ICD-10 news/resource round-up
Webinar: Documentation Excellence: ICD-10 from a Physician’s Perspective
The Colorado Medical Society and Colorado Access teamed up to present “Documentation Excellence: ICD-10 from a Physician’s Perspective” at various locations along the Front Range in August and September. View the webinar version of this seminar (40 minutes) here. Download the accompanying slides here.
Resources from the Centers for Medicare and Medicaid Services
To help physicians prepare their practices, the Centers for Medicare and Medicaid Services released an infographic to help practices successfully bill for services. It asks questions and links to resources regarding testing, coding and documentation. “If your systems are not ready and you are unable to submit claims with ICD-10 codes, now is the time to explore your options for submitting ICD-10 claims,” the federal CMS said in an email release. Click here to view the infographic.
CMS also has an ICD-10 quick start guide that outlines five steps practices should take to prepare for ICD-10. Click here to view the guide.
And, this MLN Matters bulletin delineates claims submission alternatives for providers who have difficulties submitting ICD-10 claims.
ICD-10 claims problems
Identify the source of the problem: Originating site (entry, practice management system); transmission (practice management system, clearinghouse, payer); processing system (payer); and triage accordingly.
The federal CMS has provided an ICD-10 Ombudsman to address ICD-10 related issues. Email firstname.lastname@example.org.
Many resources are available to assist providers with the transition, including the CMS ICD-10 website at www.cms.gov/Medicare/Coding/ICD10/index.html, including Frequently Asked Questions the CMS ICD-10 Quick Start Guide and the Road to 10: CMS Online Tool for Small Practices.
Private payer information
- Anthem ICD-10 FAQ and training tools
- Aetna ICD-10 FAQ
- CIGNA ICD-10 FAQ
- Humana ICD-10 FAQ
- Rocky Mtn. Health Plans Summer Bulletin included ICD-10 information
- UnitedHealthcare ICD-10 FAQ also have training tools on website
Use of unspecified codes in ICD-10-CM
The federal CMS has a number of resources that explain unspecified codes and how they should be used in ICD-10-CM:
- MLN Matters® Article SE1518, “Information and Resources for Submitting Correct ICD-10 Codes to Medicare”
- ICD-10 Basics MLN Connects National Provider Call - Call Materials from August 22, 2013
- More ICD-10 Coding Basics MLN Connects Call - Call Materials from June 4, 2014
- ICD-10 Coding Basics MLN Connects Video - January 2014
- Coding for ICD-10-CM: More of the Basics MLN Connects Video - December 2014
Visit the ICD-10 Medicare Fee-For-Service Provider Resources webpage for a complete list of Medicare Learning Network educational materials.
Colorado Workers’ Compensation
Physicians who treat injured workers through the Colorado Workers’ Compensation program may not need to be fully ICD-10 compliant by Oct. 1. The department is encouraging providers to work with the payers to see when they both will be ready for ICD-10. Pinnacol has confirmed that they will be able to accept ICD-10 by Oct. 1.
Practices should use the CMS 1500 billing form, but because version 02/012 carries both ICD-9 and 10, the department says this gives both providers and payers the flexibility to work together in implementing ICD-10 as it is rolled out in other insurance and health care systems.
Payers cannot deny payment for billed services purely based upon billing or not billing ICD-9 or ICD-10. Workers’ comp Rule 16-6 (E) says, “The payer should note that the current in-effect International Classification of Diseases (ICD) codes, when submitted, shall not be used to establish the work relatedness of an injury or treatment.” The ICD-10 PCS will be necessary in order to apply the DWC’s 2016 inpatient PPS hospital medical fee schedule under the version #33 MSDRG system.
On July 6, 2015, the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association announced a grace period for the Oct. 1, 2015 implementation of the ICD-10 diagnosis code set.
For a one-year period starting Oct. 1, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. This policy will be followed by Medicare Administrative Contractors and Recovery Audit Contractors.
To avoid potential problems with mid-year coding changes in CMS quality programs (PQRS, VBM and MU) for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores (i.e., for PQRS, VBM, or Meaningful Use). CMS will continue to monitor implementation and adjust the duration if needed.
CMS will establish an ICD-10 Ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition.And CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.
The October 1 deadline for implementation of the ICD-10 code set is fast approaching, and time is running out for physician practices to complete their preparation. The AAO has a broad range of materials available on its web site to help physicians prepare for the deadline. To learn more, go to the federal CMS website.
This site was created to help physicians navigate requirements of the International Classification of Diseases, 10th Revision (ICD-10) code sets. ICD-10 includes nearly 55,000 more codes than the previous version, which will require changes to how health care information is collected, documented and used, both within your practice and outside.
We recognize that each physician’s office is different and will need a tailored plan for your needs. Use the navigation boxes above to go step-by-step through the process and forge your pathway through the ICD-10 maze.
About the Colorado ICD-10 Training Coalition:
The Colorado Medical Society has orchestrated the formation of a statewide training coalition of interested educators, consultants, physician/practice representatives (including members of the component medical societies, and Colorado Medical Group Management Association, Pikes Peak Chapter of the Professional Association of Health Care Office Management, Colorado Health Information Management Association), the Denver Regional Office of the Centers for Medicare and Medicaid Services, and other stakeholders. We all share the goal of ensuring physicians and their staff are prepared for the implementation of ICD-10 on Oct. 1, 2014.
The statewide training coalition will make ICD-10 resources and training accessible to physicians and their staff via an organized multi-media educational campaign. Through a modular approach the coalition will provide a progressive training curriculum. A modular approach will allow practices to do much of the preparatory work now, such as project planning, impact analysis and documentation evaluation. It does not replace the need for intensive coding training, but it can be “put off” until early 2014 when the actual implementation is closer.
The coalition is open to any organization or individual who shares our goal of providing an organized, affordable approach to statewide ICD-10 training for physicians and their staff, and is willing to provide their time, talent and resources to this effort. Click here to see the current list of members and to join or pledge to be ready by Oct. 1, 2015.