ICD-10: 4 Steps to Success

ICD-10:
4 Steps to Success

Our Schedule for Today…
1 Introduction & Welcome
2 ICD-10: 4 Steps to Success
3 Discover ICD-10 Resources
4 Answer Questions

Your Hosts Today…
Michelle Cavanaugh,
RN, CPC, CANPC, CGIC, CPB, CMRS
AHIMA Approved ICD-10-CM Trainer
Lea Chatham
Editor-in-Chief, Getting Paid Blog

Participate via Social
Facebook.com/GoKareo
Twitter.com/GoKareo
We’ll be live tweeting during today’s webinar!
How to participate:
1. Follow @GoKareo on Twitter
2. Follow @LeaChatham on Twitter
3. Search for #KareoTip
4. Join the conversation using #KareoTip

Michelle Cavanaugh
 AHIMA Approved ICD-10-CM trainer
 Certified Professional Coder (CPC)
 AAPC Certified Professional Biller
 AMBA Certified Medical Reimbursement
Specialist
 Owned successful medical billing company
for 16 years
 Grew business to over 60 customers
 15 years as ICU RN
 Director of Nurses at 2 home health
agencies
 BSN, University of Maryland

What We’ll Cover Today
1. ICD-10: How Is It Different?
2. Impact on Your Practice
3. 4-Step Plan for Success
4. The Role of Technology

ICD-10-CM: How It Differs
ICD-9-CM ICD-10-CM
Diagnosis Codes are 3-5 characters Codes are 3-7 characters
Approximately 14,000+ codes 69,000+ codes
First character is numeric or alpha (E or
V) 2-5 are numeric
First character is alpha, characters 2
and 3 are numeric, 4-7 are alpha or
numeric
Difficult to analyze data due to
nonspecific codes
Expanded to allow more specificity and
accuracy resulting in improved data
analysis

ICD-10-CM: Top 5 New Features
Laterality: Left, Right, Bilateral
Combination Codes
Excludes 1
Excludes 2
X as a place holder for future
expansion of coding

ICD-10-CM: New Features
 Laterality: Left, Right, Bilateral
ICD-9-CM ICD-10-CM
374.84 Cyst of Eyelids H02.821 Cysts of right, upper eyelid
H02.822 Cysts of right, lower eyelid
H02.824 Cysts of left, upper eyelid
H02.825 Cysts of left, lower eyelid
371.01 Minor Opacity of Cornea H17.811 Minor Opacity of Cornea, right eye
H17.812 Minor Opacity of Cornea, left eye
H17.813 Minor Opacity of Cornea, bilateral

ICD-10: New Features
 Combination Codes:
 A single code is used to describe 2 diagnoses or a certain
conditions and common associated symptoms and
manifestations or complication.
 Poisonings and their associated external causes.
Example
K57.21 Diverticulitis of large intestine with perforation
and abscess with bleeding
Example
T42.3x2S Poisoning by barbiturates, intentional self-
harm, sequela

 Combination Codes, con’t.:
 Obstetric Codes: Identifies trimester instead of episode of care

ICD-9-CM ICD-10-CM
646.11 Edema or excessive
weight gain Antepartum
O26.01 Excessive weight gain in pregnancy,
first trimester
second trimester
third trimester

 Excludes1:
 Found in the tabular list only
 Indented section under main code and is
often marked by a black box around the
word Excludes1
 Lists the codes that should never be used
together – not coded here
ICD-10-CM Excludes1
D21.3 Benign Neoplasm of connective
and other soft tissue of thorax
D15.0 Benign neoplasm of thymus
D15.1 Benign neoplasm of heart
D15.2 Benign neoplasm of mediastinum

 Excludes2
 Not included here so both codes may be reported to
for the patient who has both conditions.
 May have a grey box around the word Excludes2
ICD-10-CM Excludes2
S40.87 Other superficial bite of the upper
arm
S40.27- other superficial bite of shoulder

 Fill in the Character: Character “x” is used as a character
placeholder to all for future expansion
 The use of the “x” is mandatory to have a complete code
ICD-9-CM ICD-10-CM
679.11 Fetal comp from in utero
procedure, delivered first
trimester
O35.7xx1 Maternal care for damage to fetus
by other medical procedure, fetus 1

What We’ll Cover Today
1. ICD-10: What Is It & How Is It Different?
2. Impact on Your Practice
3. 4-Step Plan for Success
4. The Role of Technology

Impact on Your Practice
 You should already have on
hand…
 CMS-1500 (01/12) claim forms
 ICD-10-CM 2015 Code Book
 ICD-10-CM Code Mapping
Book/Tool
 Report on top 50 ICD-9-CM
codes for your practice

Impact on Your Practice
 Greatest impact on three
areas in the practice:
 Claims Processing
 Productivity
 Financial

Claims Processing
Reduced denials for medical necessity
Reduced requests for additional
documentation
Likely to have the same payer issues as
we have to day – no magic wand
Some experts are warning that using
unspecified codes may result in
nonpayment in the long term
Assess your software vendor’s
readiness

Productivity
 Productivity down
 Learning curve for all providers and
staff
 Order entry, pre-auths, referrals
 Increased documentation demands
 More time to code
 Change in EHR pick lists and super
bills

Financial Impact
 Budget of the change
 Potential for delayed claims payment
 Decreased productivity
 Fewer patients on the schedule
 Training costs
 Technology upgrades may be needed

PAGE KAREO | CONFIDENTIAL
Why Engage Patients?
Many experts are suggesting that you
should expect to see a reduction in
productivity and revenue for about three
months of up to 50%.

So Where Do I Start?

Step 1: Code Mapping
 5 benefits to code mapping
 Understand ICD-10 codes specific to your
specialty.
 Learn equivalent ICD-10 codes and
determine if more specific documentation is
required.
 Improve the accuracy of your billing.
 Define changes to documents and
forms.
 Plan and customize
staff training.

Step 1: Code Mapping
Ranking ICD-9 Codes ICD-9
Diagnosis
Description
ICD-10 Codes ICD-10
Diagnosis
Description
1 401.9 Unspecified
essential
hypertension
I10 Essential
(Primary)
Hypertension
2 414.00 Coronary
atherosclerosis
of unspecified
type of vessel,
native or graft
I25.10 Atherosclerotic
heart disease of
native coronary
artery w/o
angina pectoris
3 427.31 Atrial fibrillation 148.0
148.2
148.91
Paroxysmal
atrial fibrillation
Chronic atrial
fibrillation
Unspecified
atrial fibrillation

Step 2: Improved Documentation
 Top priority for providers:
 Document in more detail now! The
expectations for detail will be higher
with ICD-10. An EHR will help.
 Know your codes. Code mapping
can provide a head’s up on what
codes you will use most after
October 1, 2015.
 Get some help. Consider hiring a
Clinical Documentation Improvement
(CDI) specialist to audit and train.

 Initial encounter: Indicated by an ‘A’ as the 7th
character
Example: T22.111A: Burn of first degree of right forearm,
First or Initial encounter
 Subsequent encounter: Indicated by the letter ‘D’
Example: T22.111D: Burn of first degree of right forearm,
Subsequent encounter
 Sequela: Indicated by the letter ‘S’ as the 7th
character
Example; T22.111S : Burn of first degree of right forearm,
Sequela

CMS believes the increased specificity in
documentation will make it easier to assign
codes correctly, which should result in fewer
errors, fewer unpaid claims, and therefore
fewer requests to resubmit claims with
supporting documentation
= Improved Cash Flow

 Examples of Specialty Changes:
 Surgeons: Certain digestive conditions are
now combination codes that require specific
information for coding.
 OB/GYN: Document the specific trimester (or
weeks+days). Many of the codes in this
section require coders to report the specific
trimester of the patient’s pregnancy.
 Orthopedics: Laterality and site specificity is
a common theme in ICD-10-CM orthopedic
coding so be sure to document this in
dictation.

 Examples of Primary Care Changes:
 Headaches: Lots of new codes for headaches.
For migraine (code G43), physicians must
specify common, hemiplegic, persistent,
chronic, ophthalmologic, abdominal, or
menstrual.
 Ear Infections: Various codes to denote
specific forms of a middle ear infection. These
codes are grouped in H65-H67 and distinguish
between forms of otitis media: Serous, Allergic,
Mucoid, Nonsuppurative, Suppurative,
Tubotympanic suppurative, Atticoantral
suppurative.

Step 3: Training
 Training for ICD-10 may vary
depending on the complexity of
changes for your specialty:
 Online and in-person.
 Cost will vary.
 Range from 4 hours to 2 days

Step 3: Training
 Clinical Providers
 Areas impacted:
 Coding Changes
 Documentation Changes
 Software Changes
 4-8 hours in person or online training
($250 - $300)
 Documentation review/training
 Medical Society specialty training
 Vendor training

Step 3: Training
 Practice Manager
 Areas Impacted:
 New Policies
 Updates to Payer Contracts
 Budgeting/Financial Planning
 New Forms/Software Changes
 4-8 hour online or in person ($250 -
$300)
 Practice management/executive
specialty training (PAHCOM, AAPC,
MGMA, AHIMA, etc.)
 Vendor training

Step 3: Training
 Billing & Coding has the greatest impact
 Impacts:
 Payer Changes
 Coding Changes
 Software Changes
 Not certified
 4-8 hours
 $250 - $300
 Certification Training
 2-3 Days
 $700 - $1200

Step 3: Training
 Front Desk
 Impact: Prior Authorizations
 4-8 basic training
 Online or in person ($250 - $300)
 Vendor training
 Medical Assistant/Nurse
 Impact: Documentation
 4-8 basic training
 Online or in person ($250 - $300)
 Vendor training

Step 4: Financial Planning

Step 4: Financial Planning - Budget

Step 4: Financial Planning – Cost Containment
 Reduce utilities and routine
overhead
 Review contracts and leases
 Automate eliminate manual tasks
 Outsource services
 Postpone pay increases and
bonuses
 Train to be ICD-10-CM Ready by the
deadline

Role of Technology
 Eliminates need to update
most forms
 Simplifies documentation
 Enables code mapping
 ICD-9-CM to ICD-10-CM
Crosswalk
 Supports more accurate,
complete coding
 Improves billing with
electronic superbill

Role of Technology
 Can make all collection
efforts more streamlined
and effective to
strengthen revenue
 Provides tools to help
manage and track claims
 Stay on top of denials,
rejections and no
response claims

Discover Kareo’s Role
Cloud-based
Billing, Scheduling & Practice Management
Electronic Health Records
Medical Billing Services
Practice Marketing & Patient Engagement
Free Education, Training, & Support
Ranked #1 by Black Book 3 Years
30,000 Providers Nationwide

Kareo.com ICD-10 Resource Center
 Small Practice Guide
 Success Checklist
 Assessments
 e-book Specialty Guides
 Mental Health
 Pediatrics
 Primary Care
 Surgery
 Orthopedics
 Resource Library
 4 Steps to Success Webinar
 Product Trainings
http://www.kareo.com/icd-10

Discover Kareo’s Role
– Kareo Practice
Management
• Multi-resource
scheduling
• End-to-end claim
management
• Patient statements
• Integrated credit
card processing
• Online billpay

ICD-10 Ready
– ICD-10 Ready
• ICD-10 Success
Dashboard
• Dual Coding
Encounters
• Encounter &
Insurance Payer
Validation
• Diagnosis
Crosswalk

Kareo Medical Billing: Web, Mobile & Messaging!
• Web and Mobile Software
• Calendar & Patient Check-in
• IBM & MAC Enabled
• Secure Messaging
• Revenue Cycle Performance
for Visibility
• Kareo Success Team

ICD-10 Survival Plan
New Kareo Medical Billing
customers receive:
• 4-week step-by-step plan
• Customer Success Coach &
training
• ICD-10 & specialty-trained
billers
• Assisted payer enrollment &
data import

Our Schedule for Today…
1 Introduction & Welcome
2 ICD-10: What Physicians Need to Know
3 Discover ICD-10 Resources
4 Answer Questions

ICD-10: 4 Steps to Success

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