billing with icd 10 understanding what centricity practice solutions can do for you
TRANSCRIPT
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Billing with ICD 10Understanding what Centricity Practice Solutions can do for you.
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Disclaimer
The content of this presentation represents the views of the author and presenters.
GE, the GE Monogram, Centricity and Imagination at Work are trademarks of General Electric Company.
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HealthCo - Our Story
• Value Added Reseller
• Over 400 clinics
• 2013 and 2014 GE Channel Partner of the Year
Presenter: Donna Dietz, Senior Implementation Consultant
Co-Presenter: Andrea Cunningham, Director - Professional Services
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Agenda
• Timelines
• Planning/Preparation
• Tools
• Set-Up
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R46.1 is “bizarre personal appearance”
“Are you going to share the story that talks about improvement in patient care or the one that makes you laugh?” … John Lynn/ HealthcareScene.com blog network
Z63.1 “Problems in relationship with in-laws”
V97.33XA “Sucked into jet engine, initial encounter”
V97.33XD “Sucked into jet engine, subsequent encounter”
V97.33XS “Sucked into jet engine, sequela”
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ICD-9 14000+ CodesLast major industrialized nation to
switch 35+ years oldLimits growth
ICD-10 68000 Codes Flexible for expansionMore specific diagnoses
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“Based on the survey results, it appears the delay has had a negative impact on some readiness activities – especially external testing. Uncertainty over further delays was listed as a top obstacle across all industry segments,” Jim Daley, WEDI past-chair and ICD-10 Workgroup co-chair, said in a public statement…..”
Author Vera Gruessner | Date April 7, 2015
https://ehrintelligence.com/2015/04/07/is-the-industry-ready-for-the-icd-10-implementation-deadline/
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Deadlines
• Prior to October 1, 2015– ICD-10 Test purposes only– ICD-9 to bill dates of service <10/01/2015
• After October 1, 2015– ICD-10 for all dates of service on or after 10/01/15– ICD-9 for all dates of service before 10/01/2015
http://cms.gov/Medicare/Coding/ICD10/index.html
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Is Your Practice– ICD-10 Ready
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CMS – ICD-10 Compliant
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Clearinghouse – ICD-10 Compliant
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Clearinghouse – Testing Status • Check clearinghouse website • State of readiness
– Testing of ICD-10 transactions• HealthCo has tested with our supported clearinghouses– Availity, Centricity EDI, HCRNet, Health-e-Web, Relay Health
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Payors – ICD-10 Compliant
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Billing Service – ICD-10 Compliant
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CPS 12– ICD-10 Compliant
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CPS 12– ICD-10 Compliant• ICD-9 Codes• ICD-10 Codes
– All available for Load – Many with ICD-9 Mapping *
• Enterprise Date• Carrier Date• Mixed Carrier Dates
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Work to Do
Practice Management
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Centricity• Enterprise ICD-10 Implementation Date• Carrier ICD-10 Implementation Date• ICD-10 Diagnosis Codes
– Cross Mapping ICD-9 Codes when applicable
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Enterprise ICD-10 Implementation Date
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Carrier ICD-10 Implementation Date
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Carrier Preparation Tasks• Identify Carriers that are exempt from ICD-10 requirements (Work Comp, Liability)
• Identify Carriers that will not be ready to accept ICD-10 codes on 10/01/2015– Websites, calls
• Update Carrier Implementation Date far future date (Example: 12/31/9999)
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Prepare for Mapping
• Determine Top Diagnoses • Identify NOS • Laterality• 7th Character• “X” Character
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ICD9>ICD10
Exact match24.2%
Approximate 49.1%
No Mapping3.0%
Multiple Choices18.7%
1 to Many2.1%
Complex 2.9%
Matching
Source: Centers for Medicare & Medicaid Services (CMS) General Equivalence Mapping (GEMs). Based on 2011 GEMS mapping.
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S
Location
Displaced Transverse Fracture
Category Extension
Shaft of Humerus Initial Encounter of closed fracture
4 2 3 2 1 A
Etiology Laterality
Right ArmHumerus Fracture
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All Femur Fracture Codes
ICD-9: 16 codesICD-10: 1530 codes
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ICD-10 CM Format• Alphabetic Index
– 21 Chapters• Tabular List• Instructional Notes
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GEMSGeneral Equivalence Mapping
• Created by CMS and CDC• Crosswalk Tool• Backward and Forward Mapping• Posted annually with updated• Will be maintained for 3 years post implementation
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ICD-10 Diagnosis Codes
• Load ICD-10 codes• Map to ICD-9 as applicable• Review “pre-mapped”
– User is responsible for accuracy
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Load ICD-10 Codes
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Mapping
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Visit Record – ICD 10
• Enterprise Date ICD 10• Insurance Carrier ICD 10 Implementation Date • Date of Service
– Prior to October 2015 – ICD-9 – October 2015 or later – ICD-10
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Claim • Insurance Carrier Implementation Date
Medicare – Implemented ICD-10
Consolidated Healthcare – Not implemented
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Visit – ICD 10 Codes Display
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Date of Service Prior to 10/01/2015
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DX Search Based
Enterprise Implementation
Date &
Date of Service
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Do you have a plan?
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Plan for Chart Requirements
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Questions
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ResourcesCMShttp://cms.gov/Medicare/Coding/ICD10/index.html
WHOhttp://apps.who.int/classifications/icd10/browse/2015/en
AMAWEB