IN THIS ISSUE
In the News
ICD-10 BOOT CAMPS
Des Moines 10/13
This e-Newsletter offers the most up-to-date and essential news and information about the transition to ICD-10. If you would prefer not to receive these monthly updates, you can change your email preferences in your account.
ICD-10 and Non-covered Entities
While preparing for ICD-10-CM transition, non-HIPAA entities need to be considered. What about non-covered entities? What are they doing for ICD-10-CM transition? What do they have to do for ICD-10-CM transition? What is a non-covered entity?
The Final Rule requires HIPAA covered entities to adopt the ICD-10-CM and ICD-10-PCS code sets. Non-covered entities do not have to transition to Version 5010 and ICD-10, although it is recommended that they do. Non-covered entities include: workers' compensation programs, life insurance companies, automobile insurance companies, and disability insurance programs that submit non-covered transactions (e.g., paper claims, quality reporting, and patient assessment data sets).
According to CMS' July 2011 "The ICD-10 Transition: Focus on Non–Covered Entities," the benefits for non-covered entities to transition to ICD-10 include:
- Expanded detail in injury codes, which will help automobile insurance and workers' compensation programs.
- ICD-9-CM codes will no longer be maintained once ICD-10 has been implemented. The ICD-9-CM code set will become less useful and resources will be continually harder to obtain.
- Not adapting to ICD-10 coding could lead to undue hardship for non-covered entities' providers.
So, what can an office, clinic, or facility do to prepare for this potential curve ball? Its homework. If you currently transmit claims to non-covered entities, it is a good idea to start assessing how many of them you are actually transmitting to. Contact the agencies you send the most claims to and ask what their plans are for ICD-10. Do they plan on converting along with the rest of the country? Are they going to hold out for a year? Two? Are they not even currently planning on converting? For agencies that you do not send a lot of claims to, assess if it is worth it to continue contracting with them if they do not transition to ICD-10 in 2013. Gather all the information available from these entities, evaluate it, and make decisions that make sense for your practice.
IN THE NEWS
AAPC Special Presentation on ICD-10
With all of the ICD-10 information and training out there, how do you determine your role, which training, and from whom you should seek assistance? To help answer these questions and more, AAPC is offering a special presentation in an interactive workshop environment. While it's too early for code set training - two years is a long time to try to remember codes that aren't being used every day and may even be outdated by the implementation date – come learn what you can be doing right now to prepare for this monumental change.
In November, AAPC will present a special workshop on ICD-10 in 52 cities nationwide. This 4-hour ICD-10 overview will introduce ICD-10 implementation, key steps for preparing, ICD-10-CM and ICD-10-PCS code set structures, documentation changes, and how your knowledge of A&P and disease processes will affect your ability to effectively interpret medical records and assign codes.
Chief Complaint: Patient presents for a scheduled annual exam. The patient is a 26-year-old male. He would also like to get his flu shot today. Diet: Adequate amount of caloric intake. The patient drinks 46 ounces of water per day. The source is city water. Diet is appropriate for age. No eating disorders. Sleep: Sleep patterns are normal. No sleep disturbances experienced. The patient is active. No drugs or alcohol in the home.
HPI: Presents for physical exam. Patient feeling well.
ROS: The patient denies constitutional symptoms, respiratory symptoms, gastrointestinal symptoms, male genital problems, and skin, hair, and nail symptoms.
Current Meds: None
Past Medical History: Physical and dental exam in 2010. Eye exam in 2010.
Family History: Unremarkable
Social History: The home is smoke free. There is no history of abuse.
Objective: BP: 122/80, Pulse: 72, Temp: 97.8, Ht: 5'10", Wt: 190lbs
Exam: Const: Healthy appearing male, well nourished and alert. Weight within the normal range for stated age. Eyes: 20/20 in both eyes without correction. No discharge from the eyes. PERRL. ENMT: Auditory canals are patent. Tympanic membranes normal. Nasal mucosa shows moistness and normal color, but no discharge. Oral mucosa: pink, smooth and moist. Neck: supple, with no adenopathy. Resp: Respiration rate is normal. Lungs are clear bilaterally. CV: Rate is regular. Rhythm is regular. Pedal pulses: 2+ and equal bilaterally. GI: Abdomen is nondistended, nontender, and soft. Bowel sounds normoactive. No palpable HSM. GU: Testes: Normal on palpation. Epididymis: Epididymides are smooth and nontender. Penis: Normal. There is a 4.5 cm firm nontender mass within the scrotum which moves easily back and forth. Does not appear to be connected to a testicle. Musculo: Spine: No scoliosis. Upper extremities: Strength: Normal and symmetric. ROM is physiologic. Lower extremities: normal and symmetric. ROM is physiologic. Skin: No rash or lesions. Neuro: Mood is normal. Affect is normal.
Assessment and plan: Annual exam. Follow up prn. Firm scrotal mass, midline, found that is somewhat worrisome. I will get an ultrasound of the scrotum. Also, I will refer to Urology. Ok for flu shot today.
- Z00.01, Encounter for general adult medical examination with abnormal findings
- N50.9, Disorder of male genital organs, unspecified
- Z23, Encounter for immunization
Rationale: Unlike ICD-9-CM, in ICD-10-CM, there is a differentiation between general medical exams with and without abnormal findings. In the case above, a scrotal mass is found. The ICD-10-CM note under Z00.01 also states to "Use additional code to identify any abnormal findings," so the scrotal mass is also coded. Another difference between ICD-9-CM and ICD-10-CM is apparent with coding of immunizations. In ICD-9-CM, a separate V-code is reported for each immunization given. In ICD-10-CM, one code, Z23, Encounter for immunization, is used for all immunizations given. The note under Z23 states that "procedure codes are required to identify the types of immunizations given."
ICD-10 Implementation Strategies
We will be sharing a number of strategies to help your practice successfully implement ICD-10-CM. Please remember to track your progress in your ICD-10 Implementation Tracker on AAPC's website.
To use or not to use crosswalks has become a big question for some offices. A practice will need to evaluate the benefits and costs to using crosswalks to help in the ICD-10-CM transition. The GEMs files are available at no charge, but were not designed for coding purposes and should be used with caution. Software will become more available to assist with crosswalking projects, along with manuals and other crosswalk aids. The most important thing, if the decision is to use crosswalks, is to use one from a trusted source and do some research. Find out how the crosswalk was designed, what was used as the basis of the crosswalk, and what was done to improve the product and ensure it to be a valid tool.
AAPC has mapped the top 50 ICD-9-CM codes to the latest ICD-10-CM codes in your specialty so you can begin consideration of documentation requirements, superbill changes, and get a jump on the 2013 implementation. These mappings include instructions as to more specific codes that are available as well as 7th character extenders and "code first" notes allowing for a more comprehensive snapshot into your future. Find out more about the ICD-10 Fast Forward crosswalks.
AAPC, along with AAPC Physician Services, has produced a white paper with the intent of educating readers on the history of ICD-10, the benefits it will provide, the projected impact it will have on our health system, and suggestions on how to have a successful ICD-10 implementation. Download your free copy of ICD-10: The History, the Impact, and the Keys to Success.