Eli's Rehab Report

Published on Mon Aug 31, 2015 PDF

Plus: Arm yourself with a wealth of information from these new resources from CMS.

If you provide therapy services in nursing homes, you’ll want to be aware of what’s at stake for skilled nursing facilities when ICD-10 is implemented. Matt McGarvey of Harmony Healthcare International LLC offered the following tips for ICD-10 preparation specific to SNFs in a Jun 25 blog posting:

1. Don’t skimp on training. Find classroom training or webinars on ICD-10 that’s specific for SNF providers. “Today’s SNF patient population is unique and challenges will be different than that of hospitals, physician practices, ambulance providers, and home care,” McGarvey noted.

2. Pow-wow with your software provider. Not only should you speak with your MDS/billing software provider, make sure you’re also discussing ICD-10 preparations with any other software providers that you use, such as those for Activities of Daily Living (ADL) coding, therapy, and other software. “Ensuring accurate ICD-10 coding across multiple platforms will be that much more difficult than doing so across a single system,” McGarvey warned.

3. Learn the ICD-10 basics. SNFs in particular will need to pay attention to the myriad of common coding practices that ICD-10 will eliminate, including V-codes to identify therapy encounters, the 18 aftercare codes for fractures, the “late effects” codes, and the hypertension table. ICD-10 will add the “X” placeholder and change the timeframe in reporting a myocardial infarction.

ICD-10 codes will have the following format:

• Digit 1 is alpha (A-Z, not case sensitive)

• Digit 2 is numeric

• Digit 3 is alpha (not case sensitive) or numeric

• Digits 4 through 7 are alpha (not case sensitive) or numeric

• “X” is used as a placeholder for codes containing fewer than six characters when a seventh character is required

4. Start coding early. You should be dually coding all residents by the Oct. 1, 2015 ICD-10 deadline.

5. Use triple check to ensure accurate coding. “The triple check process will be your best friend in ensuring accurate coding,” McGarvey said. “A sound process to compare the UB-04 to the MDS assessment to the clinical documentation and therapy notes will enhance the accuracy of your claims and ensure timely payments.”

Transition Concessions

Payment disruptions. If Medicare contractors are unable to process claims due to problems with ICD-10, CMS will authorize advance payments to providers.

Navigating transition problems. CMS will establish a communication center to monitor issues and resolve them as quickly as possible, as well as put into place an “ICD-10 ombudsman” devoted to triaging provider issues.

Beef Up Your ICD-10 Coding Knowledge With These New Resources

The transition to ICD-10 is looming, and you need to be as prepared as possible for the Oct. 1 implementation deadline. Check out these new materials and resources from the Centers for Medicare & Medicaid Services (CMS) to arm yourself with all the help you can get.

CMS released the ICD-10 Website Wheel, a tool that provides education on ICD-10 implementation and planning, statutes and regulations, Medicare fee-for-service (FFS) provider resources, and Medicare Learning Network (MLN) products. The ICD-10 Website Wheel is available at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications-Items/ICN909222.html.

CMS released a revised version of MLN Matters article #SE1408, a reissue of MM7492, on Medicare FFS claims processing guidance for implementing ICD-10 (www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1408.pdf). This MLN Matters article includes tables on claims that span the periods when both ICD-9 and ICD-10 codes may be applicable.

CMS also released a new infographic that outlines the five key steps that healthcare providers should take to transition to ICD-10. The infographic also contains links to resources. To download the infographic, go to www.cms.gov/Medicare/Coding/ICD10/Downloads/CMSICD10FullInfographic.pdf. The infographic ties into the action plan outlined on the CMS “Road to 10” website at www.roadto10.org.

Additionally, CMS updated the following ICD-10 materials:

• General Equivalence Mappings Frequently Asked Questions (www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications-Items/ICN901743.html);

• ICD-10-CM/PCS Myths and Facts (www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications-Items/ICN902143.html);

• ICD-10 Classification Enhancements (www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications-Items/ICN903187.html); and

• ICD-10-CM/PCS The Next Generation of Coding (www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications-Items/ICN901044.html).