ICD-10

Moving to ICD-10-CM has been a challenge – especially for practices that treat pediatric patients. Unlike many other specialties, you treat the entire body. So, the sheer volume of new ICD-10 codes you’ll have to learn and bill far exceeds most other specialties. Additionally, the new ICD-10 system has 5 times more codes (14,025 vs. 68,069), and an entirely new code organizational structure and rules related to how you are going to choose the right diagnosis code.

There is a 90-minute online training session that has been archived, which is specifically targeted to the needs of those practices that treat primary care pediatric patients. The session will provide you with all of the tools you need to get both your administrative and clinical staff up to speed for this massive transition.

Here are just a few of the pediatric-specific ICD-10 strategies you’ll receive by attending this practical online training session:

  • Master pediatric-specific ICD-10 fundamentals to lay a strong foundation for transition success
  • Ace ICD-10 conventions and structure for your pediatric claims to avoid significant denials come Oct. 1st
  • Incorporate successful ICD-10 documentation strategies that will have your claims sailing through and your money coming in
  • Conquer documentation requirements for the top pediatrics primary care diagnoses, some examples include:

* Asthma                      * Tonsillitis                * Newborn Feeding
* Pharyngitis                * Otitis Media            * Pharyngitis
* Counseling                * Diarrhea                  * Routine health check
* Sinusitis                     * Vaccinations           * Fracture
* Headache                   * Diabetes                  * Sports and school physicals

  • And so much more…

Please note: You won’t be allowed to submit ANY claims after October 1, 2015 if you are not utilizing ICD-10.

Unlike many other training sessions, this one is designed specifically to meet your diagnosis needs for pediatric patients.  It will focus only on those ICD-10 challenges specific to your pediatric patients, so not even a minute of your time is wasted.

Waiting any longer to get a handle on your ICD-10 transition will have catastrophic results on the financial health of your practice. In fact an American Medical Association study found that small practices could expect a payment disruption due to ICD-10 of $100,000. Can your practice survive under these circumstances? I urge you not to wait any longer.

Anyone who is responsible for applying and ensuring accurate diagnosis coding needs to be prepared for this monumental change. It doesn’t matter if you are a Coder, Biller, Practice Manager or Provider (Pediatrician, Family Practitioner, NP or PA), taking the time to learn this new system NOW is the only way to ensure you’ll be successful after its implementation.


From AAP News‘ Coding Corner: ICD-10-CM: Review the Nuts and Bolts – Prepare for the October 1, 2015 implementation with a review of the basics for applying the code set.  Master rules on locating a code, level of detail, format/structure, placeholder codes, 7th characters, punctuation and terminology.


 

Your Practice’s ICD-10 Transition is in Good Hands.  Yours!

On October 1st the U.S. health care system moved to the International Classification of Diseases, 10th Revision – ICD-10.  The change to ICD-10 allows you to capture more details about the health status of  your patients and sets the stage for improved patient care and public health surveillance across our country.  ICD-10 will help move the nation’s health care system to better, smarter care.

You may wonder when we’ll know how the transition is going.  It will take a couple of weeks before we have the full picture of ICD-10 implementation because very few health care providers file claims on the same day a medical service is given. Most providers batch their claims and submit them every few days.

Even after submission, Medicare claims take several days to be processed, and Medicare – by law – must wait two weeks before issuing payment. Medicaid claims can take up to 30 days to be submitted and processed by states.  Because of these time frames, we expect to know more about the transition to ICD-10 after completion of a full billing cycle.

Because we know this is a major transition, we’ll be:

  • Monitoring the transition in real time.
  • Watching our systems.
  • Addressing any issues that come to the ICD-10 Coordination Center.

The Coordination Center is a dedicated group of Medicare, Medicaid, billing, coding, and information technology systems experts drawn from across CMS. They have the full support of the entire CMS staff to address any issues quickly and completely.

It’s important that you know help’s available if you have problems with ICD-10:

This important moment is possible because we’ve all worked together to make it happen.  We’re grateful for your support and look forward to working with you as we make this transition.

 

Keep Up to Date on ICD-10

Visit the CMS ICD-10 website and Roadto10.org for the latest news and resources to help you prepare, including the ICD-10 Quick Start Guide.

The resources available through Road to 10 will help you:

  • Understand the basics of ICD-10, the differences between ICD-9 and ICD-10, and the opportunities associated with ICD-10
  • Explore common codes, primers for clinical documentation, clinical scenarios and physician perspectives, all broken out by specialty
  • Create a customized action plan, personalized by specialty and practice details

As part of the Road to 10 Program, CMS has also launched webcasts and training designed to support your ICD-10 transition.  On the left-hand navigation menu of the http://www.roadto10.org homepage, click the “Webcasts” tab to view the latest on-demand sessions, or click the “Events” tab for more information about in-person training opportunities.

To help your practice with this transition, the following resources are available to help you:

In addition, you may also want to…

As part of assessing how ICD-10 affects your practice, you should find out if you need:
Access to ICD-10 codes – You can find codes from a variety of sources, including:

  • Code books
  • CD/DVD and other digital media
  • Online (e.g., go to cms.gov/ICD10 and select “2016 ICD-10-CM and GEMS” to download 2016 Code Tables and Index)
  • Practice management systems
  • Electronic health record (EHR) products
  • Free and low-cost smartphone apps
  • CMS ICD-10 Code Lookup
  • Coding Conversion Tool

Clearinghouse services – Some providers who are not ready could benefit from contracting with a clearinghouse to submit claims.

  • Clearinghouses can help by:
    • Identifying problems that lead to claims being rejected
    • Providing guidance about how to fix rejected claims (e.g., more or different data need to be included)
  • Clearinghouses cannot help you code in ICD-10 codes unless they offer third-party billing/coding services.

Clinical documentation and coding training

  • Train staff on ICD-10 fundamentals using the wealth of free resources from CMS, which include the ICD-10 website, Road to 10, Email Updates, National Provider Calls, and webinars. Free resources are also available from:
    • Medical societies, health care professional associations
    • Hospitals, health systems, health plans, vendors
  • Training for clinical staff—e.g., physicians, nurse practitioners, physician assistants, registered nurses—should focus on documentation, new coding concepts captured in ICD-10.
  • Training for coding and administrative staff—e.g., coders, billers, practice managers—should focus on ICD-10 fundamentals.

New forms – It is crucial to update hard-copy and electronic forms (e.g., superbills, CMS 1500 forms).
Systems upgrades – Double check that you’ve identified all systems that use ICD codes and need upgrades (e.g., practice management systems, electronic health record (EHR) products).

  • Call your vendors to confirm the ICD-10 readiness of your practice’s systems
  • Confirm that the health plans, clearinghouses, and third-party billing services you work with are ICD-10 ready
  • Ask vendors, health plans, clearinghouses, and third-party billers about testing opportunities
  • Transition costs for small medical practices could be substantially lower than projected earlier:
    • Many EHR vendors are including ICD-10 in their systems or upgrades—at little or no cost to their customers

The ICD-10 (International Statistical Classification of Diseases – 10th Revision) is a medical classification list for the coding of diseases as maintained by the World Health Organization.  The code set allows more than 16,000 different codes, and permits the tracking of many new diagnoses.  This code set also includes mortality rates broken down by disease, age group, and sex.  The app below, from Medical Billing & Coding Certification, can provide the code for ICD-10; simply type in the diagnosis: