-10-CM codes are three to seven characters long. The first character is always a letter. The second and third are always numeric Characters 4 through 7 are alpha or numeric The first three characters signify a category: A00-B99 Infectious and parasitic diseases 3 character codes are headings and only used when a code is not further specified. Places four, five, and six are a sub-category which indicates an etiology, severity, or anatomic site. The seventh place provides details of the encounter such as it being the initial visit. 5

6 An X may be used as a placeholder to hold a space in the sequence for future expansion. An example is in the poisoning section, T36- T50 when there is a red box next to the code that indicates a seventh number or letter is required but not yet available, therefore use the X to hold the spot. T39.011X Poisoning by aspirin, accidental X placeholder for a number or letter that will be expanded on in the future but isn t there yet in the injury section: S50.02 contusion of the elbow S50.02XD contusion of the elbow, subsequent visit Changing over to ICD-10-CM Who is involved? How is it viewed? (Attitude) Do you have a plan? Who directs the plan? How do you know that you are on track for successful completion? Do you need outside help or education? What is your history in other situations? 6

7 Who comes in contact with ICD-10-CM in your office? Front office staff Nurses Physicians Billing staff Computer staff Office management Patients Using the system is a matter of getting comfortable with the specifics of it. In order to actually understand how it works in relation to your practice, a few things need to be studied. Who fills out the superbill in your office? When is it filled out? Is it reviewed for accuracy? (Correlate with the documentation) Do you do this on your own or does your computer software suggest a code? How it is viewed will make a difference in the approach you take and the steps needed to implement the plan. Is this just another pain in the (body part inserted here) required by the government? Does your practice see the value of the change? Do you have the ability to influence how the transition is viewed? 7

8 Do you have a plan? Breakdown the steps needed to develop an educational program for your staff. Not all staff members need to have the same level of education. Taylor the necessary information to the individual jobs in your office and their usage of the system. Is your hardware able to handle the change? Is your software being updated with the new codes? Does your practice management program integrate with the medical record to help with codes? Do you have a plan? Does your vendor keep you up to date on their progress of this process? Have you discussed the changeover with the insurers to which you submit billing? Have you developed anything to inform patients of the new system? How often do you review/revise your plan to make adjustments in this process? Who directs the plan? For the whole practice there should be one person who directs the program. Divide up the education for the staff according to their involvement with the new system. Have one person in each area who is a reference person for the rest to ask their questions. Nurses and physicians can be grouped together if needed but would do better if separated. 8

9 How do you know that you are on track to be successful in implementation? Each group from the educational plan needs a stepwise approach to the subject and monitoring of their knowledge base. Monthly/Bi-monthly progress should be evaluated as we are approaching the Oct. 1 st deadline. Meeting time may be done as a group or as individuals depending on your needs/time and ability to get everyone in their group up to the same knowledge base. Do you need outside help or education? Evaluate your time/expertise on the subject. Educate the primary person in your office who will implement the change. Do they feel overwhelmed by the process? Have they taken on similar responsibilities in the past? Is their track record good for projects of this nature? Consultants are available as is reference material to learn this but how does your leader learn best? Reading, webinars, one on one, combination. Ask. Don t assume. What is your history in other situations? There is a group of similar projects which your office has gone through which are good predictors of how you will do with this one. Y2K CPT changes from one year to the next HIPAA Compliance Web site development ICD-9-CM previous revisions Medicaid requirements/changes Audits/NCCI edit reviews Computer/Practice management upgrades 9

10 Your comfort level with this process is also affected by how you approach technology changes. Numerous studies show that there is a positive correlation to success depending on where you fall in the following groups: Very early adapters Early adapters Average adapters Late adapters Very late adapters Never adapt Documentation and Specificity Just as in CPT there is a set of descriptive history criteria that ICD-10-CM will require which are new: Laterality Comorbidities Manifestations of disease Etiology/Causation Complications Detailed anatomic location Degree of functional impairment Documentation and Specificity Biologic and chemical agents involved Phase/Stage of illness Lymph node involvement Localization Procedure or implant related Age related Joint involvement Initial or subsequent visit Sequelae of disease, condition or injury 10

11 CPT History: Identify a chief complaint or the reason for the visit As regards the above include in the HPI: Location Quality Severity Duration Timing Context Modifying factors Associated signs and symptoms Crosswalk to ICD-10-CM is available to help in using the new system. Watch for more to come to ease you into the new system. In Pediatrics many of these criteria are easily obtained in the CC, HPI, PMHx, and PE. The areas which have the most new information required are Orthopedics, Surgical procedures and Neoplasms. Be aware that there will be a set of codes which have special requirements in each area. Learning these specifics is key to having clean bills which get paid on first pass through the insurers. 11

12 Sepsis Eight levels of this process Bacteremia Septicemia Sepsis with Severe inflammatory response syndrome Severe Sepsis Septic Shock Sepsis with localized infection Sepsis due to a postprocedural infection Sepsis and Severe Sepsis associated with a noninfectious process or condition Bacteremia R78.81; no organism identified If a specific bacteria is identified and the patient is not septic, code for the specific bacteria/virus in the bloodstream. Sepsis can be specific to an organism or not if cultures are negative or inconclusive. Use A41.9 Severe Sepsis R65.2- without (R65.20) or with septic shock (R65.21) and requires a second code for the organism or A41.9 for negative culture and a third if there is organ dysfunction, i.e., (N17.-) acute kidney failure Neonatal Sepsis P 36.- series Twelve codes from which to chose Additionally use the B96.- codes for other organisms not identified in the P36.- series. Additionally use the R65.2- for severe sepsis and the additional codes for organ failure 12

13 Otitis media Divided into three major parts: Nonsuppurative otitis media (H65.---) Suppurative and unspecified otitis media (H66.---) Otitis media in diseases classified elsewhere (H67.-) 104 possible diagnoses from which to chose. Separate from Myringitis Respiratory diagnoses upper and lower Smoking exposure history (Z77.22) Contact with and (suspected) exposure to environmental tobacco smoke should be included as secondary diagnosis Use of nonspecific or NOS diagnoses is not preferred Be as specific as your history allows Use additional diagnoses as your history allows Use symptoms as a last resort Develop a superbill with your most common 100 (or more) diagnoses for office visits and a second one for hospitalized patients References: Principles of Pediatric ICD-10-CM Coding Pediatric Code Crosswalk: ICD-9-CM to ICD-10-CM ICD-10-CM, The Complete Official Draft Code Set Webinars 1 and 2 on ICD-10-CM through the AAP on Feb 11 and March 25, 2014 by Dr. Jeffrey Linzer Sr.,M.D. The above resource has five programs for your use including the above webinars KaMMCO in the search box put in ICD-10-CM for information regarding specific areas of interest or questions 13

14 Overall our job is to work SMARTER, not harder. Specific Measurable Achievable Realistic Timely Each visit Reimbursable 14