Resistance is futile

Transcription

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 1

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 2

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 3

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. 4

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 5

6 The Why Question is no longer important Timing Less than 1 year away (again) 6

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 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 7

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10 Abrasion ankle, left What s the main term? 10

11 Abrasion ankle, left What s the main term? 1. Go to the ICD-10 Index to Diseases & Injuries 11

12 1. Go to the ICD-10 Index to Diseases & Injuries 2. Look under A for Abrasion 1. Search for Abrasion 12

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14 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 14

15 Underscore = Hyperlink Moving to the Tabular List S

16 S90.51 category S90.51 subcategory subcategory subcategory Let the abrasion be on the right ankle 16

17 S Let the abrasion be on the right ankle S Let the abrasion be on the right ankle 17

18 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 S Scroll up 18

19 S S

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 active treatment for a condition. 20

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. 21

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 care per doctor per condition So, what is an initial episode of care? In a hospital, an episode of care is from admission to discharge 22

23 A Initial Encounter Can more than one provider code a 7 th 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 23

24 D Subsequent Encounter Used after the patient has received active treatment for the condition during the healing or 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. 24

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 1 st 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 1 st time for that condition, it s an A 7. When the patient returns for follow-up care, it s a D 25

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 26

27 Sequela Some Other Time ICD crosswalks to ICD-10 S90.511A (initial encounter) 27

28 Tada #2 28

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32 ICD crosswalks to ICD-10 G57.62 (neuroma, left lower limb ) 32

33 Tada 33

34 #3 34

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37 ICD crosswalks to ICD-10 M

38 Tada 38

39 #4 39

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42 Tada 42

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 43

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 44

45 Excludes2 Degenerative joint disease 1 st metatarsalphalangeal 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 45

46 Workflow How are you going to manage your workflow? 46

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 47

48 Workflow Link (R) and (L) to a specific diagnosis Change to read initial condition or established condition Change this section to denote specifics such as fracture information Rest of the space can be for misc. info 48

49 Back to Transitioning 6. Members should prepare because it s gonna cost something to implement ICD-10 Bottom Line Preparation Costs? 49

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 ( ) 50

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 51

52 APMA Coding Resource Center October 1, 2015 Thank you. 52