Steps for a Successful 2017 ICD-10-CM Update

Transcription

1 Steps for a Successful 2017 ICD-10-CM Update

2 Code system updates cause disruption at every level within healthcare systems. As of October 1, 2016, healthcare professionals began adapting to adjustments in the International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM). This transition features strict timing requirements at Intelligent Medical Objects (IMO), we want to help you make the most of them. CONSIDER THAT ONE SIMPLE CODING CHANGE CAN LEAD TO: Organizations updating their systems. Insurance providers changing criteria. Providers needing to learn to incorporate new details in documentation. Medical billers having to familiarize themselves with updated rule guidance. Analysts being forced to amend reports. Code system updates cause disruption at every level within healthcare systems. This year s ICD-10-CM update is even more impactful than normal, as this is effectively the first update in five years due to code freezes. Overall, healthcare systems will see the following changes in the 2017 update files: 1,974 new codes 311 deleted codes 425 revised codes In June 2016, the Centers for Medicare and Medicaid Services (CMS) published the final list of ICD-10-CM codes, which can be found here. This document includes the updated index and tabular PDFs for the new codes. It also includes an addendum that shows each addition, revision and deletion for Third-party coding books and materials based on 2017 content are now available. For an easy-to-read reference guide to the ICD-10-CM changes, please refer to the IMO Guide to 2017 ICD-10-CM Changes, which can be downloaded here. This document is not intended to replace the addendum issued by CMS, but rather to supplement it by highlighting additions, revisions and removals in a simplified format. Steps for a Successful 2017 ICD-10-CM Update 1

3 STARTING WITH ELECTRONIC HEALTH RECORDS Ensuring industry stakeholders can leverage code changes within EHRs is crucial considering the integral role these portals play in patient well-being. First and foremost, start the planning process for the 2017 ICD-10-CM update as soon as possible. To do this, review the aspects of your infrastructure that leverage ICD-10-CM codes, including: Billing systems. Core terminology and code system catalogs. Reporting and analytic systems and groupers that leverage newly inactivated codes or are missing new codes that are likely relevant. Patient instruction materials. Clinical documentation. Third-party tools. To better prepare for the update, clearly identify who is downloading the 2017 ICD-10-CM code changes and applying them to each of these systems. To better prepare for the update, clearly identify who is downloading the 2017 ICD-10-CM code changes and applying them to each of these systems. If you are taking advantage of IMO s Problem IT content to provide the update within your applications, the data has been made available. Also visit our What s New tool for greater insight into what changes to expect. If you are leveraging other code systems (such as UMLS or SNOMED CT), there may be applicable updates that must occur in tandem. Steps for a Successful 2017 ICD-10-CM Update 2

4 USE OF UNSPECIFIED CODES There has been a great deal of discussion regarding the treatment of unspecified codes and their acceptance by payers. We encourage you to write to your insurance carriers and work with your state medical associations, billing associations and health information management associations to address this issue (The state-run Medicaid programs, in contrast to Medicare, have the authority to determine rules around billing claims in their respective states). While some payers have been trying to reduce their use, CMS guidelines clarify when their use may be appropriate in section I.B. 18 of this document. Sign/symptom and unspecified codes have acceptable, even necessary, uses. While specific diagnosis codes should be reported when they are supported by the available medical record documentation and clinical knowledge of the patient s health condition, there are instances when signs/symptoms or unspecified codes are the best choices for accurately reflecting the healthcare encounter. Each healthcare encounter should be coded to the level of certainty known for that encounter. The state-run Medicaid programs, in contradistinction from Medicare, have the authority to determine rules around billing claims in their respective states. CMS is stating that healthcare encounters should only be documented at the level of specificity known, meaning unspecified codes are acceptable in certain circumstances. What cannot be identified in the diagnosis can be made up for with greater documentation of signs and symptoms. Steps for a Successful 2017 ICD-10-CM Update 3

5 IMO is currently following this CMS policy. We believe that complete removal of unspecified codes will force documentation to specify details that are not known. For example, J18.9 (Pneumonia, unspecified organism) is an important and commonly recorded diagnosis in both the ambulatory and Emergency Department settings, though the bacterial or viral cause is often unknown at the time of diagnosis with bacterial cultures taking two to three days to process. That said, we certainly would encourage provider education around the need to fully specify a diagnosis wherever it is possible, particularly with simply coding in the right family of codes no longer being sufficient. Overall, IMO continues to monitor CMS s handling of unspecified codes. We fully recognize the complexity of this issue. We d appreciate any further feedback you have and if you have received additional specific guidance from your carriers or state agencies We believe that complete removal of unspecified codes will force documentation to specify details that are not known. UNDERSTANDING CONFLICTING TABULAR INFORMATION AROUND UNCONTROLLED DIABETES IMO s content team has found conflicting information regarding diabetes. The 2017 ICD-10-CM Index updated the entry for uncontrolled diabetes, requiring the user to select if the uncontrolled status was due to hyperglycemia or hypoglycemia. However, similar entries for diabetes subterms (whether inadequately controlled, out of control, or poorly controlled) were not updated in the same manner, making them inconsistent with this update. IMO has sent a query to the ICD-10 Coordination and Maintenance Committee regarding this inconsistency and is awaiting a response. In the meantime, IMO is defaulting uncontrolled diabetes to hyperglycemia (E08-E13.65). Steps for a Successful 2017 ICD-10-CM Update 4

6 IMO: YOUR PARTNER FOR 2017 ICD-10-CM UPDATE SUCCESS Consider IMO your partner in successfully transitioning to the 2017 ICD-10-CM updates. We strive to make navigating code changes as simple as possible so medical experts can focus on what truly matters: delivering high-quality patient care. Our suite of terminology products ensures healthcare systems can fully leverage code systems without sacrificing efficiency, accuracy or fidelity. These products include: IMO 2.0 Enhanced Terminology Platform (ETP) for MEDITECH Users ETP is a comprehensive tool that maps IMO clinical interface terminology to ICD- 9-CM, ICD-10-CM and SNOMED CT and all standardized reimbursement codes in combination with five other tools: IMO 2.0 Appliance, Long Term Terminology Management (LTTM), Map (IT), CQM Dashboard and the IMO Anywhere Application. This allows healthcare systems to make code update transitions regardless of the vernacular they utilize. Plus, users are prepared for any changes down the road, as the IMO 2.0 ETP is able to automatically update dictionaries as needed. IMO Anywhere IMO works to minimize the impact of code changes for organizations by managing interface technologies, code systems and groupers. IMO Anywhere allows users to access IMO Terminology at any time and in any location. With user-friendly implementation and training functionality, IMO Anywhere is an ideal tool for exploring and navigating the ICD-10-CM updates independent from the EHR. Problem IT Plus for NextGen Users Healthcare systems can smoothly transition to ICD-10-CM changes without disrupting patient records with the help of Problem IT Plus. IMO Problem IT Plus Terminology provides a simple and intuitive interface to ensure ICD-10-CM is captured at the greatest possible level of specificity. With the Enhanced Problem List Management clean up duplicate problems, update inaccurate descriptions and SNOMED mappings, and resolve or remove records. Surg IT for Epic Users Surg IT is a library of surgical scheduling procedures that allows for proper searching, scheduling, communicating and preauthorization. By using language clinicians are accustomed to, Surg IT increases efficiency overall and can improve Medicare reimbursement. Steps for a Successful 2017 ICD-10-CM Update 5

7 IMO: YOUR PARTNER FOR 2017 ICD-10-CM UPDATE SUCCESS Whether you re adapting to the ICD-10-CM changes for 2017 or ones down the road, we have you covered. Our staff will guide you through each step of the process so clinicians can stop worrying and get back to focusing on their patients Intelligent Medical Objects, Inc. and IMO are registered trademarks of Intelligent Medical Objects, Inc. All rights reserved. SNOMED and SNOMED CT are registered trademarks of the International Health Terminology Standards Development Organization. Steps for a Successful 2017 ICD-10-CM Update 6

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