The 10 Step Preparation Blueprint for ICD-10

The 10 Step Preparation Blueprint for ICD-10

The transition to ICD-10 encompasses much more than simply acquiring the codes and using them. It’s an involved process that requires careful planning, organization, funding and training. With the Oct. 14, 2014 implementation date just a few months away, it’s imperative that clinicians have an action plan in place to meet the deadline. Failure to be ready will result in practices being out of compliance and the denial of reimbursements.

Make A Plan

Planning is key for ICD-10 implementation. The plan must include a timeframe for all the changes and training to be completed, along with a review of the regulations and requirements for transition. ICD-10 can’t be put in place piecemeal. Solicit volunteers or appoint a single individual or team that will be in charge of ensuring each planning step is accomplished.

Break It Down

The transition will include several phases, from the installation of software and hardware to staff training and equipment testing. Break the implementation process into smaller bites to make it more manageable.

Discover if there are any steps or measures that must be completed by a certain time. Clinicians should select a single person or a team to oversee each additional phase of the transition. These individuals will be responsible for ensuring training, IT, software, funding and other associated steps are addressed and completed correctly.

High-Level Assessments

No action plan can be launched without knowing what the impact of ICD-10 will be on the practice. Practices are not the same, even within the same field or specialty. ICD-10 will affect documentation, billing and coding, and the practice’s technology, along with staff education, procedures and funding. An in-depth assessment of the practice and staff will identify areas of concern.

Two of the most critical departments are billing/coding and documentation. Constant and continued communication with vendors, payers and clearinghouses must be maintained to determine compatibility during testing phases. This is also a good time to discover any changes in reimbursements that may be coming in the future. Documentation practices will need evaluation to ascertain if they’ll meet ICD-10 coding requirements.

Secure Funding

Implementation is going to be expensive. Funding will need to be secured for a multitude of expenses, many of which may change along the way. There will be costs associated with software upgrades. Practices that opt to maintain their own on-site server will require equipment purchases and advanced security protection.

Until all patient data has been transitioned to the ICD-10 system, clinicians will be utilizing dual coding. The most recent version will be needed in software and printed form. There will be hardware systems to upgrade and software to install. Technical modifications may be required to meet HIPAA standards or meet high-speed data transmission.

Personnel Training

Training staff in the use of ICD-10 and new privacy guidelines is necessary, and clinicians should be prepared for a loss of productivity. A wide array of professional organizations and companies offer training in multiple formats. All staff members won’t require the same amount of education and not all people learn the same way.

Training services offer sessions that incorporate eLearning, interactive exercises, and mobile and smartphone applications, along with classroom education, discussion forums, practice tools and simulations. Some customize the training to the individual. Clinicians should ensure that the training entity maintains an appropriate means of ensuring that each staff member is proficient.

Clinicians should be aware that the ICD-10 transition requires new knowledge, skill sets and procedures. Not every staff member may be able to make the transition successfully. New staff may need to be hired to replace those unable to cope with the changes. Training should begin with coders, clinicians, clinical staff and other staff, in that order. Everyone should be aware of the training schedule.

Internal Testing

Practices should begin internal testing of their new hardware and software systems to address the inevitable problems that come with such a major undertaking. IT professionals will be a common sight in practices as they perform upgrades, test systems and address problems, all of which can result in productivity losses. Be prepared.

External Testing

When internal testing is complete, practices should begin testing their systems with clearinghouses, insurance companies, payers and vendors as soon as possible. Staff should know when testing is scheduled and be prepared for interruptions. Conduct simulations and test runs to ensure communication with critical entities and develop a contingency plan for any potential problems.

HIPAA compliance standards must be met for the secure transmission of data. Clinicians work with a host of pharmacies, labs, hospitals and other physicians and they’ll also need to communicate securely and seamlessly with those entities. This is also the time when clinicians should determine which ICD-9 codes they use most often and map them to the ICD-10 version.

Going Live

Once all system software is working in concert with critical entities, begin dual coding as needed. Create an ongoing plan for determining the source of any errors or problems. Identify any staff members that may need additional training. Additional staff may need to be hired to address back-logs and loss of productivity in the first few months of ICD-10 implementation.

Getting Paid

Coding and billing activities deserve special monitoring to ensure continued productivity. In-house billing/coding departments could require additional personnel to maintain a steady workload. The alpha-numeric composition of ICD-10 coding requires billers/coders to switch between their keyboard and numeric pad. It will take extra time to complete the billing process. Any denied claims will need careful tracking to determine where documentation or coding errors may be occurring.

Auditing The Process

There are sure to be glitches along the way, even after several months of ICD-10 use. Processes and procedures throughout the practice have changed. The new codes should be audited to ensure the latest versions are being employed and communication with essential entities monitored for any undetected problems that may have crept in. Most importantly, monitor reimbursements to ensure that pre-ICD-10 implementation amounts have remained the same.

The ICD-10 changeover will be many things – exciting, expensive and frustrating. Creating an action plan will alleviate many of the potential problems. Appropriate training and education is essential and ongoing monitoring of revenues, procedures and processes will ensure a successful transition.

The Impact of ICD-10 on Management

The Impact of ICD-10 on Management

ICD-10 implementation means changes at all levels. One of the first responsibilities for managers will be to analyze the practice environment and personnel to determine specific needs to bring the practice into compliance and readiness for implementation. The entire process will require many managers to assume duties with which they’re unfamiliar or require them to step out of their comfort zone.

Managers will take on the role of overseeing and coordinating the implementation of ICD-10 and that will include contacting vendors, payers, clearinghouses and billing professionals. Contracts will all need to be evaluated, revised, updated and receive final approval before the official implementation date. New policies for employees will need to be revised, distributed and a signed copy returned.

Budgetary concerns will occupy a large part in managers’ responsibilities. Operating funds must be set aside to account for the inevitable reimbursement delays to come. There will be numerous software and hardware updates, purchases and IT considerations. Testing is a crucial part of preparation to ensure that the practice can communicate appropriately with others in the system. It’s a process that will take time and will rely on the readiness of other entities.

The transition to ICD-10 will require training and education for all staff members and sufficient money will need to be appropriated. Implementation will affect staff members in different ways. Managers will be responsible for determining the level of education each individual requires, ensure staff participation and that they’re fluent upon completion. Managers will want to explore various instruction methods, from online options to on-site instruction. Not all staff will need the same level of training.

The workflow in practices and the billing department will experience delays. These should be expected. Staff training and system testing will require a significant amount of time, resulting in a loss of productivity prior to implementation. It may be necessary to hire extra staff in various departments to alleviate back-up and loss of productivity. Additional personnel may be required for up to six months following implementation.

Significant risk accompanies ICD-10 implementation. HIPAA compliance for securely transmitting medical information is critical. Sufficient safeguards must be in place. Part of the implementation process involves how information will be stored and manipulated by those within the practice and entities with which the practice works.

The additional documentation and coding required by ICD-10 places much more patient information at risk and security measures must be addressed. Risk management also extends to potential loss in revenues after the conversion. The best laid plans may encounter snags and delays. A contingency plan to handle any problems will be essential.

The implementation of the new coding system is a major undertaking at all levels of the practice. It will require new methods, practices and policies. Medical practice managers will be extremely busy ensuring that staff receives training, the revenue flow experiences minimal disruptions, and the practice is in compliance for the ICD-10 conversion. During the transition, managers should take care not forget to obtain the ICD-10 training they need.

Coding Guidelines for ICD-10 Codes – Part 1

Coding Guidelines for ICD-10 Codes – Part 1

The rules of coding for ICD-10 have been established in cooperation by the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), the Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). It’s a standard to which all clinicians must adhere.

Reviewing The Basics

ICD-10 encompasses 21 chapters and expanded code options that have been reorganized and expanded.  Injuries are described by site first and then by type. They include laterality, greater specificity and combination codes.

ICD-10 codes are now identified with an alpha-numerical system that can include up to seven characters and the first will always be a letter. The letters I and O are not used, as they can easily be confused with the numbers 1 and 0. Letters aren’t case sensitive.

The first three identifiers represent the category, the next three describe the anatomical location and severity, and the last is an extension that identifies if it as the first or subsequent encounter, or the result of a previous injury or disease. X is used as a placeholder in some codes.

Injuries are grouped by body part rather than injuries. Clinicians will focus on documenting the current complaint of the client. Never assume that “standard” treatment has been provided or code on a suspected diagnosis. Payers just want the facts of what’s readily observable.

Practitioners will need to document variables that were not required under ICD-10. Clinicians will need to include data on all external causes that led up to the actual injury, the exact location of the injury, and the patient’s actions at the time of the injury.

Documentation will also require information about the environment in which the injury took place, and any measures the patient has taken to alleviate the problem. Additional data must be included on any complications, the results of tests and exams, and very detailed data on the treatment plan.

Conventions

The conventions for ICD-10 have an alphabetic index of terms and codes that may apply.  It’s broken down into four parts: Index of Diseases and Injury, Index of External Causes of Injury, Table of Neoplasms, and Table of Drugs and Chemicals. ICD-10 also has a tabular list that divides codes into different chapters that’s based on condition or body system.

ICD-10 coding conventions dictate that clinicians record the underlying or casual condition first. This should be followed by the condition displayed. Up to 12 diagnosis codes can be included for accurate representation of all conditions related to the patient’s visit.

A new coding convention for ICD-10 provides laterality in reporting. Clinicians now have designations for right, left, bilateral and unspecified. Coding can then be specified for the type of injury, disease or condition, along with an even more finely detailed description of the affected area.

Medication conventions have also been expanded. An example of this is drug under-dosing, a concept that doesn’t exist in ICD-9 but can be coded for under ICD-10. Many of the new codes reflect changes in terminology and technology. Some codes have been updated, while other terms have been eliminated or disassociated from specific conditions.

Even punctuation is addressed in the conventions. Specific guidelines have been established for the use of parentheses to designate supplementary words and terms that should be documented, but won’t change the diagnosis. Clinicians can differentiate between signs, symptoms and unspecified codes.

While ICD-10 codes are extensive and comprehensive, the good news for practitioners is that they generally won’t have to contend with the entire complement of code options, only those that affect their specialties. For instance, physical therapists and dermatologists won’t be coding for the same types of disease or injuries.

Unusual Examples of ICD-10 Codes

Unusual Examples of ICD-10 Codes

Clinicians preparing and training for implementation of the ICD-10 code set have encountered some unusual results. In an effort to be more specific, eliminate waste, reduce fraud and save money, the ICD-10 codes are very specific, sometimes to the point of being humorous.

Practitioners can now provide coding that may leave insurance companies wondering about their clients and the activities in which they’ve been engaging. Every clinician remembers a strange or unique situation for which they’ve billed – and the difficulty they had explaining it to the patient’s insurance company. The following are some examples of the unusual and sometimes humorous coding available with ICD-10.

Members of the animal kingdom can be unpredictable, but ICD-10 coding points out just how unanticipated some situations can really be, from fast moving turtles to equine collisions. In the animal category, practitioners will find some interesting injuries to be noted and places where the event took place.

  • W59.22XA – Struck by a turtle
  • W611.2XS – Struck by a macaw, initial encounter
  • S30.867A – Anal insect bite, non-poisonous
  • V80.730A – Animal-rider injured in collision with a trolley
  • Y92.72 – Injury obtained in a chicken coop

All families have problems, but it seems that some clichéd situations are eternal. When families have problems, there’s a code for that.

  • Z63.1 – Problem with in-laws
  • Z62.891 – Sibling rivalry
  • W21.31XS – Struck with footwear
  • Z62.1 – Parental overprotection
  • Z73.4 – Inadequate social skills, not elsewhere classified
  • R46.1 – Bizarre personal appearance
  • G44.82 – Headache associated with sexual activity
  • R45.2 – Unhappiness
  • The arts can be dangerous and that’s amply demonstrated by ICD-10 codes that identify the supposedly safe venues in which to enjoy entertainment, but may not be as protected as individuals might think.
  • Y92.253 – Injured in an opera house
  • Y9250 – Injured at an art gallery
  • Y92.26 – Movie house or cinema
  • Y92.251 – Museum

Work-related accidents and injuries are a common complaint for medical professionals and the new codes reflect such injuries. It would appear that some individuals are at high risk of being injured is some unique ways, and some return for an encore performance.

  • V97.33XD – sucked into a jet engine, subsequent encounter
  • X52 – Prolonged stay in weightless environment
  • V95.41XA – Spacecraft crash injuring occupant
  • Z89.419 – Acquired absence of unspecified great toe

Leisure time activities account for a large portion of injuries. Sports-related injuries top the list, but there are some lesser known activities that can be just as dangerous. When it comes to leisure time activities, clients are presented with multiple opportunities for injuries.

  • V91.07XA – Burn due to water skis on fire
  • Y93.D1 – Stabbed while knitting or crocheting.
  • Y92.146 – Hurt at prison swimming pool
  • T63 – Unspecified event, undetermined intent (to be specific)

Some of the ICD-10 codes bring to mind weird and wacky laws that have outlived their usefulness, but have never been removed from the books. It bears remembering that while some codes were developed to address potential problems and injuries of the future as technology advances, many of the codes currently exist because a particular situation actually happened to someone, somewhere, sometime…

A Physical Therapy Documentation and ICD-10 Code Preview

A Physical Therapy Documentation and ICD-10 Code Preview

Coding with ICD-10 will offer some interesting experiences for clinicians. Practitioners must keep in mind that they need to bill at the highest level whenever possible. That means taking extra time if necessary to track down the correct codes for optimal billing. Getting the codes right will mean the difference between getting reimbursed and delayed payments.

The following is an example of the type of coding required to provide premium treatment for the patient and optimal reimbursement for the clinician.

Subjective:
Mrs. Smith was riding her horse through an orchard road adjoining her property. Her two siblings were riding their horse with her. As she neared an irrigation pond on the property, a Canadian goose flew up and startled one of the other horses. The second horse whirled to put his rump toward the “threat” and lashed out with both back hooves. One hoof struck Mrs. Smith on the tailbone causing immediate pain. The injury happened two weeks prior and she still experiences pain, along with numbness at the tailbone, radiating 3-4 inches in all directions from the site of the injury. Over the counter medications offer no relief. Past medical history is unremarkable. She followed up with her primary care physician who referred her to physical therapy. Patient indicates no x-rays or other diagnostic tests have been done.

Objective:
Patient is 5 feet tall and weighs 120 lbs. Blood pressure is 120/70, pulse rate 72 and respiratory rate is 16. She has full strength and function in all muscle groups, but now walks slowly and hunched over. Has pain upon walking, sitting and reclining. Range of movement is normal but patient complains of pain upon movement and examination. Special tests: X-ray.

Assessment:
Exam/x-ray shows bruising, swelling and fracture of the coccyx. Treatment is to rest and to address pain. Postural exercises and home exercise for continued mobility.

Coding:
Y93.52 – Horseback riding, describes the activity at the time of the injury

W55.12XA – Struck by horse, describes what caused the injury

532.2XXA – Fracture of coccyx, initial encounter for closed fracture, describes the anatomical area where the injury is located and indicates this is a first time injury

R26.2 – Describes the symptom of the injury (constant pain and difficulty walking, sitting and reclining)

Clinicians know that ICD-10 codes are much more specific, but part of the learning curve will be wading through massive numbers of potential codes to arrive at the options that best suit the injury or need. The new codes include activities ranging from gardening and pollen reactions to knitting and running into a lamp post, complete with initial and subsequent encounters. It’s unlikely that therapists will require the codes for those potential incidents, but it points out the increased specificity of the new codes.

One of the challenges that practitioners will face is the sheer volume of data contained in the new code sets. GEMs provide a partial solution, but in an effort to stamp out fraud and save money, clinicians are now being inundated with too much information. GEMs, EMRs and other software can sort through data quickly and provide potential solutions, but they can’t make decisions about what to display for a given situation.

The final decision on which codes to utilize will ultimately fall upon the practitioner. GEMs and other computerized solutions can present the possibilities, but it will be the clinician’s practical experience and understanding of ICD-10 to code accurately and profitably.

The ICD-10 Documentation Analysis

The ICD-10 Documentation Analysis

The new documentation requirements for ICD-10 have a focus on the specifics. Payers want as many in-depth details as possible for each claim so they can decide if they’ll make the reimbursement or if the financial responsibility can be shifted elsewhere.  Clinical documentation is a critical element for clinician reimbursement.

The American Academy of Professional Coders (AAPC) estimates that only 37 percent of current clinician documentation provides enough detail to meet the stringent reporting requirements of ICD-10. Documentation will require more detailed information on topics that include the what, when, where and why of injuries, diseases and conditions.

Typical information about the client’s height, weight and vital signs will remain, but the details of an injury and surrounding circumstances are much more specific. In the previous example of the woman who suffered shoulder pain and headaches after an accident on a cruise ship, the following information will be required under ICD-10 coding.

    1. All external causes that led up to or contributed to the injury;
    2. The exact location of the injury on the patient’s body;
    3. The patient’s actions and activities at the time of the injury and after;
    4. Injury codes require a character extender to identify the type of encounter and if the patient sought medical attention;
    5. Data will be required to identify where the client sought medical treatment, any tests that were conducted and referrals that were made;
    6. The patient’s location when the injury took place or when the symptoms appeared is essential and ICD-10 provides data that narrows the location to a specific room, environment or mode of public transportation, including cruise ships;

  1. Applied specificity is required for any number of accidents and injuries to document the immediate symptoms experienced by the patient at the time of the incident, as well as ongoing symptoms, severity and frequency;
  2. Clinicians must indicate any methods the patient has used for pain relief or to alleviate the problem, from over the counter medications to hot and cold therapies;
  3. Documentation must identify if the pain or symptoms from the injury are chronic or acute;
  4. Any related complications encountered;
  5. The result of hands-on examination and any tests ordered;
  6. A detailed account of the treatment plan, including the symptoms that will be addressed and how.

Complete and detailed documentation is essential for reimbursements and Medicare requires clinicians to maintain records on all of a patient’s health and medical history both past and present. A number of variables must be documented that were not required under ICD-9 code sets.

Clinicians will need to exercise caution to ensure each item is thoroughly documented with the corresponding code. The new documentation requirements have a focus on the immediate complaint and no suspected diagnosis must enter the equation, only what can be clearly determined from the available information.