What is ICD10 and how will it affect me?

What is ICD10 and how will it affect me?

Vikki Lindemuth Blue Cross and Blue Shield of Kansas Statewide Specialty Provider Representative

Nancy Ratzlaff Billing Director - LifeTeam Critical Care Ambulance Service

Tanya Ratzlaff Coding and Documentation Specialist LifeTeam Critical Care Ambulance Service

ICD10-CM Documentation Training For use in ALL healthcare settings. Affects the diagnosis coding of everyone covered by HIPAA. Effective 10/01/2015 ICD-10 allows for more accurate reporting of the patient condition & care received.

Transition to ICD10 Coding Began 10/01/2015 Codes increased from 14,000 ICD9 codes to 68,000 with ICD10 Will require much more detailed documentation Will result in more claim denials at the front end if documentation is not specific enough Will NOT ask for anything you don t already know, just requires that you document more than ever before

Why Switch? Or Why are you doing this to me?????? The United States is one of the last countries in the world to make the switch to ICD10 ICD9 simply cannot do the job any longer ICD-10 allows for more accurate reporting of the patient condition & care received. This is a very DYNAMIC field. It is constantly changing and we must change with it!

Documenting for Success! Or How do I get everyone on board with the new requirements? Motivation Incentives Education Punitive Remember that Billing, Admin & Medical are all on the SAME team with the same ultimate goal in mind.

Three good reasons why Billing is everyone s responsibility If we don t collect, we can t provide Documentation has a dramatic impact on revenue Patient care does not stop when we deliver the patient to the hospital

Top 4 Excuses 1. I m not paid to do billing/that s Billing s job 2. I was too busy/ran too many calls 3. My partner was supposed to do the run report. 4. I am paid to save lives/i am too busy saving lives to bother with paperwork.

Sad Facts Without the appropriate documentation we cannot bill anymore than you could treat a patient without the proper medical equipment If you didn t write it down, it didn t happen and all billing MUST be supported by documentation in the event of an audit A happy customer/patient will tell 2-3 friends while an unhappy customer/patient will tell a minimum of 10 people If you save a patient s life but they are forced to declare bankruptcy due to medical bills, which do you think they will remember?

Emergent vs. Non-emergent Dispatch driven EMD protocols may apply Response vs Transport

ALS vs. BLS Driven by actual care provided What did you do & why?

Scheduled vs. Unscheduled Scheduled Transfers Always considered Non-emergent Requested at least 24 hours in advance Requires a valid, signed PCS prior to transport Unscheduled Transfers Still considered non-emergent 48 hr window to obtain PCS

Billing Forms Patient Consent /HIPAA Form Physician s Certification Statement (PCS) Advanced Beneficiary Notice (ABN Form) Attestation Form

ABN Forms Non-emergent ONLY! Rarely used for ambulance providers Air vs Ground Level of Service Downgrade Not medically reasonable and necessary

Billing Forms Cont d. Do I need an ABN? Is this service a covered ambulance benefit? AND Will payment for all or part of this service be denied as not reasonable and necessary? AND Is the patient stable and the transport non-emergent? (the non-emergent status here is not driven by dispatch but rather by the patient s condition) If the answer to ALL 3 of these questions is YES then you need an ABN form.

Charts/Run Reports Narratives should always answer the following questions: What is wrong with the patient? When did this happen? Why does he/she need to be transported by ambulance vs. an other means? For inter-facility transfers: Where is the patient being transferred and what care can they receive there that they can t get where they are now? Why #2 are they not going to the closest facility?

Charts/Run Reports Cont d. The Three C s of Billing Consistently Conservatively Correctly

Charts/Run Reports Cont d. EPCRs Drop-down boxes vs narratives - Technician signatures - Supporting documentation - Date of Service

Signature Requirements Must be legible or have name AND credentials printed beneath signature. Applies to: PCR s PCS ABN Consent forms Illegible or missing signatures will likely require an attestation statement.

Signatures Cont d Consent Form Must be signed prior to filing claim with Medicare Must document a legitimate, medical reason patient can t sign Must have an acceptable alternative sign if patient can t NOTE: If the patient simply refuses to sign document (& witness) their refusal and then bill the patient.

So Let s Talk About ICD-10 Or What s it really going to mean to me?

Requirements specific to ICD10 Laterality Type, quality & location of pain Location Type or distance of fall Activity involved in at time of incident

ICD10 Requirements Cont d.. External Causes/Contributing Factors MVA Burns Falls

ICD10 Requirements Cont d.. Intent Was this an accident Was it intentional (Overdose may now be considered either intentional OR accidental) Work Status Was patient a civilian, military, volunteer or employed

In Other Words The question(s) we may want to ask now: Did the patient fall? Where was he when he fell? What was he doing when he fell? Where did he fall from? What did he hurt when he fell? Was he being paid to do what he was doing when he fell? What was he thinking when he fell (just kidding)

ICD10 Requirements Cont d.. Glasgow Coma Scale (GCS) All unconscious or altered patients must include a GCS Must indicate level of response or total score Who recorded it When & where it was recorded If a Hospital to Hospital transfer & you are recording their GCS be sure to indicate origin.

Let s put it all together Cardiac Patient Patient was admitted to ABC Hospital yesterday for complaint of palpitations and chest pain. During Cath procedure the echo showed a blockage that the doctor felt needed more specialized care. It was determined the patient should be transported to XYZ Hospital for further specialized cardiac care not available at ABC Hospital.

What s Missing? Doesn t state what type of chest pain the patient had been experiencing. Doesn t state if the patient is still having chest pain or if pain meds were given. Doesn t state what kind of advanced care he was being transferred for i.e. CABG, Stent etc. Doesn t state the age or GENDER of the patient! Action Needed: This is a poor narrative & really should be returned to the crew for correction via an addendum. Note: This claim may be denied for medical necessity as it is not documented if the patient was still having chest pain, only that he had it earlier.

Fall Victim Responded to XYZ Nursing Home for report of elderly fall victim. On arrival found 80 YOF patient in bed confused and agitated. Patient voiced no complaints. Staff states patient fell in hallway landing on her hip. Staff assisted patient back to her bed & called for EMS. Assessed patient and found pain to hip but no obvious deformity. Moved patient to cot & transported to hospital. IV attempted without success. Patient released to ER.

What s missing? Laterality Mentions only pain to hip. Doesn t say which hip. Type of fall Doesn t say if she fell from a standing position, out of bed, out of her wheelchair or off the roof! Baseline Doesn t mention patient s normal mental status. We don t know if confusion/agitation is normal i.e. Alzheimer s or could she have struck her head when she fell.

Unresponsive Patient EMS dispatched to the corner of Main & South St. for unconscious person. Upon arrival Law Enforcement stated they found patient lying in yard, unconscious with a bloody nose & strong odor of ETOH. Friends of patient told Law Enforcement that he d been in a bar fight earlier that evening and decided to walk home. Friends state it had been approximately 3 hours before they came to check on him, found him in current condition and called 9-1-1. Maintained c-spine, secured patient to spine board & moved to unit. Patient remained unresponsive throughout transport. Patient transported to ABC Hospital ED in above condition.

What s missing? Location No location is given for where the patient was found. Was it in the yard of a private residence or not. Was it his home or a neighbor s? GCS No documented GCS given

MVA (Motorcycle) Patient is a 16 yr old male involved in a motorcycle vs deer at approximately 70 MPH. Patient was ejected from motorcycle and found lying in field. Patient s injuries include C1/C2 fractures, left clavicle fracture, right tension pneumothorax (chest tube inserted), pelvic fracture and small abrasions. Patient was brought to local ED by ABC County EMS and is currently being transported to XYZ Hospital for level 1 trauma services including trauma surgeon, orthopedics, pediatrics, neurology, neuro-surgeon, pulmonary and rehabilitation services.

What s missing Location Doesn t say where the MVA occurred (highway, residential street, dirt road etc.) Helmet Doesn t say if patient was wearing a helmet Type of FX Burst, Arch etc. (Since this is a Hospital to Hospital transfer you MIGHT know this information but you would really have to be on your toes & ASK questions of the doctor)

In Conclusion. Documentation has always been important but now more than ever. Details are critical! Record everything you see & hear. Do NOT delay patient care! Patients before Paper! BE KIND TO YOUR BILLER(S) AND REMEMBER YOU ARE ALL ON THE SAME TEAM!