CMS-AAPC ICD-10 Code-a-thon Video

Uploaded by CMSHHSgov on 26.07.2011

WOMAN: Hello, everyone, and welcome
to today's ICD-10 Code-a-thon event.
The event will now begin with an introduction
from Alexis Johnson with Ketchum public relations.
JOHNSON: Thank you. Good afternoon, everyone.
This is Alexis Johnson from Ketchum Public Relations
and I'd like to welcome you
to today's ICD-10 Code-a-thon event.
In an effort to make sure that providers
and other industry professionals are preparing for the transition
to ICD-10, the Centers for Medicare & Medicaid Services
and the American Academy of Professional Coders
are collaborating to bring you this event
to help you get your coding questions answered.
AAPC-certified trainers are ready to assist you
and are looking forward to your great ICD-10 questions.
Before I get started, I just wanted to give you an overview
of how today's session will run.
If you take a look at the schedules
lined up on the screen, you will see
that we are going to kick off the Code-a-thon event
with presentations on ICD-10 from Denise Buenning of CMS
and Rhonda Buckholtz from the AAPC.
Their presentations will be followed by a brief wrap-up
where we address some of the common
frequently asked questions, and then we will start
the online-only Q&A session with the ICD-10 trainers from AAPC.
At that point, the audio portion of our session will end,
but the online platform will go live.
To ask a question during the online Q&A,
just select the Q&A button on the top gray bar
and type in your question.
The AAPC trainers
will address your questions as quickly as possible.
Lastly, I want to let you know that,
during today's audio portion, all phones will be muted
so that you can hear the presentation very clearly.
Today's presentations are also being recorded.
The audio portion and transcripts will be posted
to the CMS Web site at
And I'll just give you that Web site one more time.
They'll be available on the Web site within two weeks.
Please note that there are no handouts for the events,
but all the materials will be available
on the CMS Web site, as I just mentioned.
AAPC is offering two CEU credits
for participating in this Code-a-thon event.
The CEU number is
And I'll say that one more time.
The CEU number is AAPC0413110323A.
And attendees must stay for the entire time
to receive credit.
If you need any assistance during this event,
please call 1-877-283-7062.
And that number is at the bottom of the slide on the screen.
Now, I'd like to turn it over to my colleague Lauren Hoffman,
who will introduce our first speaker.
HOFFMAN: Great. Thank you, Alexis.
I'd like to introduce Denise Buenning.
She's the director of
the Administrative Simplification Group
at the Centers for Medicare & Medicaid Services
Office of E-Health Standards and Services
in Baltimore, Maryland.
Denise authored both the agency's proposed and final
ICD-10 rules and her areas of responsibility include
CMS's ICD-10 program management office,
HIPAA Transaction and Code Set enforcement,
and HIPAA Administrative Simplification.
She's going to be speaking to you today about why
the transitions to ICD-10 and Version 5010 are occurring;
what, exactly, is changing; who is affected by the change;
tips on how to prepare;
and the resources that are available from CMS.
So, without any further ado,
I will pass it on to Denise to start the presentation.
BUENNING: Great. Thank you, Lauren,
and thanks to everybody today who's joining us.
Good afternoon, and, for our colleagues
on the West Coat, good morning.
This is Denise Buenning
with the Centers for Medicare & Medicaid Services
Office Of E-Health Standards and Services
and I want to thank everyone today
for taking time out to participate in this event.
Particularly, I want to thank the AAPC.
When we first had this idea, a number of months ago,
they really jumped on it
and developed it into the event it is today.
As you know, we had around 2,000 slots open
for this particular event and they quickly filled up
and I think it's just very gratifying
that everyone has an interest in learning more about this.
You know, we, here at CMS, talk about this all the time
and we often think that, perhaps, everybody knows
about ICD-10 and 5010 and, you know,
from the response that we've gotten today,
we know that that isn't necessarily the case,
so we're really excited about this opportunity
to partner with AAPC and use their coding expertise
to get some of your specific coding questions answered.
So many times, when we have these calls,
we don't have the time or don't have
the subject-matter experts on hand
to answer individual coding questions,
so we'll try and do a little bit of a general overview
for everyone, to level the playing field,
as to why the transitions are being made and then, again,
when we get into our webinar section,
deal with our specific questions.
So, again, our thanks to AAPC, Deb Grider, Rhonda Buckholtz,
and all the other AAPC leadership
for helping us with this.
So let's talk a little bit about what this is all about.
The topics that we're going to cover today,
as, I think, Lauren went over: what is changing;
who's affected; some of the key details about Version 5010;
why we're making the changes; getting ready; important dates;
and, of course, resources to help you all prepare.
And there are lots of them out there.
So exactly what's going to be changing?
Two different changes are going to be taking place:
the ICD-10 diagnosis and procedure codes
are going to be transitioned from the current ICD-9 version
over to ICD-10 and, along with that,
there's going to be a change in the HIPAA standards.
The current Version 4010 and 4010A1
are going to be upgraded to Version 5010.
And these standards are used to, basically,
electronically transmit claims
and other administrative transactions.
Now, I know that that sounds very technical and, perhaps,
to a lot of providers on the call,
they may not recognize these particular terms,
but, especially when it comes to 5010, if you ask providers
if they ever send an eligibility inquiry
or a claims-status inquiry, they know exactly what that is.
Version 5010 is basically what's under the hood.
It's a software change that upgrades the system
to really bring it forward and accommodate
a lot of the changes that have been necessitated
by changing industry needs.
So we're talking about going from 9 to 10
on the international classification of diseases
and from 9- to 10-PCS.
You'll see, currently, where you have ICD-9,
you'll have Volume 1 and Volume 2
and then Volume 3, which is basically your procedure codes.
Well, we're breaking that out
into ICD-10 CM, which is your diagnosis codes;
and ICD-10-PCS, which are your procedure codes.
Again, Version 4010 and Version 5010A
are the current HIPAA standards and they get upgraded here,
actually, as of January 1st of 2012.
So who has to do this? Anyone who's covered by HIPAA.
And, if you're a health care provider,
you pretty much know what HIPAA is.
Health care providers who conduct electronic transactions,
like eligibility inquiry, health care health claims status;
payers, and that includes Medicare and Medicaid.
We're the largest insurance group --
if you want to call it that -- in the world,
so we are also subject to the HIPAA provisions.
Clearinghouses also are covered under HIPAA
and they have to adhere to the HIPAA rules.
There are some noncovered entities
that use the ICD-9 codes currently:
some business associates, some vendors,
workers' compensation programs, life insurance companies.
The majority of the industry is changing over to 5010
and ICD-10 and, while these noncovered entities
aren't obligated, aren't mandated,
to make the changeover, we've been getting anecdotal reports
that they are going to accommodate the new code sets,
just from a practical perspective.
It's very difficult to have an entire health care industry
using one set of codes and some segments of it not,
so, as I say, nothing official, but we're getting
anecdotal reports of inquiries being made and some
of the workers' compensation programs, in particular,
working towards making the transition to ICD-10.
So let's talk a little bit more about Version 5010 and ICD-10.
Version 5010 replaces the 4010 and, again,
although you may not be necessarily familiar
with the current standards,
they're in use every day in the United States.
These standards are really the platform or the foundation
used in practice management or other software
that allows you to electronically send
and receive information to and from a plan,
to verify eligibility,
to submit a medical claim for reimbursement.
Many professionals are familiar with the transactions,
but, again, not necessarily
the mechanism that gets it there.
As I say, it's always what's underneath the hood.
You don't necessarily need to know what's there,
but you need to know that, when you turn the key,
the engine works well.
5010 and 4010, pretty much, are the same way.
The new version is important, for a number
of different reasons, and the most important thing,
at least, from an ICD-10 perspective,
is that you cannot have ICD-10 without Version 5010.
Because, in Version 5010, for lack of a better description,
there's a toggle switch that basically tells the software
and tells the system you're using ICD-10 codes
because the format's a little bit different,
so it's really important that Version 5010 is in place first.
Version 5010 fixes the deficiencies
in Version 4010.
On our next slide, I think we --
Okay, we changed it. Okay.
Version 5010 fixes the deficiencies in 4010
and a lot of these were caused
by changing business needs in the industry.
For example, Medicare Part D prescription drug program.
What the industry has been doing
was kind of a patchwork approach.
It was making a lot of workarounds or quick fixes
to try and make the standards work
with the current business needs of the industry,
so when the updated version came around, Version 5010,
it accommodated a lot of those changes,
but it also does a number of other things:
it increases processing time;
it will increase or make more efficient office workflows.
You'll get more information back when you make an inquiry.
So you're spending less time on the phone,
following up on where something is
or an eligibility for a patient and, of course, we all know
that the less staff time spent on administrative types
of transactions and procedures, the more time that can be spent
in patient care, and also, you save in costs.
So we can't continue to use the 4010 and the 4010A.
It lacks functionality and, most importantly, for us,
it does not accept the ICD-10 codes.
So what's our implementation timeline for this?
For 5010, all covered entities must be fully compliant
by January 1st of 2012, and that's just about
six months away, which is not a whole lot of time.
What, basically, "compliance" means is
that "providers and plans need to be able to conduct
these HIPAA transactions successfully."
The compliance dates are firm. They're not subject to change.
So, as of January 1st of 2012, if you're not using 5010,
then that is a noncompliant transaction and, most likely,
it will be sent back and asked for 5010 or it will be rejected.
Medicare actually started accepting test claims
with the basic version of 5010 in January.
Now, since that time, there has been a second version
of the 5010 standard,
what they call an errata version.
And what happened with this was
the Standards Development Organization
that was responsible for Version 5010, called X12,
they started getting reports in as people started using
and testing and preparing for Version 5010,
that there were some glitches, perhaps a typo here
or a misplaced space there, that made it difficult
to use the standard, so they accepted all of these --
what we call "maintenance changes"
and they issued what they call an "errata."
And, this month, CMS fee-for-service,
Medicare fee-for-service, started accepting
both test and production claims into our systems
and we will continue to accept both 4010 and 5010
through the end of the year.
Of course, once we hit January 1st of 2012,
we will accept only Version 5010.
But it's important for us to test because that makes sure
that all of your transactions will be going through smoothly
and that reimbursements will be coming back timely,
without any problems.
ICD-10 is the next transition that comes after 5010
and it provides the opportunity to accommodate
new procedures and new diagnoses
unaccounted for in the current ICD-9 code set.
As, I think, most of you who are familiar with ICD-9 know,
it produces only very limited data about
patients' medical conditions and hospital procedures
and the space is really limited --
we're literally running out of room.
Most of you are probably familiar
with the chapters of ICD-10 and, you know, it got to the point
where we were putting cardiology codes
in the eye section and vice versa
and that really slows down coding.
If you're looking for a particular code,
you've got to literally know where to look.
It's not very intuitive, at this point.
Many of the categories are full.
So the ICD-10 codes allow for much more space for expansion
and, considering all the advances that we have,
in terms of, now, laser surgery, arthroscopic surgery,
different procedures --
now, we really need to have that kind of expansion room,
given the kind of advances that we're looking at in medicine.
So it's not just a matter of expanding a field
and adding more digits on.
The expansion of the number of codes
allows for greater specificity and exactness
in describing a patient's diagnosis
and in classifying inpatient procedures.
ICD-10 will accommodate
newly developed diagnoses and procedures,
innovations in technology and treatment,
performance-based payment systems, more accurate billing.
Now, under ICD-9, according to a RAND study,
only 1 in 5 hospital claims are paid completely
without the need for additional questions or paperwork
and we're hoping that the use of
the more robust ICD-10 code sets will really cut down on that.
In addition, we'll have better data
to improve the management of patient care,
to better describe new diseases.
You know, we're the only Big 7 country
that hasn't made the transition, long ago, to using ICD-10
and we're also the only country in the world
that uses it for reimbursement purposes as well.
So sometimes it's difficult to compare
other countries' experiences with ICD-10 to our own
because each country has its own version
and uses it for different purposes,
but, we feel, especially when it comes to tracking pandemics
and being able to share health information across borders,
that this will really bring us
into line with the rest of the world.
Okay, your ICD-10 code set, as I said before, consists
of two parts: you have the CM, for your diagnosis coding;
and it now has "laterality,"
it will "describe left versus right";
whether an encounter is initial or subsequent;
whether it's routine, versus delayed, healing;
nonunion versus malunion.
So, for example, if a patient comes into an office
and has been diagnosed with a brain tumor,
the ICD-9 code would give you a general code
for that particular diagnosis, but, in ICD-10, it will give you
more specific diagnosis coding, by allowing you to choose
between left and right hemisphere
and whether this is an initial occurrence or a recurrence.
And it's not that this is going to change the way
a medical record is notated, because providers always provide
as best a description of patient conditions and procedures
and treatments as they possibly can, in the medical record.
This just reflects better that detailed level
of medical record notation, so you're not writing
to the code, you're basically coding
to what's in the medical record already.
Another example: a patient comes in with an arrhythmia
and needs to have a pacemaker inserted.
9 doesn't have a code for a pacemaker,
but the ICD-10-PCS code set gives you a distinct code
for a number of different devices
and it isn't nearly as general as the ICD-9 code set.
Now, we're talking about a jump in the number of codes,
from approximately 15,000 codes in ICD-9
to about 150,000 codes in ICD-10.
And I know, when we talk about those numbers,
people panic a little bit,
thinking they're going to have to know all the codes.
Well, you know right now, that, if you're working
in a provider office, in a specialty,
a clinical area like cardiology or dermatology,
you're using only a subset of the codes.
It's very similar to a phone book.
All the phone numbers are there for you to access, however,
it's likely that you're only going to be using
a couple of numbers and the most frequently used codes
are the ones that you're going to be putting
on your superbills and on your cheat sheet, so to speak.
You won't need all the codes all the time,
but they're there, if you need them.
The other important thing to note is that the CPT codes
that are used for outpatient and office procedures
are not affected by ICD-10 transition,
so what you're going to see is the ICD-10,
especially the PCS codes, are used
for inpatient, hospital procedures only.
There are a number of tools that CMS has developed
to help the industry and they can use them, if they wish.
The most important of these are what we call the GEMs,
the General Equivalency Mappings,
and they're a crosswalk between ICD-9 and ICD-10
and they're a forward crosswalk and a backward crosswalk.
You can look at an ICD-9 code and be provided
with the most appropriate ICD-10 matches, and vice versa.
Just as you find multiple words in the dictionary,
you'll find multiple definitions,
depending on how the word is used,
it's been up to the clinician to determine
which is the most appropriate match.
Again, you're going from 15,000 9 codes
to around 150,000 10 codes and, in many cases,
there's a one match to many match,
but only about 5% of the codes represent
80% of the most commonly used codes.
So, again, you won't use every number, every code,
but it's nice to know that they're all there.
The GEM is a useful tool, but, when you're talking
about a large volume of claims, you're talking about a payer
having to adjudicate millions and millions of claims a year.
It's not a substitute; it is a tool,
but it's not a substitute for a system changeover
to ICD-10.
The Affordable Care Act, which I think you all know
as "health care reform," required the Secretary of HHS
to task the ICD-10 Coordination and Maintenance Committee
to have a meeting before January 1st of 2011
and the reason they asked for that meeting is
they wanted to get stakeholder input
regarding the crosswalks between 9 and 10.
They wanted to get as much public input as possible
to make appropriate revisions so that the ICD-10 code set
would be pretty much ready to go by the time October 1st of 2013
rolls around, which is the compliance deadline.
They also made another stipulation.
Congress put in the health care reform bill that the crosswalks
should be posted to the CMS Web site, as revised,
based on public input and feedback,
and that they should be treated as a code set
for which the Secretary's adopted a standard.
So, basically, what does that mean?
That means, if you're going to use a crosswalk,
the Affordable Care Act tells you that should use
the version posted to the CMS Web site.
And that's really important; it's important because,
if we have plans -- or whoever else --
doing proprietary crosswalks, then it's going to be
very difficult for providers to know which particular version
of the crosswalk they should be using
for whatever payer they're trying to file a claim with.
So, if we have a standardized crosswalk,
it's going to make things a lot easier and a lot more consistent
through the industry, so that's why that provision is in there.
So, again, if you choose to use the GEMs,
you should use the ones posted
to the CMS Web site.
There are going to be updates and changes to the code sets.
I think all of you who are familiar with coding know
that there are two updates made every year
to whatever code set happens to be in force at the time,
but we also wanted to make sure that there wasn't going to be
a change in the code sets just prior to the implementation
that would require systems to change
and coders to make changes as well,
so there's going to be a partial code freeze,
to eliminate that kind of uncertainty and, again,
this was in reaction to industry asking for at least a stop point
that they could count on in order to get ICD-10
properly loaded into their systems.
So the last regular annual update to both ICD-9
and to the current ICD-10 code sets will be made
on October 1st of 2011.
There'll be a partial code freeze that will last
until October 1st of 2014 and then you'll see
regular updates to ICD-10 will be resuming.
There'll be limited updates to both code sets,
on October 1st of 2012, for both ICD-9 and 10;
and then on October 1st of 2013 for ICD-10 only.
Limited updates will be reserved for addition
of major new technologies and diseases only.
There won't be any other changes allowed.
Again, trying to limit the numbers of changes
so that everyone can go forward with a stable set
of ICD-10 codes.
So what are we doing here at CMS?
Obviously, we have a lot of work to do, because,
not only do we have to change over all of our systems,
we have to change over and assist the states,
our Medicaid agencies, with making changes
to their systems and we also have to
make policy decisions that may impact the industry.
We have a Program Management Office here at CMS for ICD-10
and we've been working, now, for the past few years,
to identify all of the touchpoints here
at the agency and look at our internal policies and processes
and see what the crosscutting issues are.
Our ICD-10 Steering Committee meets every other week
and what we've been doing lately -- and I think
that this is really significant -- is
we've gotten past the planning stages of ICD-10
and we're really starting to work
on the work of implementation of ICD-10.
We're starting to see change requests go out
to our Medicare Administrative Contractors, our MACs.
We're starting to get input back from them,
as to what changes they feel their systems will need
and how long and how much that will take.
We're starting to gather all of the questions that we get
from events like this, from teleconferences,
from JAD sessions with our contractors,
from e-mails that are just submitted to us,
of policy questions that we need to make decisions on.
And what we're doing is
we maintain an internal log of decisions to be made.
We've actually gone through the log the past month or so
and started to come up with answers to many of the questions
that I know you all have, regarding CMS policy.
And, once we get change requests issued to our contractors,
we will announce those decisions and our policies
through our FAQs on the ICD-10 Web site.
But we have to wait until that happens to make sure
that our MACs don't have any questions or determine that,
perhaps, there may be some contraindications
to whatever policy decisions we might be making.
So, once we get those CRs issued,
we'll start to post these things to our CMS Web site.
Transitioning to ICD-10 is a major initiative and,
when we first started out on this,
it was really compared to the Y2K initiative.
Well, as we have found out, it's bigger than that
because it doesn't just affect a field,
it doesn't affect a date;
it really affects systems, business processes, manuals.
And, while, with an organization as large as CMS,
we face all of those issues,
still, no matter what size you are -- if you're
a small-provider office or a multiphysician practice
or whatever else -- a small community hospital --
it's important to get organized early.
This is not a change that can be made
a month before the compliance date.
This is not a change that is just going to be phased in.
It's a one-time date where we basically
throw the switch and everything changes over.
Given that, there are steps everybody can take
to prepare for ICD-10.
You know, we talk about organizations
attending management support and putting the structure
in place, such as an ICD-10 committee,
and that's great, if you're a larger organization,
but if you're a small doctor's office
in Beloit, Kansas, call a staff meeting.
Ask everybody where these codes are popping up in their work.
Talk to your vendors, talk to your software vendors
who are carrying your physician
or your practice management software.
Ask them "When are you going to be able to deliver to me
updated software that we can start loading and testing?"
Organize your organization;
assign responsibility to people for certain tasks.
Check with your professional associations,
to see what information they have available.
You know, obviously,
the larger the organization, the more complex.
This doesn't have to be complicated,
but you do have to pay time and attention to it.
And, again, we're finding that our ICD-10 Web site
is getting a lot of hits --, no hyphen --
and also the AAPC Web site, your association Web sites.
We just did some research, showing that
the first place that the industry is going is
to their respective association Web site,
to get information on ICD-10, so that's going to be
really critical, as you move forward.
There's lots of information out there; please access it
as early and as often as you possibly can.
One of the things I know that coders and even those providers
who aren't necessarily professional coders,
but still code, have questions about is training.
Training, when we did our proposed rule,
back in 2008, was a major concern.
How do we get everybody trained? Where do we go for training?
And I know we have some suggested curriculum
of the basics of what you should be looking for
and these are just some of the titles:
clinical definitions, workflow changes, how to code
diagnosis and inpatient hospital procedures.
It's important, for any organization,
to identify what your staff training needs
are going to be, relative to coding.
Identify the staff in your office that code.
And it may be physicians, it may be nurses,
it may be medical assistants.
Just because you don't have the title "coder"
doesn't necessarily mean that you don't code.
So in talking to organizations like AAPC and others,
the recommendation is to schedule the training
six months prior to October 1st of 2013,
which is the ICD-10 compliance date.
And we thought that that was strange, quite frankly,
when we first had this discussion, because we figured,
gosh, the sooner you get training, the better, but,
of course, our friends at AAPC showed us the error of our ways
and recommended that, you know, if you don't use it,
you're going to lose it, and that's very true.
You can get your training a year out, but if you're
not using the codes, then you fall out of practice with them
and your early training may end up necessitating
some refresher training.
So the recommendation from our experts is that there's
a lot of training out there available, through associations,
online courses, webinars, onsite training,
but do it around six months out.
And, again, if you're short on resources, you know,
you don't have the time or the money
to be able to afford to send the staff to training,
again, take advantage of online training
or collaborate together.
Get a number of offices together, have one or two people
go for training and then come back and train the rest.
That can really help you stretch
your training dollars and your resources.
So, basically, here are the dates; plan ahead.
January 1st of 2011, providers and payers should already
have started their external testing of Version 5010.
And what that means is that, during this time,
they really should be testing with their payers,
their plans, to see, you know,
if what they have loaded in their systems works.
Can they successfully conduct a 5010 transaction
and have it sent back properly?
And, while not too many were ready to test, at that point,
now that we have the errata version of 5010 in place
and Medicare fee-for-service has started accepting
production claims and test claims with Version 5010,
I think you'll see a lot more payers starting
to say that they'll be ready.
So contact payers, find out when they're going to test,
what they're going to test, and how you get that started.
On January 1st of 2012, 5010 goes into full implementation.
All electronic claims must use Version 5010, as of that date.
Around a year and a half later, you've got full implementation
of ICD-10 and that means any claims for services provided
on or after October 1st of 2013 must use ICD-10 codes only.
There's no dual coding: you can't put an ICD-9
and an ICD-10 code on the same claim.
If you submit with an ICD-9 claim,
most likely, it will be returned to you
and you'll be asked to provide the ICD-10 code.
So, again, you know, don't wait until right before those dates.
Test early, test often, work with your vendors.
You'll need the time in order to make sure
that everything goes through smoothly.
Obviously, any delays in these dates
could really cause your organization problems,
in terms of workflow and in terms of reimbursement,
so we very much want to make sure
that all of these deadlines are met.
So just to recap:
compliance deadlines and transitions are mandatory.
There seems to be some urban legends going on there
that we would accept ICD-9 codes,
that you could use either/or after October 1st of 2013,
and that's not true.
You must use ICD-10 after October 1st of 2013.
It's a big transition.
The codes are structurally different and, again,
it's going to take a lot of training and a lot of effort,
but I think that, in the end,
considering all of the changes that it will effect,
it definitely will make a difference
in the way health care is looked at.
These are foundational, really,
all the other implementations that are coming around.
So, again, important dates to have your plans in place.
Remember your dates: external Version 5010 testing;
full implementation on January 1, 2012
of Version 5010; start your training
around April 1st of 2013 for your ICD-10-CM and -PCS;
and then, again, October 1st of 2013, full implementation.
And, again, on that date. There is no phase-in.
I also heard some other rumors that we were going to allow
payers and providers, if they were ready
to start using ICD-10 ahead of time, to do so.
No, it really would create chaos, in terms of
all the other systems that would have to be in place
in order for that to happen, so we're sticking
to the October 1, 2013 implementation.
There is no phase-in, as there have been
with some other HIPAA initiatives,
where you have a longer time for small health plans.
No. Everybody flips the switch on the same time.
Okay. Let's talk, very quickly, about resources.
We mentioned, before, the ICD-10 Web site.
We also have a listserv that you can sign up
and get free information, whenever anything happens,
on the Web site, that's updated.
We have specific links
to Medicare fee-for-service providers; Medicaid programs;
again, the opt-in to receive your e-mail updates.
And we continuously update this Web site with the new tools
and information throughout the transition and, in fact,
we're going to be having some small-provider hospital
and some payer handbooks up there, hopefully, in June,
that will provide very simple directions
on how to make an easy transition to ICD-10,
so look for that in around a month and a half or so.
Again, check your professional trade associations
and explore what's available on their Web sites.
Our industry update provides subscribers
with timely information.
Here's an example of what you'll see.
You can opt in.
I believe, now, we have approximately 30,000 people
signed up for this and it grows on a daily basis.
Again, you receive updates on all the information that changes
and important notices and reminders
of where you should be in your transition planning.
We also have lots of fact sheets.
These are things that you can download, print off,
and share at a staff meeting or a board meeting
or, again, just to use in your implementation.
They just give you the basics of what you need to know
and then refer you on to the Web site
or other resources for more information.
So these are a great resource and, as you can see, they cover
a wide variety of things for medical practices,
the transitions, what you should be asking your vendors.
So we keep adding to our list
as needs are identified.
We also are running a bunch of advertising
in national publications and these are running
in national pubs like, you know, Health Care Economics,
you know, JAMA -- all of the big publications,
but we also made an effort to run them
in state and regional publications,
like the South Carolina family practitioner.
Just to be able to reach physicians, to say, you know,
"This is coming. Will you be prepared?
Here's what it means and this is
where you need to go for more information."
So we've been running these, now, for a number of months
and starting, I believe, in June, we'll also
start running some more extensive online banner ads
and we'll see how those go as well.
But, again, just trying to raise awareness
out there in the provider community
and also in the vendor community.
The message to the providers is "Ask your vendor."
The message to the vendor community is
"Your providers are going to be asking.
Will you be able to respond?"
So these have been a nice leveling field out there,
in terms of just raising general awareness among two key groups.
So that's pretty much what we have to talk about today,
in terms of CMS.
My e-mail address is up there,
in case anybody has any questions.
Again, I thank you so much for your time today.
I think this is a really important initiative.
It's foundational to health care reform;
it's foundational to meaningful use.
It really ties in to so many more initiatives
that are going to be looking --
as we look down the road in the future.
So I hope that you embrace it;
I hope that you look at it enthusiastically.
And now, I'm going to hand this off to -- I think it's Rhonda
who's going to talk to you a little bit
about what's available through AAPC. Rhonda.
HOFFMAN: Yeah, that's right; I'm just going to give
a quick update, give everybody some information
about our next presenter, Rhonda Buckholtz,
vice president of Business and Member Development
at the American Academy of Professional Coders.
She has more than 20 years' experience in health care,
working in the reimbursement, billing, and coding sector.
Rhonda is a lead member of AAPC's
ICD-10 training and education team,
which is charged with the development and training
of curriculum on ICD-10 implementation
and preparation for providers, facilities, and health plans.
She has developed training modules for ICD-10-CM
for all specialties for the AAPC and is responsible
for all ICD-10 training and curriculum development
for the AAPC, and the new
Certified Professional Medical Auditor credential for AAPC.
Rhonda's going to discuss
complex diagnosis coding examples,
best practices and ideal training for ICD-10, as well as
the tools and resources available from AAPC
to help assist with the transition. Rhonda.
BUCKHOLTZ: Thank you.
As Denise indicated earlier, you know,
one of the largest transitions that we have is going to be
the jump in the sheer number of codes.
And you can see, in ICD-9-CM, we have about 14,000.
We're going to jump, or transition, to 69,000,
just slightly over 69,000 on October 1st of 2013.
And, as coders,
that's the biggest sticking point in our heads.
But this code set and the actual portions of it
that we're going to be using is just one, actual, small chain
in the link of events that need to happen,
in order for us to be successful
in ICD-10 transitions.
So this presentation is actually going to go down
through the physician practice
and all of those areas of impact,
or all of those changes that are going to need to happen,
then we'll get into some of those changes
where you're going to see some format and structure changes
with ICD-10, that you can keep in mind for you.
We do believe that it is too soon to learn the code sets,
however, the format, the structure,
and having a general understanding
is really important for us,
as we move forward and make that transition.
So the first thing that I want to talk about is
the physician's office
and the map that we have that's available.
So we're going to start in the manager's office.
And so some of the areas of impact, for the manager --
and when I say that this manager's
going to get hit hard --
All of us, in our own departments,
are going to be hard-hit and really have to work
towards making a transition,
but the manager's going to bear a large responsibility of it.
You're going to have to take a look
at your new policies and procedures.
So, basically, any policy or procedure
that's tied to a diagnosis code --
your disease management tracking, your PQRI,
any of those processes that you have internally,
are now going to gave to be rewritten, revised,
and reformatted for ICD-10.
All of the contracts that you have in your practices
need to be evaluated, whether they be vendor or payer,
and updated, as needed, to make this transition.
So, with your health-plan contracts,
if you have any type of language that's tied in to them,
regarding reimbursement and a disease process
or diagnosis, you need to reevaluate those as well.
Vendor contracts: making the transition over to I-10
and what they can and can't handle
and how that's all going to come into play.
All of that, of course, is also going to require budgeting.
Anything that we do -- any software updates,
training, education, new contracts, new paperwork --
somehow, that has to get paid for.
So now is actually one of those times
that we really need to have a long-term budget
in our practice, in health care.
Now, I usually make the joke that,
in those smaller practices, oftentimes,
the process of a budget is whatever we happen to have
in our bank accounts, at any given moment.
We need to actually think strategically through this
and figure out where we're going to
have to spend our money over the next several years,
in order to have ICD-10 implemented successfully.
And, of course, on top of that, we're going to need to have
some type of training plan because, basically,
every single person in your practice is going to need
some type of I-10 training -- whether it be
just a slight overview of the changes
that are coming down along the way or,
as you go down through with your coders and billers,
the more intense coding training and your clinicians.
you need to determine how much training everyone
in your practice is going to need
and then how are you going to get it done?
The next area that we're going to hit is our clinical area.
Our clinical area is going to see the majority of the changes.
They're going to see changes to patient coverages.
All of the health-plan policies, payment limitations,
all of those types of things that are tied in
are going to need to be changed.
New order forms for any diagnostic test that we order,
any labs, X-rays -- think along those types of lines.
ABN forms may need to be revised as they go down along the way.
You're going to have to take a look at them and see
how you have yours set up because your policies
and procedures regarding when you're going to issue those
are going to have to change to meet the new
policy limitations that will be out there.
Superbills: think about whether you're
in an electronic world or paper world.
All of your superbills, no matter what,
are going to have to be revised.
Depending on the practice that you're in,
the paper superbill or encounter form
may be impossible for us to transition to,
leaving the diagnosis codes on.
There have been a lot of different practices
that have actually taken their normal, 2-page superbill,
which is one page, front and back,
where the one page is devoted to a diagnosis code and,
suddenly, these have expanded to, you know, 5, 6, 7, 8 pages.
Obviously, that's not a way to conduct business in the future
and we're going to have to find out
how we can make that transition,
if we're going to stay with paper superbills,
and how are we going to revise those,
so these are all strategic areas
that we're going to have to take a look at.
Our health plans, of course, are going to revise
all of our policies that are linked
to either our local coverage determinations
or national coverage determinations --
those types of things.
Those forms are going to have to be reformatted
and patients are going to have to be educated
to the changes that are going to come down along the way.
Next, we're going to transition to the physician.
There's going to be a greater need for specificity.
It's going to increase dramatically
with the use of ICD-10.
Physicians are going to have to document: laterality,
stages of healing, weeks in pregnancy, episodes of care,
and other instances in ICD-10,
where we're going to make those transitions.
And when we say that changes to documentation need to occur,
it's not because we see or we feel
that physicians are poor documenters,
it's because the concepts have changed in ICD-10
and they're going to have to make sure that they now capture
those nuances that are found in ICD-10,
to make sure that they can actually, accurately,
assign an ICD-10-CM diagnosis code.
And our code sets are actually going to grow to over 140,000.
Now, that's if you include ICD-10-PCS.
So the physicians have to be trained
on where those changes are going to occur
and what needs to be included in their documentation.
In the nurses' station, we have our changes to our forms.
So think about that: every single order form that we have
has to be changed, revised,
or completely redone or reformatted.
The nurses are going to need to make sure that they document
with the increased specificity that's going to be required
to make sure that all changes can be captured.
And I'm sure there will be changes
to prior authorizations coming down along the way.
All of those policies on the prior authorizations
are going to change to fit the new diagnostic codes.
So it's going to require training
and updates to all of the forms that are going to be out there.
The lab is going to see significant changes.
Oftentimes, especially in outside laboratories,
we don't give them enough information in ICD-9
for them to be able to process the claims
and it results in numerous phone calls back and forth.
Changes are going to need to be made because, now,
with a higher level of specificity,
the labs are going to need to make sure
that they gather that information
and we, on the physician's side, give them those.
There probably will also be new requirements
for the ordering and the reporting of services
as health plans go down through and revise
their policies and procedures and update them for ICD-10-CM.
Our billing and our coding
are going to be significantly impacted.
All payer reimbursement policies tied
to any type of diagnostic medical necessity reasoning
is going to have to be revised to fit ICD-10-CM.
The billers are going to have to be trained
on the new policies and procedures for ICD-10-CM
and we're going to have to
run dual systems for quite some time.
Now, as Denise indicated before, the transition to ICD-10-CM
is included as part of the HIPAA standards.
Now, there are certain entities that she indicated
that aren't covered by HIPAA.
Workers' comp is one of those.
So, for workers' comp, this is actually going to be one
of those transitions where it's going to be
state-by-state, carrier-by-carrier.
So some states have some protections in place already,
where workers' comp is forced or encouraged through law
to adhere to the HIPAA standards.
Not all states have
those policies and procedures in place.
So there's going to be the need for dual systems,
which means your coders and billers are going to
have to run dual systems for a period of time,
until everyone makes the transition.
There's nothing to say
that workers' comp has to make that transition.
So you want to check and start looking now, strategically,
to see what kind of plans they have in place
to make those transitions, because,
if you're participating on panels,
you want to know ahead of time,
because this is going to be an administrative nightmare.
You're going to want to make sure that, you know,
they know what plans they need
to bill ICD-10-CM with and ICD-9
because you want to make sure those claims go through
so that they accept them right on the first time.
Again, with our coding, we know we're going to
transition over to the code set.
So we know there's going to changes in the book.
As Denise says, it's a big book,
but you're not going to use the entire book.
So, for most of us, that are in a limited specialty,
we might only use a portion of the book,
however, that doesn't mean that we're not going to
have some changes that come down along the way,
that we're going to have to learn.
There's a lot of formatting and structure
that is different in ICD-10-CM than it is in ICD-9.
Because of the higher level of specificity,
for those coders that don't have a strong understanding
of anatomy and pathophysiology, they might need a refresher
on some courses that will help bring them up to speed
with the higher level of specificity
that's found in the new code set.
And keep in mind that they're also going to have to code
in dual systems for some period,
while everyone makes the transition
outside of the covered entities.
Even the people who work your front desk
are going to need some type of training.
For those practices that might have been very detailed
in their HIPAA privacy policy, they might need to be revised
and patients are going to have to sign new forms.
It really depends on the structure
and how far in-depth you went with your HIPAA privacy notice.
Updates will more than likely be required by your systems
and that may mean training
on new ways of handling patient encounters
and taking a look down through along that way as well.
Another thing, when you're talking about the waiting room,
is that patients will need to also be educated
because this transition will affect them
and their coverages as well, so that might fall along
on the people at your front desk as well, so they'll need to have
an understanding of ICD-10 and what changes
so that they can give a brief explanation
to the patients that come down along the way.
So those are, briefly, just the very easily identified
areas of impact in a physician's practice.
And those are the steps that you need
to start looking at, in those key areas because
implementation is really what we should be focusing on now,
however, in order to successfully implement,
we do have to have a good understanding
of the codes and how they interact and relate.
So I'm going to go over a few slides that
are going to show you some of the differences
in the translations so that you can have a good understanding
of what will be coming down along the way.
First and foremost, let's talk about diabetes.
There were significant changes to the diabetes coding
and the majority of the codes are combination codes.
So we actually have six diabetes categories
in ICD-10-CM right now.
So we have E08 for diabetes due to an underlying condition,
E09 for the subcategory
for drug- or chemical- induced diabetes,
E10 for the Type 1, E11 subcategory for Type 2,
E13 for other specified, and E14 for unspecified.
Now, the thing to keep in mind, with our diabetes, is,
with the combination codes, we should actually
have to use less codes to actually explain
our encounter or the patient's condition.
In ICD-9-CM, usually, we need two or three codes
in order to complete the encounter
with the use of combination codes.
In diabetes, you will see that,
a lot of times, you can use fewer codes.
So diabetes codes were expanded to include the classifications
of both the diabetes and the manifestation
and so the terms and the codes have actually been updated
to reflect all of the current
clinical classifications out there on diabetes.
Diabetes is no longer classified
as "controlled" or "uncontrolled"
and we give you a couple of examples here.
We have E08.22, which is diabetes due to
an underlying condition with diabetic chronic kidney disease.
An example, there, of a good combination code.
E09.52, drug- or chemical- induced diabetes mellitus
with diabetic peripheral angiopathy with gangrene.
So you can see where we give you some examples
of the diabetes codes that are in there as well.
The other thing to keep in mind is that, for anyone
that has been on long-term use of insulin,
there's also a secondary code that we have to report,
with our E codes as well,
and that would be Z94.4, for the long-term use of insulin.
Now, we talked about combination codes a little bit,
with our diabetes codes,
but the combination codes extend well past that chapter.
Because ICD-10 consists of greater specificity,
we do have the availability
of combination codes that are out there.
And this is a hard concept for some people to grasp,
when we talk about the combination codes
and having to use less codes, or fewer codes on our encounters
because when you think about going to 69,000 codes,
you automatically think that it's such a difference
from the 14,000 that we're using.
A lot of times, in ICD-10-CM, we can actually use fewer codes
to capture the encounter and the true intent
of what the patient was being seen for.
Now, this slide just actually shows you
a couple of other combination codes that are out there
that requires a level of greater specificity.
So we have I25.110, which is arteriosclerotic heart disease
of the native coronary artery with unstable angina pectoris.
K50.013, which is
Crohn's disease of the small intestine with a fistula.
So now you can see, actually, with our Crohn's disease,
we actually have the manifestation
or the other issues that are going along with it
combined into one code.
Then we have K71.51,
which is toxic liver disease with chronic, active hepatitis
that's captured in there as well.
Now, think about this: in ICD-9, we only have one code
for complications of a foreign body
that's accidentally left in the body following a procedure.
In ICD-10-CM, we have 50 different codes for this
that are available.
So you can see where that's expanded on.
And this example just gives you
some different scenarios that are out there.
So we have T81.535, which is perforation
due to a foreign body accidentally left in the body
following a heart cath.
We have T81.530, which is accidentally left in the body
following a surgical operation.
Then you can see where we go down,
where we actually have one that's following -- or this is
actually an obstruction, T85.524, obstruction due to
a foreign body accidentally left in the body
following endoscopic examination.
We have T81.516, which is adhesions
due to the foreign body accidentally left in the body
following aspiration, puncture, or other catheterization.
So these were greatly expanded to allow us to actually capture
the detail of those complications.
Another big change that you're going to see down,
come along the way is our coding of our fractures.
Our fracture codes actually require a seventh character
to identify if the fracture is opened or closed.
The fracture extensions
are listed here below and so it's actually
A is for the initial encounter for a closed fracture,
B is the initial encounter for an open fracture,
D is subsequent encounter for a fracture with routine healing,
then we have G for subsequent
for a fracture with delayed healing,
K is subsequent encounter for fracture with nonunion,
P is subsequent encounter for fracture with a malunion,
and S is for sequelae.
Now, keep in mind that these extensions,
the seventh-character extension, actually change within
the different subcategories, so you always will have to
refer back and make sure that you check your seventh --
We used to say seventh "digit," "Check your seventh digit."
We'll now have to say "Check your seventh character"
because of the alpha characters that are contained in it.
But you can see we have a displaced fracture
of a shaft of the last clavicle
initial encounter for a closed fracture, S42.022.
We need that seventh character captured,
so the code now becomes S42.022A.
Here's another example that we have for you.
A patient underwent surgery for an open burst fracture
of a lumbar vertebrae which became unstable.
So in this example, we have S32.012B,
and that seventh character, B,
in this subcategory, actually identifies
the initial encounter for the open fracture.
Here's where we can get into
some greater level of specificity.
So if you think "fracture of a clavicle,"
a clavicle is really just one long bone.
We had one choice for it in ICD-9-CM.
We have 24 choices for a fracture of clavicle
found in ICD-10, so, in this instance,
our documentation has to include: laterality;
whether it's displaced (anterior or posterior displacements);
or nondisplaced, the location -- is it the sternal end,
the shaft, the lateral end, or is it unspecified.
We'll also need a seventh-character extender,
which, in this example, could be either A, B, D, K, P, or S.
So, for an example of the anterior displaced fracture
of the sternal end of the right clavicle initial encounter
for an open fracture, we have S42.011B.
For the malignant neoplasm of the breast,
when we talk specificity, there are actually 54 choices
found in ICD-10-CM for both the male and female breast.
So our documentation actually has to include laterality;
location, or the exact site; the use of an additional code
to identify estrogen receptor status.
And we give you an example, there, of the malignant neoplasm
of the upper-outer quadrant of the left male breast.
So in ICD-10-CM now --
Keep in mind that the codes are in draft format,
but the code now is C50.422.
For our large and small intestine,
we actually have 26 choices available and our documentation
actually has to include the specific site.
And you can see that I have listed all
of the different sites that are covered under ICD-10,
such as: appendix, cecum, colon, rectum.
Then we go down through the jejunum.
So, in our example, we have a malignant neoplasm
of a splenic flexure, and that's C18.5 in ICD-10-CM.
Now, I like to use the example on this slide
as a really good example of
the physician has the documentation here,
but the concept has changed in ICD-10-CM.
So you can see where we have
that it's a foreign body in a nose
and the patient is a 3-year-old who comes in
after having put a raisin in her left nostril
and her grandma was unable to remove it.
And so the physician documents the raisin was grasped
with the forceps and removed
and examination of the nostril fails to reveal
any further foreign body or problems.
Now, in order to code this in ICD-10-CM --
and I have this slide up here to show you just an example.
You can actually find this example on the AAPC Web site,
under our code translator, and, basically,
all we've done is taken the GEMs files
that are available through CMS
and put them in a user-friendly format,
so that you don't have to search through all of the text.
So you enter the diagnosis code, which, in ICD-9, was 932,
and it will crosswalk you over
to some of the different scenarios.
Now, keep in mind that GEMs won't give you all of
the matches that are out there,
or all of the examples that I'll show you.
I really like this example because you can see,
in ICD-10-CM, I actually have two choices.
So now, I need to know whether or not the foreign body was
in the nasal sinus or in a nostril,
which we have the documentation of.
I also am going to need a seventh-character extender.
And so, here, it shows us the initial encounter,
but is it a subsequent?
Because think about -- for those of you that have worked
in EMT practices or along that line, sometimes a physician
isn't able to get it on the first attempt
and sometimes they have to go back or put them under,
so you have to kind of take a look at those different types
of scenarios, to see what was the actual encounter.
Was it initial? Was it subsequent?
What was the encounter?
I also like this example because you can see
the actual code for that is either T17.0 or T17.1.
Those two Xes that you see are considered
dummy placeholders in ICD-10
and that's so we can keep the code integrity
and actually put that seventh-character extender.
So on those code situations
where we don't have seven characters
and we need that seventh-character extender,
we have to use a dummy placeholder
to keep that code integrity in place and keep it together.
So let's talk a little bit, now, on what you can do now
to begin to prepare for ICD-10.
As Denise said, this isn't a quick fix.
ICD-10 is going to take a lot of time and effort
in our practices and we have a lot of competing things
going on in our practices that are getting our attention now,
with EMRs, stimulus moneys, things coming down
in the HITECH Act, and those kinds of things,
that are kind of competing for our ICD-10.
We want to make sure that we keep ICD-10 on the forefront
and begin to work with it
and integrate it with all of those other areas
that we're working on in our practice.
So at the AAPC, we have what we consider
16 steps for successful ICD-10 implementation.
So your first step is really going to be
to organize your implementation effort.
if you're in one of those larger practices,
this is where you're going to get your committee together
and you're going to take a look at what's going on down along.
If you're in a smaller practice,
it might just be you and the doc.
Then you're going to move on and you're going to
develop your communication plans.
Again, when you're in those larger practices,
the communication plan is very important.
In the smaller practice, this could be
a simple staff meeting, meeting with the doc
after-hours or before-hours, whenever you can get the time.
You're going to conduct your impact analysis.
Now, for those of you guys that work in practice management
or have ever done some type of process management review
in your office, this is where you're actually --
Normally, we would take the patient
and we would follow the patient the whole way through the office
and, basically, find out where you have gaps,
where things are falling down,
where everything has been touched.
You're going to do the same thing with that process,
only, now, you're going to replace the patient process
with a diagnosis code.
So you're going to actually take a 360° review of your practice
and figure out where all the diagnostic codes
impacts or touches your practice
and that's going to be your impact analysis.
Then you're going to organize -- especially if you're
in those larger practices, your cross-functional efforts.
In the smaller practices, this step would not be necessary.
You're going to work on your budget development
and budget development is going to be important,
no matter what size practice you're in.
For your internal systems design and development,
keep in mind: if you use an outside vendor
for your IS or your IT, you want to make sure
that you're on their timeframe and that they have
a good understanding of what's going to
come down along the way with ICD-10.
This is one of those areas where,
if you use external forces, you want to make sure
that they're going to be available for you
when this change happens.
Develop your training plan.
You're going to contact and work with your system vendors
and make sure that they're on track for everything.
Then you're going to begin your implementation planning.
Step 10 is your Phase I training.
Now, Phase I training is what we refer to as
you're going to learn the fundamentals of ICD-10.
You're going to learn the format,
the structure, the history, how the code sets interact,
those types of things,
but you're not going to learn the code sets in-depth.
Then you're going to take a look
at all of your business processes
and how those interact in your practices.
Phase II training: this is where Denise said, you know,
you don't want to get it too soon; you want to wait
until six or nine months before implementation.
This is where you're going to get
your specialty-specific code set training,
where you're really going to become very familiar
with working with your code sets.
And you want to make sure you take that training just in time
because it's true: if you're not using it,
you're going to lose the knowledge.
You want to make sure that you can work with it
and that you continue practicing with it
after you've learned it in-depth.
Once you get through those phases,
then you've got to take a look at all of your policies
and whatever changes might need to be made to those
down along the way.
It's really important that, anytime we implement
such a large change -- which, ICD-10 is going to be one
of the largest changes to ever hit health care --
that we have some way to measure the outcomes.
Is it what we expected?
What improvements do we need to make?
Those types of things that come down along the way.
Step 15 is really just that deployment of the code,
so any changes that we need,
any vendor solutions that we're going to use,
this is when the vendors are going to give it to us
and make sure that it's in a user-friendly format
and then we're going to do our testing
and make sure that we can work with our fields
and all of that that comes down along the way.
And, of course, step 16 is going to be our go-live,
our implementation compliance date.
Which, of course, we all know, is October 1st of 2013.
Now, AAPC has a lot of resources
that are available on their Web site.
We have lots of news articles, frequently asked questions,
where you can go in and find information.
We have our code translator,
which uses the GEMs codes to take your ICD-9 codes
to what selections might look like in ICD-10.
We also have a benchmark tracker that's available.
This benchmark tracker is a really important tool for you
because it goes down through those 16 steps with checkboxes
so that you can go down along the way to make sure
that you strategically hit that October 1, 2013 go-live date.
And this is just a sample of what our benchmark tracker is.
So you click on any of those steps
and then that will give you what-all you should be doing
during that step and you can check it off
and then that's going to change the colors for you.
Green means you're good to go;
yellow means you're cautioned, you're falling behind;
and red means that you're really behind
and you really need to step it up
in order to get your compliance in.
We also have training options that are available out there.
We do not have code-set training available, as of this time,
because it's not time.
The focus now should be on implementation
of ICD-10 in your practices.
And, of course, we have resources that are out there.
We do have links to the CMS Web site.
They have great resources that are out there.
As Denise mentioned, you want to make sure
that you always go to your trade associations,
your doctor's associations that he belongs to,
your state medical societies, and those types of things,
to see what they have in mind and how they
can help you prepare as you go down along the way.
And, Alexis, that's the end of my presentation.
If we want to start.
JOHNSON: Great! Thank you, Rhonda and Denise,
for your incredibly informative presentations.
Again, I just want to just give a quick reminder
that the presentation transcripts and audio, Q&A,
will all be available on the CMS Web site
within about two weeks following this presentation.
Before we begin the online Q&A with the AAPC traders
that are available, I'm just going to go ahead
and cover off on a couple of frequently asked questions.
So I'm going to jump into that with Denise and Rhonda.
"Is there any possibility that the transition deadline
for ICD-10 will change, at all?"
BUENNING: Hi, this is Denise. I can answer that.
Right now, we have absolutely no reason to believe
that the dates are going to change on either 5010 or ICD-10.
Those dates are firm; again, January 1, 2012 for 5010
and October 1st of 2013 for ICD-10.
JOHNSON: Great. Thank you.
"Are there any provider groups who will be
more affected than others by the transition to ICD-10?"
BURKHOLTZ: This is Rhonda.
There are some provider groups that will be affected more.
Obviously, family practice or internal medicine
because they use a larger subsection of the code,
as well as orthopedics, cardiology.
Those are practices that have some changes
that are coming down along the way
that require a higher level of specificity
and a more intense use of the code set,
so they would want to take a long, hard look at the impact.
JOHNSON: Okay, great.
Now, there are a lot of competing priorities
for health care providers right now,
with the HITECH Act, among a whole bunch of others.
"Why do providers need to make sure that they still keep ICD-10
kind of on their radar and their agenda
and really start planning?"
BUENNING: This is Denise. I can take that one.
As, I think, I mentioned before, when we first developed
both 5010 and ICD-10 regulations,
a lot of the initiatives that we're looking at now,
such as meaningful use and some of the other regulations
that are coming through the system, weren't even,
you know, a twinkle in our eye, so to speak.
But I think that there are a couple of things
that are really critical to remember.
Number 1, they're mandatory. This is not an either/or.
This is by regulation and we have to adhere to it.
Number 2, these are really foundational.
you can't have really meaningful use without the kind of robust
patient-encounter information and data
that the ICD-10 code sets are going to generate.
You're not going to have administrative simplification
and streamlining of a lot of the business processes
of health care that could really save the industry a lot of money
if you don't have a system, like 5010,
that really provides more robust information
and gives people, upfront, the information they need,
so that they're not calling back the plans;
they're not spending time on the phone;
they're not having to resubmit more information.
So I think that, while, you know, again, a lot of this
is coming down always in a short amount of time,
the first one out of the gate is 5010 and ICD-10
and they really will help further down the line,
as we get more into carrying out Congress's intent to really
streamline the operations of the health care industry
and to use the resources that we're currently spending
on that segment of the industry and putting it more
towards patient care and making it better
for providers and for payers
to get reimbursed fairly and properly and timely.
JOHNSON: Great. Thanks, Denise.
Participants, we're now ready to move
into the Q&A portion of the Code-a-thon.
If you look at the current slide,
you'll see some instructions for asking questions.
So I'll just kind of walk you through the process.
You'll select the "Q&A" tab
at the top of the menu bar in gray, type your question,
click "Ask", and an AAPC trainer will then take your question.
You'll see a pop-up box appear, notifying you
that your question's been answered.
Please keep in mind that the same AAPC trainer
who answered your first question may not be the same
as the one who answers your follow-up question,
so just be sure to try to explain your question in detail.