1. No category

3/5/2014
ICD-10: How to make
the Transition: part II
Presented by Evan M. Gwilliam, MBA DC
CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA
Director of Education for
1
Which parts of a practice will
be affected?
Front Desk
• System updates, training
Providers
Management
• Documentation with more
• Vendor and payer contracts specificity
• Budgeting
• New code specific training
• Training plan
• Compliance plan, coding
guidelines
1
3/5/2014
Which parts of a practice will
be affected?
Clinical areas
• New patient coverage policies
• New super bills
• New LCDs (available by 4/10/2014)
Billing
• Code set training
• Reimbursement policies (more denials?)
4
2
3/5/2014
CMS-1500 Claim form
•Approved for official
use 08/05
•www.nucc.org for
official instructions
5
6
3
3/5/2014
CMS-1500 Claim form
Revision 02/12
•Changed to match the electronic format (5010) and ICD-10
codes
•Adds space for eight more diagnosis codes in box 21.
•January 6th, 2014 - Health plans and clearinghouses must
accept the form.
•April 1st, 2014 – Providers must use the new form
7
Why can’t we keep using ICD-9?
ICD-9
~14,000
codes
ICD-10
~68,000
codes
8
4
3/5/2014
How are ICD-9 and ICD-10 different?
9
How do I find the ICD-10 code?
General Equivalence Mappings (GEMs)
o Created by the National Center for
Health Statistics, part of the CDC
o Forward maps from ICD-9 to ICD-10
o Backward maps from ICD-10 to ICD-9
o Download the free tablet/smartphone
app called “FindACode”
o Use the Code Map section in the
ChiroCode ICD-10 book (pages 57-133)
o ChiroCode members can access the
MapACode tool in their accounts
10
5
3/5/2014
How do I find the
ICD-10 code?
One-to-one mapping:
723.1 Cervicalgia 
M54.2 Cervicalgia
One-to-four mapping:
724.4 Thoracic or lumbosacral neuritis (radicular
syndrome of the lower limbs)
M54.14, M54.15,M54.16, M54.17
Radiculopathy
How do I find the
ICD-10 code?
One-to-many mapping:
733.82 Other disorders of bone and cartilage,
nonunion of fracture 
S02.91XK through S92.919K
(for a total of 2530 corresponding ICD-10-CM possibilities)
6
3/5/2014
How do I find the
ICD-10 code?
Look up 724.3 using GEMs:
-M54.30
-unspecified codes need to be investigated
Look up “sciatica” in the ICD-10 index
-M54.3
-at least five characters required to code to
the highest level of specificity
Now find it in the tabular list
13
How do I find the
ICD-10 code?
Combination mapping:
724.3 Sciatica
M54.30 Sciatica, unspecified side
M54.31 Sciatica, right side
M54.32 Sciatica, left side
OR
M54.40 Sciatica with lumbago, unspecified
M54.41 Sciatica with lumbago, right side
M54.42 Sciatica with lumbago, left side
7
3/5/2014
What does the documentation
look like?
Codes must be supported by
the documentation in the
patient record.
The AAPC estimates an
increase in documentation
time of 15%.
The AAPC also found that
65% of physician notes were
not specific enough.
Examples of details not
necessary in ICD-9:
• side of dominance
• trimesters
• stages of healing
• laterality
• ordinality
15
What does the documentation
look like?
“Exam findings are consistent with cervical sprain/strain and
acute cephalgia due to motor vehicle accident”
In ICD-9, the codes might be:
• 847.0 Cervical sprain
• 339.21 Acute post-traumatic headache
• E813.0 Motor vehicle traffic accident involving collision with
other vehicle; driver of motor vehicle other than motorcycle
injured
16
8
3/5/2014
What does the documentation
look like?
“Exam findings are consistent with cervical sprain/strain and
acute cephalgia due to motor vehicle accident”
In ICD-9, the codes might be:
• 847.0 Cervical sprain
• 339.21 Acute post-traumatic headache
• E813.0 Motor vehicle traffic accident involving collision with
other vehicle; driver of motor vehicle other than motorcycle
injured
17
What does the documentation
look like?
“Exam findings are consistent with cervical sprain/strain and acute cephalgia
due to motor vehicle accident”
In ICD-9, the codes might be:
• 847.0 Cervical sprain
General Equivalence Mappings (free FindACode app) suggest the following
codes:
• S13.4xxA Sprain of ligaments of the cervical spine, initial encounter
OR
• S13.8xxA Sprain of other parts of the neck, initial encounter
Note: When you look up S13.4xxA in the tabular list, you will find which
parts of the cervical spine it includes in the fine print. This is why you
need a complete book, not just a short crosswalk list of codes.
18
9
3/5/2014
What does the documentation
look like?
“Exam findings are consistent with cervical sprain/strain and acute
cephalgia due to motor vehicle accident”
In ICD-9, the codes might be:
• 847.0 Cervical sprain
If you knew to look up
“injury of muscle, facscia and tendon atneck level”
in the index you would also find:
• S16.1xxA Strain of muscles, fascia and tendon at neck level, initial
encounter
Note: Sprain and strain are separate codes in ICD-10.
Crosswalks won’t tell you about this code, you need to know how
to use the alphabetic index.
19
What does the documentation
look like?
“Exam findings are consistent with cervical sprain/strain and
acute cephalgia due to motor vehicle accident”
In ICD-9, the codes might be:
• 847.0 Cervical sprain
• 339.21 Acute post-traumatic headache
• E813.0 Motor vehicle traffic accident involving collision with
other vehicle; driver of motor vehicle other than motorcycle
injured
20
10
3/5/2014
What does the documentation
look like?
“Exam findings are consistent with cervical sprain/strain and
acute cephalgia due to motor vehicle accident”
In ICD-9, the codes might be:
• 339.21 Acute post-traumatic headache
GEMs suggest:
• G44.319 Acute post-traumatic headache, not intractable
Note: In the index G44.319 is next to G44.311 which is the intractable
version of this condition.
o Intractable means “hard to control or deal with”
o This must be documented in order to select the correct code.
21
What does the documentation
look like?
“Exam findings are consistent with cervical sprain/strain and
acute cephalgia due to motor vehicle accident”
In ICD-9, the codes might be:
• 847.0 Cervical sprain
• 339.21 Acute post-traumatic headache
• E813.0 Motor vehicle traffic accident
involving collision with other vehicle;
driver of motor vehicle other than
motorcycle injured
22
11
3/5/2014
What does the documentation
look like?
“Exam findings are consistent with cervical sprain/strain and
acute cephalgia due to motor vehicle accident”
In ICD-9, the codes might be:
• E813.0 Motor vehicle traffic accident involving collision with
other vehicle; driver of motor vehicle other than motorcycle
injured
Note: External cause codes describe location, circumstances,
and causes of injury. More detail is needed since these codes
are greatly expanded in ICD-10.
(However, they are only required if you already use ICD-9 E-codes)
23
What does the documentation
look like?
“Exam findings are consistent with strain and sprain of the ligaments
and muscles of the cervical spine and acute traumatic headache, which
does not respond to over the counter medications. Patient was the driver
of a vehicle that collided with another motor vehicle on the interstate. He
was not treated at the scene.”
The ICD-10 codes in this case are:
• S13.4xxA Sprain of ligaments of the cervical spine, initial encounter
• S16.1xxA Strain of muscles, fascia and tendon at neck level, initial
encounter
• G44.311 Acute post-traumatic headache, intractable
• V49.40xA Driver injured in collision with unspecified motor vehicle,
traffic accident, initial encounter
• Y92.411 Interstate as place of occurrence of the external cause
24
12
3/5/2014
What does the documentation
look like?
“Exam findings are consistent with strain and sprain of the ligaments
and muscles of the cervical spine and acute traumatic headache, which
does not respond to over the counter medications. Patient was the driver
of a vehicle that collided with another motor vehicle on the interstate. He
was not treated at the scene.”
The ICD-10 codes in this case are:
• S13.4xxA Sprain of ligaments of the cervical spine, initial encounter
• S16.1xxA Strain of muscles, fascia and tendon at neck level, initial
encounter
• G44.311 Acute post-traumatic headache, intractable
• V49.40xA Driver injured in collision with unspecified motor vehicle,
traffic accident, initial encounter
• Y92.411 Interstate as place of occurrence of the external cause
25
What does the documentation
look like?
“Exam findings are consistent with strain and sprain of the ligaments
and muscles of the cervical spine and acute traumatic headache, which
does not respond to over the counter medications. Patient was the driver
of a vehicle that collided with another motor vehicle on the interstate. He
was not treated at the scene.”
The ICD-10 codes in this case are:
• S13.4xxA Sprain of ligaments of the cervical spine, initial encounter
• S16.1xxA Strain of muscles, fascia and tendon at neck level, initial
encounter
• G44.311 Acute post-traumatic headache, intractable
• V49.40xA Driver injured in collision with unspecified motor vehicle,
traffic accident, initial encounter
• Y92.411 Interstate as place of occurrence of the external cause
26
13
3/5/2014
What does the documentation
look like?
“Exam findings are consistent with strain and sprain of the ligaments
and muscles of the cervical spine and acute traumatic headache, which
does not respond to over the counter medications. Patient was the driver
of a vehicle that collided with another motor vehicle on the interstate. He
was not treated at the scene.”
The ICD-10 codes in this case are:
• S13.4xxA Sprain of ligaments of the cervical spine, initial encounter
• S16.1xxA Strain of muscles, fascia and tendon at neck level, initial
encounter
• G44.311 Acute post-traumatic headache, intractable
• V49.40xA Driver injured in collision with unspecified motor vehicle,
traffic accident, initial encounter
• Y92.411 Interstate as place of occurrence of the external cause
27
What does the documentation
look like?
“Exam findings are consistent with strain and sprain of the ligaments
and muscles of the cervical spine and acute traumatic headache, which
does not respond to over the counter medications. Patient was the driver
of a vehicle that collided with another motor vehicle on the interstate. He
was not treated at the scene.”
The ICD-10 codes in this case are:
• S13.4xxA Sprain of ligaments of the cervical spine, initial encounter
• S16.1xxA Strain of muscles, fascia and tendon at neck level, initial
encounter
• G44.311 Acute post-traumatic headache, intractable
• V49.40xA Driver injured in collision with unspecified motor vehicle,
traffic accident, initial encounter
• Y92.411 Interstate as place of occurrence of the external cause
28
14
3/5/2014
What does the documentation
look like?
“Exam findings are consistent with strain and sprain of the ligaments
and muscles of the cervical spine and acute traumatic headache, which
does not respond to over the counter medications. Patient was the driver
of a vehicle that collided with another motor vehicle on the interstate. He
was not treated at the scene.”
The ICD-10 codes in this case are:
• S13.4xxA Sprain of ligaments of the cervical spine, initial encounter
• S16.1xxA Strain of muscles, fascia and tendon at neck level, initial
encounter
• G44.311 Acute post-traumatic headache, intractable
• V49.40xA Driver injured in collision with unspecified motor vehicle,
traffic accident, initial encounter
• Y92.411 Interstate as place of occurrence of the external cause
29
What does the documentation
look like?
“Exam findings are consistent with strain and sprain of the ligaments
and muscles of the cervical spine and acute traumatic headache, which
does not respond to over the counter medications. Patient was the driver
of a vehicle that collided with another motor vehicle on the interstate. He
was not treated at the scene.”
The ICD-10 codes in this case are:
• S13.4xxA Sprain of ligaments of the cervical spine, initial encounter
• S16.1xxA Strain of muscles, fascia and tendon at neck level, initial
encounter
• G44.311 Acute post-traumatic headache, intractable
• V49.40xA Driver injured in collision with unspecified motor vehicle,
traffic accident, initial encounter
• Y92.411 Interstate as place of occurrence of the external cause
30
15
3/5/2014
What does the documentation
look like?
“Exam findings are consistent with strain and sprain of the ligaments
and muscles of the cervical spine and acute traumatic headache, which
does not respond to over the counter medications. Patient was the driver
of a vehicle that collided with another motor vehicle on the interstate. He
was not treated at the scene.”
The ICD-10 codes in this case are:
• S13.4xxA Sprain of ligaments of the cervical spine, initial encounter
• S16.1xxA Strain of muscles, fascia and tendon at neck level, initial
encounter
• G44.311 Acute post-traumatic headache, intractable
• V49.40xA Driver injured in collision with unspecified motor vehicle,
traffic accident, initial encounter
• Y92.411 Interstate as place of occurrence of the external cause
31
How do I implement ICD-10
in my practice?
ICD-10 Myths and Facts
•
•
•
•
•
The date will be delayed
Myth
Worker’s Comp and Auto insurance will still use ICD-9
Fact
The number of codes make ICD-10 impossible to use
Myth
Documentation requirements are impractical
Myth or Fact
ICD-10 is already out of date
Myth
ICD-10 will replace CPT
Myth
http://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD-10MythsandFacts.pdf
16
3/5/2014
How do I implement ICD-10
in my practice?
33
How do I implement ICD-10
in my practice?
Budgeting for ICD-10 falls into four categories:
1. Information systems upgrades
2. Education and training
3. Staffing and overtime costs
4. Auditing and monitoring
documentation for ICD-10
According to a RAND corporation study, it
could cost as much as $40,000 on average,
but small clinics may be closer to just $4,000.
17
3/5/2014
How do I implement ICD-10
in my practice?
Questions for your software vendors:
• Do I need to pay for an upgrade?
• Will the software have a built in crosswalk? If
so, is it based only on GEMs?
• Will you provide any training or assistance?
• Will the software be able to report both ICD-9
and ICD-10 codes if necessary?
• When will you be ready to test your program?
http://www.cms.gov/Medicare/Coding/ICD10/Downloads
/ICD10TalkingtoVendorforMedicalPractices.pdf
How do I implement ICD-10
in my practice?
Medicare: free training
FindACode.com: Crosswalks and
other advanced tools
ICD10Monitor.com: free articles
AAPC.com: Books and expensive
training
AHIMA.org: more expensive
training
18
3/5/2014
How do I implement ICD-10
in my practice?
How do I implement ICD-10
in my practice?
1. Learn the basics-review these notes again with your whole
office
2. Buy a copy of ChiroCode Complete and Easy ICD-10 Coding for
Chiropractic. Save $10 with “DRG10”
3. Dedicate a few minutes of each office meeting to ICD-10
• Assign someone to read articles in trade journals or
ICD10Monitor.com and share them at each meeting.
• Run a report with the list of most common ICD-9 codes
for your office, then create your own crosswalk
• Take a real patient file and crosswalk it to ICD-10, then
rework the documentation.
19
3/5/2014
How do I implement ICD-10
in my practice?
5. Consider using project management to do all of the
following:
• Plan a budget for implementation expenses
• Create an internal crosswalk
• Update all your forms
• Contact all your vendors
• Conduct internal testing,
6. Use consulting services if
you need extra help.
7. Have a good time!
Is ICD-10 good….
or bad?
• Researchers will have better data
• Physicians will need to work on documentation
• Billers and coders will need to get familiar with
which codes are preferred by payers
• Payers will be able to reimburse more accurately
• Expect increased rejections, denials, and payment
delays as both health plans and providers get used
to the new codes.
40
20
3/5/2014
Is ICD-10 good….
or bad?
Recommendation: don’t procrastinate.
41
Procrastination
ChiroCode.com
Coupon code:
“DRG10”
42
21