ICD-10 Implementation, New Features, Benefits, and Our Plan of Action for Internal Medicine Web: www.vocisinc.com Sales: 866 365 3909 Email: contact@vocisinc.com
ICD-10-CM/PCS COMPLIANCE DATE
Implementation scheduled for 1st October 2014
Testing of these codes starts effective January 2014
BENEFITS OF ICD-10-CM
ICD-10-CM incorporates much greater clinical detail and will be more specific than ICD-9-CM.
For example : ICD-10 for Right knee pain-M25.561 and Left knee pain-M25.562 where as ICD-9 for Right or Left knee pain – 719.46
Reducing the need for attachments to explain the patient’s condition
Improving clinical, financial, and administrative performance
Preventing health care fraud and will be more informative
Once coding is completed , ICD-10 makes claim submission more efficient
Difference
ICD-9
ICD-10
Consists of 3 – 5 characters
Consists of 3 – 7 characters
1st character is alpha or numeric
1st character is always alpha
Shorter code description as not specific and abbreviated codes
Longer code description as more specific and detailed codes
13,600 codes
69,000 codes
Eg. Rotator cuff sprain and strain is Eg. Rotator cuff sprain and strain is 840.4 S43.429A Eg. Hip Pain : 719.45
Eg. Hip Pain : M25.559
Eg. Rotator cuff sprain and strain is Eg. Rotator cuff sprain and strain is 840.4 S43.429A
ICD 9
DIAGNOSIS
ICD 10
Hypertension Hypertension, unspecified
401.9
I10
Hypertension, uncontrolled
401
I10
DM type 2
Diabetes 250
E11.9
DM type 1
250.02 250.01
E11.65 E10.9
DM type 1, uncontrolled
250.03
E10.65
DM type ii, Uncontrolled
Neoplasm Malignant neoplasm, lung
162.9
C34.90
Metastatic neoplasm liver
197 212.3
C78.00 D14.30
Benign neoplasm, lung
Frequently Used Codes – VOCIS observation VOCIS checked the documentation for the most often used codes in your practice
Diagnosis
ICD 9
ICD 10
Hypertension
401.9
I10
Chronic pain syndrome
338.4
G89.4
Congestive heart failure
428.0
I50.9
Long term medication
V58.69
Z79.899
Fatigue
780.79
R53.1
Constipation
564.00
K59.00
Allergic rhinitis
477.9
J30.9
Back pain
724.5
M54.9 Continued‌
Diagnosis
ICD 9
ICD 10
Diabetes - Type II
250.00
E11.9
Hyperlipidemia
272.4
E78.5
Degenerative Disc Disease Lumbar Spine
722.52
M51.36
Anxiety
300.00
F41.9
Depression
311
F32.9
Chronic pain
338.29
G89.29
Anemia
285.9
D64.9
Atrial Fibrillation
427.31
I48.91
Coronary Artery Disease
414.00
I25.10
Cerebral Vascular Accident Degenerative Disc Disease Cervical Spine
434.91
I63.50
722.4
M50.30
Hypothyroidism
244.9
E03.9
ICD-10 impact on Revenue Cycle Management
VOCIS anticipation
Delayed reimbursement from government during ICD-10 implementation as this is in the transition phase, some delays can be expected
Account Receivable days may increase by 20 to 40 percent post implementation through a transition period
As per survey “Workgroup for Electronic Data Interchange” (WEDI) – (the leading authority on the use of Health IT to improve healthcare information exchange in order to enhance the quality of care, improve efficiency and to reduce costs of the American healthcare system)
estimates that rejection and denial rates may increase by 100 – 200 percent during the same period
Continued…
VOCIS Plan of Action
We have already started training for our staff on ICD-10 implementation via attending Webinars and trainings arranged by AAPC
Will keep educating the Providers on the updates and changes for ICD-10 implementation
ICD-10 codes is already imported in the billing software so that the testing can be started at the earliest and to get familiar with new codes – Testing starts effective Jan 2014
Generally we accept 45-60 days in AR as quite reasonable, but we would have to be more aggressive , more goal oriented. In actual words its time to challenge the process
VOCIS planned to focus on the AR a bit early so that the
denials can be captured on time and can be worked accordingly. This will fasten the payment process. Continued…
Few of the AR reporting will help to manage the accounts
Zero to 30 days, separated by payer
Daily and weekly revenue
Outstanding days
Insurance verification for all the patients/accounts will be checked before billing the claim to insurance. This will ensure that we are billing the claim to the right insurance and will speed up the payment process and at the same time will reduce the denials
Additional Information
New claim form/CMS-1500 named 02/12 form (sample on next page)will be used, with more columns to add the ICD-10 codes which results in more accurate payment flow from the insurance side
The current claim form/CMS-1500 has the limitation of using only 4 ICD-9 codes
During the training period we will bill ICD-9 and ICD-10 simultaneously to the insurance on the same claim form to ensure that we are billing correct codes
The version 02/12 form will likely be accepted by Medicare in January of 2014, but providers can still use the old forms until April 1, 2014, when only the 02/12 form will be accepted
Suggestions -
Important for Providers
Providers will need to improve documentation because unless they are as specific as possible, coding staff will never be able to assign the right code which might lead to billing complications
Front desk should always discuss the patient responsibility before treatment and COPAY should be collected on the day of service also patient should be informed of the left over balance after the insurance pays : will be Patient’s responsibility
ICD-10 implementation may require the need for financial back up OR line of credit to offset cash flow challenges due to government glitches Continued…
NEW FEATURES IN ICD-10-CM
Laterality (Left, Right, Bilateral)
Examples:
C50.511 – Malignant neoplasm of lower-outer quadrant of right female breast;
H16.013 – Central corneal ulcer, bilateral; and
L89.012 – Pressure ulcer of right elbow, stage II.
Combination Codes For Certain Conditions and Common Associated Symptoms and Manifestations
Examples:
K57.21 – Diverticulitis of large intestine with perforation and abscess with bleeding;
E11.341 – Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema; and
Continued…
Character “x” is Used as a 5th Character Placeholder in Certain 6 Character Codes to Allow for Future Expansion and to Fill in Other Empty Characters (For Example, Character 5 and/or 6) When a Code That is Less Than 6 Characters in Length Requires a 7th Character
Examples:
T46.1x5A – Adverse effect of calcium-channel blockers, initial encounter; and
T15.02xD – Foreign body in cornea, left eye, subsequent encounter
Inclusion of Clinical Concepts That Do Not Exist in ICD9-CM (For Example, Underdosing, Blood Type, Blood Alcohol Level)
Examples:
T45.526D – Underdosing of antithrombotic drugs, subsequent encounter;
Z67.40 – Type O blood, Rh positive; and
Y90.6 – Blood alcohol level of 120 – 199 mg/100 ml.
Continued…
A Number of Codes Are Significantly Expanded (For Example, Injuries, Diabetes, Substance Abuse, Postoperative Complications)
Examples:
E10.610 – Type 1 diabetes mellitus with diabetic neuropathic arthropathy;
F10.182 – Alcohol abuse with alcohol-induced sleep disorder; and
T82.02xA – Displacement of heart valve prosthesis, initial encounter
Who We Are
In 2000, A group of Healthcare Industry veteran talents teamed up to launch, 'Vocis', an organization with a difference, that specialized in making medical groups more competitive for today's world
Advised and owned by Physicians
A BBB Accredited; Practice Management Company based in Louisville KY, involved in Medical Credentialing, Billing, Collections, Transcription, Practice Marketing, Virtual Receptionist, and Practice Set up for independent NPs, PTs, and MDs
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Web: www.vocisinc.com Sales: 866 365 3909 Email: contact@vocisinc.com
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“We charge just amount”
4 to 8% of collected
Contact Us Sales 866 365 3909 General Information Phone – 502 638 4285 Web – vocisinc.com Email – contact@vocisinc.com