2013 Webinar Series #8 ICD- 10 Coding Q & A with Government Payers. October 15, 2013

Transcription

1 2013 Webinar Series #8 ICD- 10 Coding Q & A with Government Payers October 15,

2 Today s Panelists: Novitas SoluNons, Inc., Debra Fulfer, RN, BSN, Manager Provider Outreach & Educa?on, Jurisdic?on H Colorado Dept. of Health Care Policy & Finance, Judy Zerzan, MD, MPH, Chief Medical Officer/Clinical Services Office Director Colorado Division of Workers CompensaNon, Debra Northrup, RN, CPC, CPMA, Medical Policy Specialist 2

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4 Debra Fulfer, RN, BSN, Manager Provider Outreach & Education, Jurisdiction H Novitas Solutions, Inc.

5 Testing Novitas: All Standard System changes have been completed, tested, and are in Production. Currently reviewing Internal User Files for any impact. CMS: See the end-to-end testing page on the CMS website: Administrative-Simplification/Affordable-Care-Act/End-to-End- Testing.html

6 Processing MLN Special Edition (SE) 1239: Implementation date October 1, 2014 o Date of Service specific for Part B o Date of Discharge specific for Part A Learning-Network-MLN/MLNMattersArticles/Downloads/ SE1239.pdf

7 Processing Date of Service o Ambulatory and physician services provided on or after October 1, 2014 will use ICD-10-CM o Claims with dates that span (services before and services after 10/1) dates will have to be split and submitted separately Hospital claims for inpatient stay based on date of discharge o Inpatient discharges on or after October 1, 2014 will use ICD-10-CM and International Classification of Disease Tenth Edition Procedure Coding System (ICD-10-PCS) diagnosis

8 Coding CPT and HCPCS Codes: o No impact on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes o CPT and HCPCS codes will continue to be used for physician and ambulatory services including physician visits to inpatients

9 Coding Change Request (CR) 8348 Instructs all Local Coverage Determinations (LCDs) and associated articles with ICD-10 codes will be published no later than April 10, %20CR%20Tracking/Attachments/210/MM8348.pdf

10 Coding Change Request (CR) 7818 ICD-10 Conversion from ICD-9 and Related Code Infrastructure of the Medicare Shared Systems as They Relate to CMS National Coverage Determination (NCDs) (CR 10 of 3) (ICD-10) The Medicare Shared Systems began implementation of necessary changes to the NCDs to incorporate ICD-10 in January 2013 and have continued making changes in preparation for the October 1, 2014 implementation date. Network-MLN/MLNMattersArticles/Downloads/MM7818.pdf

11 Coding After LCD s and NCD s have been updated with ICD-10 diagnosis codes providers should: o Review LCD and NCD o Identify opportunities to improve coding processes o Communicate revisions to applicable staff

12 Coding High quality documentation can help to: o Avoid misinterpretation by third parties (auditors, payers, attorneys, etc.) o Justify medical necessity o Provide a more accurate clinical picture of quality of care provided

13 Training CMS Official source for ICD-10 Information: The CMS ICD-10 website: o The ICD-10 webpage offers: The latest ICD-10 news Recent Update messages Information for providers, vendors, and payers ICD-10 National Provider Teleconference Call information and transcripts Medscape ICD-10 Continuing Medical Education Modules

14 Resources CMS Sponsored International Classification of Disease, Tenth Edition (ICD-10) Teleconferences o CMS-Sponsored-ICD-10-Teleconferences.html MedScape Modules o Downloads/ MedscapeModulesAvailableonICD10.pdf

15 Resources Frequently Asked Question: ICD-10 Transition Basics ICD10/downloads/ICD10FAQs2013.pdf ICD-10-CM/PCS Myth and Facts: ICD10/Downloads/ ICD-10MythsandFacts.pdf

16 Resources 2013 ICD-10-CM and GEMs: ICD-10-CM-and-GEMs.html 2013 ICD-10 PCS and GEMs: ICD-10-PCS-GEMs.html Center for Disease Control (CDC): ICD-10-CM files, information and general equivalence mappings between ICD-10-CM and ICD-9-CM:

17 Resources Sign up for CMS ICD-10 Industry Updates: CMS_ICD-10_Industry_ _Updates.html Subscribe to Latest New Page Watch: USCMS/subscriber/new? topic_id=uscms_609

18 Resources Novitas ICD-10 Implementation website: ICD-10 Implementation Novitas Outreach & Education Page available at: Outreach and Education

19 Colorado Medicaid and ICD- 10 Judy Zerzan, MD, MPH October 15, 2013

20 TesNng Describe your internal and external tes?ng process and associated?melines. Internal Tes?ng: Our Fiscal Agent, Xerox with a goal comple?on of Spring 2014 External Tes?ng: Being developed and is an?cipated to be available Summer 2014 Summer 2014 will be ready to begin external tes?ng To be determined: If phased tes?ng (i.e. connec?vity first, then eligibility, then remi[ance, etc.) If send no?ce to providers reminding them that they have not completed their ICD- 10 tes?ng No?ce to providers if clearing house has successfully tested Conduc?ng full cycle end- to- end tes?ng? Due to limited resources tes?ng may not be possible for all providers Will communicate to the provider community end- to- end tes?ng plans in Spring 2014

21 Processing Do not an?cipate any further implementa?on delays Do not an?cipate any lag?me in processing claims Management of claim cross- overs By date of service: if original claim is prior to 10/1/2014 and an adjustment claim is processed for that same transac?on then ICD- 9 codes will be required Aber 10/1/2014 ICD- 10 codes will be required Department will not convert ICD- 9 codes to ICD- 10 for the provider

22 Coding Unspecified or non- specific ICD- 10 codes Currently carefully reviewing all ICD- 10 codes op?ons If certain codes not accepted this will be published in the provider bulle?ns in advance of the compliance date and yes, the claim would deny Codes be submi[ed to the highest level of specificity to include all of the placeholders (X) and extensions? The addi?on of placeholders and extensions is a cri?cal element of the transi?on to ICD- 10- CM because many disease categories and code groups require its inclusion Probably would require the diagnosis codes be submi[ed to the highest level of specificity as we ask that now of ICD- 9 codes

23 Coding External Cause diagnosis codes For inpa?ent/outpa?ent hospital claims it is op?onal for hospital to use the external cause diagnosis codes. Release of internal ICD- 10 to CPT mappings Updated polices with ICD- 10 codes will be posted on our public website, in bulle?ns and billing manuals If an inpa?ent or observa?on facility claim is ques?oned or hung up in your system, will you hold the physician(s) claim(s) un?l the facility s claims are released? To be determined

24 ContracNng No new electronic trading partner agreements will be necessary

25 Training HCPF has no plans to host physician training We currently have cer?fied physician and hospital coders on staff We have no plans to increase coding staff at this?me

26 COLORADO ICD-10 TRAINING COALITION WEBINAR TUESDAY OCTOBER 15, :00 NOON TO 1:00 PM DEBRA J NORTHRUP, RN,CPC, CPMA MEDICAL POLICY UNIT CO DIVISION OF WORKERS COMPENSATION OCTOBER 16, /17/13

27 NEW CMS BILLING 1500 BILLING FORM IN 2014 INCLUDING ICD-9CODES TO ICD-10 CODES 10/17/13 27

28 NEW CMS 1500 BILLING FORM AND MOVING FROM ICD-9 TO ICD-10 IN 2014 The 02/12 CMS1500: Aligns with the electronic billing standards and the Professional (837P)Version 5010 Technical Report Type 3; and, Can accept either ICD-9 or ICD-10. DWC does not require a specific version of diagnosis codes in the current rule or in the 2014 Rule 16 or 18 changes, except: When billing inpatient hospital services (ICD-9 PCS drives reimbursement) ; and Not allowing insurers to use the E codes to establish work relatedness. 10/17/13 28

29 CMS 1500 VERSION 02/12 IMPLEMENTATION TIMELINE The National Uniform Claim Committee (NUCC), creator of the form, and Medicare are implementing the revised CMS 1500 claim form (version 02/12): January 6, 2014: Medicare begins receiving and processing paper claims submitted on the revised CMS 1500 claim form (version 02/12). January 6 through March 31, 2014: Dual use period during which Medicare continues to receive and process paper claims submitted on the old CMS 1500 claim form (version 08/05). April 1, 2014: Medicare receives and processes paper claims submitted only on the revised CMS 1500 claim form (version 02/12). These dates are tentative and subject to change. CMS will provide more information as it is available. 10/17/13 29

30 DWC RESPONSE TO BILLING FORM RULE 16-7(B)(1)&(2) - DELETES 08/05 The specific version (08/05) of the CMS 1500 form was deleted from Rule 16. Enables payers and providers to work together to update systems, including ICD-9 to ICD-10, as needed to keep everyone compliant with all regulations in and outside of CO Workers Compensation 10/17/13 30

31 1. 2. Field 21 of the CMS 1500 version 02/012 contains the Diagnosis Codes or Nature of Illness or Injury and relates the diagnosis to the billed service line in field ICD Indicator: 9=ICD-9 0=ICD-10 [Can accommodate up to 12 DX codes] Place of Service Codes (POS) Needs to correct (Rule 16-7(C) 10/17/

32 ICD-9 TO ICD-10 IS IMPLEMENTED OCTOBER 1, 2014 BUT CO Workers Compensation is not requiring it?? According to Medicare : ICD-9-CM will no longer be maintained after ICD-10-CM/PCS is implemented, it is in non-covered entities best interest to use the new coding system. The increased detail in ICD-10-CM/PCS is of significant value to non-covered entities. The Centers for Medicare & Medicaid Services (CMS) will work with non-covered entities to encourage their use of ICD-10-CM/PCS. ICD-10MythsandFacts.pdf 10/17/13 32

33 RECOMMENDATIONS: CO WORKERS COMPENSATION Pinnacol Assurance is planning to be able to accept ICD-9 and ICD-10 s by 10/1/2014. Contact: Poonam Wadhwani (303) Other payers in CO Workers Compensation I would recommend contacting the following major links in the bill processing systems: Coventry bill review for lots of TPAs and self-insurers Corvel Travelers Liberty The Hartford The version of ICD9 or 10 billed can not be used to deny payment. If the payer does deny payment, then use appeal process under Rule 16-11(D). If the payer continues to deny send your submitted appeal information under Rule 16-11(D) to the DWC with a completed WC form # /17/13 33

34 RECOMMENDATIONS: STATE WORKERS COMPENSATION Each state workers compensation system will be different: Laws and Regulations (more legal than administrative or vice versa) Fee Schedule may or may not be up to date with the current CPT codes May or may not adopt a version of ICD-9 or 10 Working with the nationwide commercial CO insurers (Travelers, Liberty Mutual, The Hartford etc..) will probably tell you what they are doing for other states with regard to ICD-9 to ICD /17/13 34

35 RECOMMENDATIONS: FEDERAL WORKERS COMPENSATION Contact Office of Workers Compensation for Federal Workers Compensation. They typically follow Medicare. Medical Bill Processing company for OWCP is: Southwest Region (Consists of the Dallas and Denver offices) Sharon Tyler (Acting) One Denver Federal Center, Building 53 Denver, CO (303) /17/13 35

36 THANK YOU!! Contact Information Phone#: Fax #: Address: Website: http/ 10/17/13 36

37 Next Steps November 19 th Next webinar Today s recording posted by 10/18/

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