ICD-10-CM - National Council for Behavioral Health [PDF]

www.TheNationalCouncil.org. ICD-10-CM. An overview of changes relevant to behavioral health. Presented by: Donna Pickett

0 downloads 5 Views 2MB Size

Recommend Stories


National Health Council
In every community, there is work to be done. In every nation, there are wounds to heal. In every heart,

behavioral health application for services
Kindness, like a boomerang, always returns. Unknown

Behavioral Health
Never wish them pain. That's not who you are. If they caused you pain, they must have pain inside. Wish

Behavioral Health
Sorrow prepares you for joy. It violently sweeps everything out of your house, so that new joy can find

Resources for Behavioral Health Services
If your life's work can be accomplished in your lifetime, you're not thinking big enough. Wes Jacks

National Environmental Health Science Protection & Accreditation Council
You can never cross the ocean unless you have the courage to lose sight of the shore. Andrè Gide

National Council for Higher Education
Everything in the universe is within you. Ask all from yourself. Rumi

Behavioral Health Barometer
Kindness, like a boomerang, always returns. Unknown

Untitled - Behavioral Health Administration
If you want to go quickly, go alone. If you want to go far, go together. African proverb

Behavioral, Health, and Cost
When you do things from your soul, you feel a river moving in you, a joy. Rumi

Idea Transcript


www.TheNationalCouncil.org

ICD-10-CM An overview of changes relevant to behavioral health Presented by: Donna Pickett - CDC/OPHS/NCHS Joe Nichols - MD Date: January 24, 2014 Contact: [email protected] 202.684.7457

Agenda www.TheNationalCouncil.org

• Overview – ICD-10, the basic facts – How is ICD-10-CM different?

• Clinical documentation - What’s needed to support proper coding in ICD-10-CM? • What’s changed for behavioral health • What are the business impacts? • What do I need to do to prepare? Contact: [email protected] 202.684.7457

2

Source: Health Data Consulting

ICD-10-CM Overview Contact: [email protected] 202.684.7457

3

ICD10 Quick Facts • ICD-10 international version – Adopted by WHO in 1990 – Most countries other than the US currently use ICD-10 – ICD-10 (International version) ~ 12,500 diagnostic Source: Health Data Consulting codes – ICD-10 used for mortality reporting in the US - 1999 • ICD-10-CM (US version) – ~ 69,000 diagnostic codes – Final rule published – 2012 – Compliance date – Oct 1, 2014 Source: Health Data Consulting Contact: [email protected] 202.684.7457

4

ICD-9 Diagnosis Codes vs. ICD-10-CM (Diagnosis Codes) ICD-9-CM Diagnosis Codes 3 to 5 digits Alpha “E” and “V” on 1st character No place holder characters Terminology Index and Tabular Structure Coding Guidelines Approximately 14,000 codes Severity parameters limited Does not include laterality Combination codes limited

ICD-10-CM Diagnosis Codes 7 digits Alpha or numeric for any character Include place holder characters (‘x’) Similar Similar Some what similar Approximately 69,000 codes Extensive severity parameters Common definition of laterality Combination codes common

Source: Health Data Consulting Contact: [email protected] 202.684.7457

5

ICD9 Comparison to ICD10-CM Diagnosis Codes – Clinical Example

A patient is evaluated for a [drug induced] [sleeping disorder] that is related to [dependance] on a [sedative drug]. ICD9 Code

Description Drug induced sleep disorders

29285 ICD10 Code F13282

Description Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sleep disorder

Source: Health Data Consulting Contact: [email protected] 202.684.7457

6

ICD9 Comparison to ICD10-CM Diagnosis Codes – Clinical Example

A patient is evaluated for a [drug induced] [sleeping disorder] that is related to [dependance] on a [sedative drug].

ICD9 Code

Description Drug induced sleep disorders

29285 ICD10 Code F13282

Description Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sleep disorder

Source: Health Data Consulting Contact: [email protected] 202.684.7457

7

“There are too many Codes” • There are lots of words in the dictionary, but that doesn’t seem to trouble authors… • 34,250 (50%) of all ICD-10CM codes are related to the musculoskeletal system

• 17,045 (25%) of all ICD-10CM codes are related to fractures

• ~25,000(36%) of all ICD-10-CM codes to distinguish ‘right’ vs. ‘left’

• Only a very small percentage of the codes will be used most providers Source: Health Data Consulting Contact: [email protected] 202.684.7457

8

Current Distribution of ICD-9 diagnosis codes 3 Years of Data - All claims - All lines of business - 1million Lives

Total Charges by Code 3years - $10 Bill

80.0% 70.0% 60.0% 50.0% 40.0% Charge % 30.0% 20.0% 10.0% 0.0% 5%

next 5%









Contact: [email protected] 202.684.7457













Source: Health Data Consulting

















9

Varying Code Volume By Clinical Area

Clinical Area Fractures Poisoning and toxic effects Pregnancy related conditions Brain Injury Diabetes Anxiety Disorders Autism Spectrum Disorders Mood related disorders Schizophrenia Hypertensive Disease End stage renal disease

ICD-9 Codes 747 244 1104 292 69 27 6 75 56 33 11

ICD-10 Codes 17099 4662 2155 574 239 47 4 71 11 14 5

Source: Health Data Consulting Contact: [email protected] 202.684.7457

10

Documentation It could be better…

Bad Mojo

is not a diagnosis • Incomplete clinical documentation is bad for Payers, Providers and Patients.      

Billing accuracy Quality measures Population management Risk management Healthcare analytics Patient Care

Contact: [email protected] 202.684.7457

11

Good Clinical Documentation is Not a New Requirement

• The number and type of new concepts required for ICD-10 are not foreign to clinicians

• The focus of documentation is good patient care • Patients deserve to have accurate and complete documentation of their conditions

• If other industries understand the value of accurate and complete documentation of data about encounters; shouldn’t we? Source: Health Data Consulting Contact: [email protected] 202.684.7457

12

Documentation Why is it important?

• Supports proper payment reduced denials • Assures accurate measures of quality and efficiency • Assures accountability and transparency • Captures the level of risk and severity • Provides better business intelligence • Supports clinical research • Enhances communication with hospital and other providers • It’s just good care! Source: Health Data Consulting Contact: [email protected] 202.684.7457

13

Coding – The Patient Interface Where it all begins

Physical Exam Internal Record Review

History

External Record Review Studies

Assessment/Diagnosis Contact: [email protected] 202.684.7457

14

Getting to the Code A Necessary Step

Back-office Coding

The “Super Bill” Contact: [email protected] 202.684.7457

Back to the Doctor? 15

The Super Bill Not That Super Really…

[Note] For all codes related to fractures of the radius: •ICD-9 codes = 32 •ICD-10 codes = 1731 Contact: [email protected] 202.684.7457

16

New concepts supported by ICD-10

• • • • • • • • •

Drug “use” vs “dependence” vs “abuse” Bipolar II Recurrent depressive disorder Mood disorder related to physiologic condition Adjustment insomnia Adjustment reaction with withdrawal Asperger's syndrome Rett's syndrome Distinguishes between current episode and most recent episode for bipolar disorders

Source: Health Data Consulting Contact: [email protected] 202.684.7457

17

Removed concepts from ICD-9

• Substance dependence o o

continuous episodic

• Amphetamine o o

Dependence Abuse

• Bipolar I • Passive-aggressive personality • Pervasive Disorders o o

current or active state residual state

Source: Health Data Consulting Contact: [email protected] 202.684.7457

18

Removed concepts from ICD-9

• Schizophrenia o o o o o o o

Latent Simple type Subchronic Chronic Subchronic with acute exacerbation Chronic with acute exacerbation In remission

Source: Health Data Consulting Contact: [email protected] 202.684.7457

19

Source: Health Data Consulting

ICD-10-CM Key coding changes relevant to behavioral health Contact: [email protected] 202.684.7457

20

Changes in detail and content Code Examples – Substance related sleep disorders:

More Codes ICD-9 Code 29285

Description Drug induced sleep disorders

ICD-10 Code

Description

F11182

Opioid abuse with opioid-induced sleep disorder

F11982

Opioid use, unspecified with opioid-induced sleep disorder

F11282

Opioid dependence with opioid-induced sleep disorder

F14182

Cocaine abuse with cocaine-induced sleep disorder

F14282

Cocaine dependence with cocaine-induced sleep disorder

F14982

Cocaine use, unspecified with cocaine-induced sleep disorder

F13182

Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced sleep disorder



Multiple other substances

Source: Health Data Consulting Contact: [email protected] 202.684.7457

21

Changes in detail and content Code Examples – Substance related abuse:

More Codes ICD-9 Code 30550

Description (Non-dependent) Opioid abuse, unspecified

ICD-10 Code

Description

F1110

Opioid abuse, uncomplicated

F11120

Opioid abuse with intoxication, uncomplicated

F11121

Opioid abuse with intoxication delirium

F11122

Opioid abuse with intoxication with perceptual disturbance

F1114

Opioid abuse with opioid-induced mood disorder

F11150

Opioid abuse with opioid-induced psychotic disorder with delusions

F11151

Opioid abuse with opioid-induced psychotic disorder with hallucinations

F11181

Opioid abuse with opioid-induced sexual dysfunction

F11182

Opioid abuse with opioid-induced sleep disorder

F11188

Opioid abuse with other opioid-induced disorder

F1119

Opioid abuse with unspecified opioid-induced disorder

Source: Health Data Consulting Contact: [email protected] 202.684.7457

22

Changes in detail and content Code Examples – Schizophrenia:

Less Codes ICD-9 Code

Description

29530

Paranoid type schizophrenia, unspecified

29531

Paranoid type schizophrenia, subchronic

29532

Paranoid type schizophrenia, chronic

29533

Paranoid type schizophrenia, subchronic with acute exacerbation

29534

Paranoid type schizophrenia, chronic with acute exacerbation

29535

Paranoid type schizophrenia, in remission

ICD-10 Code

Description

F200

Paranoid schizophrenia

Source: Health Data Consulting Contact: [email protected] 202.684.7457

23

Changes in detail and content Code Examples – Schizoaffective disorder:

More Codes ICD-9 Code

Description

29570

Schizoaffective disorder, unspecified

ICD-10 Code

Description

F250

Schizoaffective disorder, bipolar type

F251

Schizoaffective disorder, depressive type

F258

Other schizoaffective disorders

F259

Schizoaffective disorder, unspecified

Contact: [email protected] 202.684.7457

Health Data Consulting © 2013

24

Changes in detail and content Code Examples – Post traumatic Stress Disorder:

More Codes ICD-9 Code

Description

30981

Posttraumatic stress disorder

ICD-10 Code

Description

F4310

Post-traumatic stress disorder, unspecified

F4311

Post-traumatic stress disorder, acute

F4312

Post-traumatic stress disorder, chronic

Contact: [email protected] 202.684.7457

Health Data Consulting © 2013

25

Changes in detail and content Code Examples – Childhood Emotional Disorders:

Less Codes ICD-9 Code

Description

3130

Overanxious disorder specific to childhood and adolescence

3131

Misery and unhappiness disorder specific to childhood and adolescence

31321

Shyness disorder of childhood

31322

Introverted disorder of childhood

3133

Relationship problems specific to childhood and adolescence

31382

Identity disorder of childhood or adolescence

31383

Academic underachievement disorder of childhood or adolescence

31389

Other emotional disturbances of childhood or adolescence

3139

Unspecified emotional disturbance of childhood or adolescence

ICD-10 Code F930 F938 F939

Description Separation anxiety disorder of childhood Other childhood emotional disorders Childhood emotional disorder, unspecified

Source: Health Data Consulting Contact: [email protected] 202.684.7457

26

Changes in detail and content Code Examples – Conversion Disorders:

More Codes ICD-9 Code

Description

30011

Conversion disorder

ICD-10 Code

Description

F444

Conversion disorder with motor symptom or deficit

F445

Conversion disorder with seizures or convulsions

F446

Conversion disorder with sensory symptom or deficit

F447

Conversion disorder with mixed symptom presentation

F4489

Other dissociative and conversion disorders

F449

Dissociative and conversion disorder, unspecified

Source: Health Data Consulting Contact: [email protected] 202.684.7457

27

Changes in detail and content Code Examples – Other substance abuse:

More Codes ICD-9 Code

Description

30592

Other, mixed, or unspecified drug abuse, episodic

ICD-10 Code

Description

F550

Abuse of antacids

F551

Abuse of herbal or folk remedies

F552

Abuse of laxatives

F553

Abuse of steroids or hormones

F554

Abuse of vitamins

F558

Abuse of other non-psychoactive substances

Contact: [email protected] 202.684.7457

Health Data Consulting © 2013

28

Changes in detail and content Code Examples – Attention Deficit Disorders:

More Codes ICD-9 Code

Description

31400

Attention deficit disorder without mention of hyperactivity

31401

Attention deficit disorder with hyperactivity

ICD-10 Code

Description

F900

Attention-deficit hyperactivity disorder, predominantly inattentive type

F901

Attention-deficit hyperactivity disorder, predominantly hyperactive type

F902

Attention-deficit hyperactivity disorder, combined type

F908

Attention-deficit hyperactivity disorder, other type

F909

Attention-deficit hyperactivity disorder, unspecified type

Source: Health Data Consulting Contact: [email protected] 202.684.7457

29

Business Impacts Contact: [email protected] 202.684.7457

30

Business Impacts •

Coding    



Contracting   



Scope of services Case rates Carve outs

Billing   



EHR updates Super Bill??? Training Coding software

Billing code updates Charge masters Billing Edits

Benefits and coverage determinations

Contact: [email protected] 202.684.7457

Health Data Consulting © 2013

31

Business Impacts (Cont.) • Compliance  

HIPAA Reporting

  

 

National State Regional Initiatives

Contract requirement Accreditation

• Reimbursement    

Pay for performance POA, “never events”, re-admissions, HACs, tiered payment models Network inclusion Denials

• Audits   

RAC Fraud and abuse Coding

Contact: [email protected] 202.684.7457

Health Data Consulting © 2013

32

“ICD diagnosis codes are irrelevant to my business.”



ICD-9 codes factor into: 

Payer processing rules



The determination of appropriateness



Measures of quality (pay for performance)



Compliance (meaningful use)



Contracting decisions



Risk adjustments



Fraud waste and abuse



Audits



Authorizations

Contact: [email protected] 202.684.7457

Health Data Consulting © 2013

33

“ICD diagnosis codes are irrelevant to my business.”



ICD-10 codes are likely to factor into: 

Changes in reimbursement based on both “what” was done and “why”



Managing financial risks for contracted populations (ACO’s)



Changes in reimbursement based on more robust models of payment adjusted for risk and severity



More sophisticated weighting of payments based on DRGs, episodes or other groupers of care.

Contact: [email protected] 202.684.7457

Health Data Consulting © 2013

34

Business Impacts •

Compliance  

HIPAA Reporting o o o

 



Contract Accreditation

Reimbursement    



National State Regional Initiatives

Pay for performance POA, “Never Events”, Tier Models Network inclusion Denials

Audits   

RAC Fraud and abuse Coding

Contact: [email protected] 202.684.7457

35

Cash Flow

Impacts inbound and outbound

Lack of Provider Preparation

Payment Delays

Increased Cost Contact: [email protected] 202.684.7457

36

Cash Flow

Impacts inbound and outbound

Source: CMS Contact: [email protected] 202.684.7457

37

Implementation Getting your ducks in a row Contact: [email protected] 202.684.7457

38

Implementation Strategy

• Short term goals with a long term visions  

What solution do I need today? Will that solution extend to tomorrows needs?

• Awareness of touch points with other initiatives 

Overlap and conflicts

• Down Stream Impacts 

What works well for one business area, may bring another business area to it’s knees

• Positioning for competitive advantage   

Can you predict risk better than you competitor? Are you perceived as a supporter and facilitator for the transition challenge to providers and other stakeholders? Can you manage the “burden of illness” of your population better than your competitors?

Contact: [email protected] 202.684.7457

39

Phases of Transition 1. Assessment  

Inventory of impacted systems and processes Identifying risk

2. Analysis/Planning   

Prioritizing focus Establishing business area specific approaches Creating specifications for mapping to support implementation

3. Implementation and Operations    

Translating codes from 9 to 10 and from 10 to 9 using crosswalks Changing analytic models to support both codes Operationalization of coding to ICD-10 from source information Changing processing logic to operate directly from ICD-10 codes

4. Leveraging ICD10 capabilities 

Using the enhanced information within ICD-10 codes to improve processing and analysis based on improved concepts buried within the ICD-10 codes

Contact: [email protected] 202.684.7457

40

Scenario-Based Testing What is it?

• The scenario: 

The identification of some event or condition that we are familiar with today



Recreating that event virtually through some verbal or data representation



Defining a variety of assumptions and variables around this virtual representation

• Applying one or more of these scenarios in a Reference Implementation Model (RIM). 

Walk through current systems or processes using these scenarios with varying assumptions and variables to determine if expected results can be achieved and the required changes to achieve those expected results.

Contact: [email protected] 202.684.7457

41

Leveraging ICD-10

A changing world of cost containment

Accurate and complete documentation and coding provides opportunities to support the transition into a “value-based”, “accountable care” reimbursement environment.

• Better representation of severity and risk • Recognition of varying levels of complexity • Better claim information to support automated processing and more rapid reimbursement

• Opportunities to reduce audit risk exposure • Improved business intelligence to support population risk management

• More accurate measures of quality and efficiency Contact: [email protected] 202.684.7457

42

Q&A

Review of Q&A from Attendees

If you have a question that has not been addressed, please send it to us at the ICD-10 Questions Mailbox: [email protected]

Contact: [email protected] 202.684.7457

43

Online Resources Review of Q&A from Attendees

• CMS - https://www.cms.gov/ICD10/ Coding Documentation (Indexes, Coding Guidelines, Code Files): http://www.cms.gov/Medicare/Coding/ICD10/index.html

 

General Equivalency Mapping [GEM] (Mapping files, Guidelines, Procedure and Diagnosis)  GEMs Crosswalk documents: http://cms.hhs.gov/Medicare/Coding/ICD10/2014-ICD-10-CM-andGEMs.html  GEMs 2014 General Equivalence Mappings: http://cms.hhs.gov/Medicare/Coding/ICD10/2014-ICD-10-PCS.html



Medicare Learning Network Articles: http://www.cms.gov/Outreach-andEducation/Medicare-Learning-NetworkMLN/MLNGenInfo/index.html?redirect=/mlngeninfo



Implementation Guides: https://implementicd10.noblis.org

Contact: [email protected] 202.684.7457

44

Online Resources Review of Q&A from Attendees

• CMS - https://www.cms.gov/ICD10/ (Continued)  







Implementation Guides: https://implementicd10.noblis.org ICD-10 National Provider Calls: http://www.cms.gov/Medicare/Coding/ICD10/CMS-Sponsored-ICD-10Teleconferences.html National Coverage Determinations (NCDs): http://www.cms.gov/medicare-coverage-database/overview-and-quicksearch.aspx Medicare Testing Week: http://www.cms.gov/Outreach-andEducation/Medicare-Learning-NetworkMLN/MLNMattersArticles/Downloads/MM8465.pdf Medicare Claims Processing Guidance for ICD-10: http://www.cms.gov/Outreach-and-Education/Medicare-LearningNetwork-MLN/MLNMattersArticles/downloads/MM7492.pdf

Contact: [email protected] 202.684.7457

45

Online Resources Review of Q&A from Attendees

• CMS - https://www.cms.gov/ICD10/ (Continued) 

  

 

Medicare Reimbursement Mappings 2014 Reimbursement Mappings – Diagnosis Codes and Guides http://cms.hhs.gov/Medicare/Coding/ICD10/2014-ICD-10-CM-and-GEMs.html 2014 Reimbursement Mappings – Procedure Codes and Guides http://cms.hhs.gov/Medicare/Coding/ICD10/2014-ICD-10-PCS.html Links to ordering the ICD-10 Pilot Version 31.0 Mainframe and PC version of the ICD-10 MS-DRGs and Medicare Code Editor (FY 2014 version) from NTIS have been placed on the CMS website under the Related Links section at http://cms.hhs.gov/Medicare/Coding/ICD10/ICD-10-MS-DRG-ConversionProject.html http://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNGenInfo/index.html?redirect=/mlngeninfo FAQ, Coordination and maintenance Committee minutes

Contact: [email protected] 202.684.7457

46

Online Resources Review of Q&A from Attendees

• CDC - http://www.cdc.gov/nchs/icd/icd10cm.htm ICD-10-CM files (Alphabetic Indexes, Tabular List, Coding Guidelines, Codes and Descriptions Files, FY2014 Addenda)

 

General Equivalency Mapping [GEM] (Mapping files, Guidelines, Procedure and Diagnosis)  GEMs Crosswalk documents:  GEMs 2014 General Equivalence Mappings:



Detailed List of Codes Exempt from Diagnosis Present on Admission Requirements



Public Health Transition to ICD-10-CM/PCS http://www.cdc.gov/nchs/icd/icd10cm_pcs.htm

Contact: [email protected] 202.684.7457

47

Online Resources Review of Q&A from Attendees

• WEDI - http://www.wedi.org/      

List serves Workgroups White papers Implementation forums Industry advocacy and issue Access to standards leaders

• AHIMA - http://ahima.org/     

Training and certification Extensive documentation libraries Bookstore Communities of practices ICD-10 focused conferences

Contact: [email protected] 202.684.7457

48

Online Resources Review of Q&A from Attendees

• HIMSS - http://www.himss.org/   

White papers Bookstore Webinars

• Vendors • Consulting Organization • Online news

• Blogs

Contact: [email protected] 202.684.7457

49

Online Resources Review of Q&A from Attendees

• Health Data Consulting white papers:      

ICD-10 A Primer ICD-10 Physician Impacts Scenario Based Testing ICD-10 The Case for Moving Forward ICD-10 Clinical Documentation – The Role of the Clinician in Capturing Accurate Data ICD-10 – Specified or Unspecified?

http://healthdataconsulting.com/resources/white-papers/ Contact: [email protected] 202.684.7457

50

Smile Life

When life gives you a hundred reasons to cry, show life that you have a thousand reasons to smile

Get in touch

© Copyright 2015 - 2024 PDFFOX.COM - All rights reserved.