ICD-10 FAQ - Pulse Systems, Inc

ICD-10 FAQ - Pulse Systems, Inc
ICD-10 Frequently Asked
Questions
September 2015
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ICD-10 FAQ
Acknowledgments
Document Number: 01
Date: September 7, 2015
Pulse Systems Inc.
3020 N. Cypress Suite 200
Wichita, KS 67226
1-800-444-0882
www.pulseinc.com
Copyright 2014 Pulse Systems, Inc.
pulseinc.com + 1.800.444.0882
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ICD-10 FAQ
Table of Contents
ICD-10 Frequently Asked Question’s ............................................................................................................ 4
1. Industry .................................................................................................................................................. 4
Q: Where can I find a list of ICD-10 codes? .............................................................................................. 4
Q: Can I just rely on my coder to implement ICD-10? ............................................................................... 4
Q: Can I just rely on a mapping system like General Equivalence Mappings (GEMS) to convert ICD-9
codes to ICD-10 codes? ............................................................................................................................ 4
Q: What kinds of training will my staff and I need to implement? .............................................................. 4
Q: Shouldn’t my EHR be able to code for me? ......................................................................................... 4
Q: What will I need to include in my documentation? ............................................................................... 5
Q: I am “cash only” practice and do not contract with any payers. Do I still need to use ICD-10? .......... 5
Q: Are the ICD-10 codes replacing Current Procedural Terminology (CPT) coding?............................... 5
Q: What benefits are there for non-covered Entities to transition to ICD-10? ........................................... 5
Q: I am a solo practitioner, and I don’t have staff to help me get ready for ICD-10. What do you
suggest? .................................................................................................................................................... 6
Q: Are there factors to consider when referring patients to other providers for services rendered after
the deadline? ............................................................................................................................................. 6
Q: When will Emdeon be testing end to end with Insurance? ................................................................... 7
2.
Software ................................................................................................................................................. 7
Q: Will Pulse Systems automatically convert our current ICD-9 codes in the chart, on billing forms, and
so on to ICD-10? ....................................................................................................................................... 7
Q: If I only utilize Practice Management and not an EHR, will I be required to create new paper charge
forms? ........................................................................................................................................................ 7
Q: Is there a statistics report we can run for Top Diagnosis Codes or only the Top 100 by Encounter
report? ....................................................................................................................................................... 7
Q: Will both my EHR and Practice Management solutions be able to support ICD-10? .......................... 7
Q: Am I going to be able to use the same templates and content that I currently have or will I need to
re-customize them all for the new ICD-10 compliant software? ................................................................ 8
Q: Will I need new hardware to accommodate your ICD-10 upgrade? ..................................................... 8
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ICD-10 FAQ
ICD-10 Frequently Asked Question’s
1. Industry
Q: Where can I find a list of ICD-10 codes?
A: The ICD-10-CM and ICD-10 PCS code sets, are available free of charge on the CMS website. There
are links in the assets section of this webinar portal that will take you to the ICD-10 CM code page and
the ICD-10 PCS code page. Additionally, it is important to contact your payers and trading partners to
request a copy of the crosswalk mapping tool they are utilizing to ensure its accuracy.
Q: Can I just rely on my coder to implement ICD-10?
A: ICD-10 is more robust and requires a significant amount of patient-specific information. If the
documentation is not complete and does not provide the necessary information, the physician will be
required to provide the coder with more details.
Q: Can I just rely on a mapping system like General Equivalence
Mappings (GEMS) to convert ICD-9 codes to ICD-10 codes?
A: Mapping tools do not drill deep enough for the fourth through seventh digits. Also, because there is not
always a one-to-one mapping between ICD-9 and ICD-10, mapping tools cannot always provide the
definitive code for a given situation. GEMs helps to find a code that would be in the general vicinity of the
correct code in ICD-10. Just like translating between languages, translating between coding systems
does not necessarily yield an exact match. Providers should use GEMs as the first step in finding the
most specific code that applies to their patient and manually look up codes under ICD-10 as well to
ensure accuracy. Using only the GEMs will likely lead to audits and other problems with claims
submission.
Q: What kinds of training will my staff and I need to implement?
A: Each person in your practice will require some level of ICD-10 training. It is best to begin with
designated experts in your practice. Once they are trained, they can teach the rest of your team.
Physicians and coders/billers will need the most intensive training, clinical staff will need intermediate
training, and front-office staff and schedulers will require only a basic understanding. You can train your
staff using external, on-site, or online formats.
Q: Shouldn’t my EHR be able to code for me?
A: The EHR should have the codes in the system for you and may even help you select a code for a
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ICD-10 FAQ
given situation, but will not instruct you on what else is needed to implement ICD-10 in your practice or
the guidelines surrounding the codes. .
Q: What will I need to include in my documentation?
A: In general, you will need to include details such as laterality, level of subluxation, ordinality, or
dysfunction. For specific conditions, requirements will vary; some examples for common conditions in
family medicine include:
•
Asthma: intermittent, mild persistent, moderate persistent, severe persistent
•
Fractures: Gustilo classification, type of fracture
•
Seizures: General or focal, type, intractability
•
Pregnancy: Which trimester
•
Poisoning or toxic effect: Which substance
•
Ulcers: Which stage
•
Diabetes: What type
•
Injury: Type, location such as a muscle or tendon, including separating strain from sprain,
stage of care and external cause
•
Headache: type, persistence and cause
Q: I am “cash only” practice and do not contract with any payers. Do
I still need to use ICD-10?
A: While technically you do not have to do so under the HIPAA federal regulations, it is still a good idea to
include ICD-10 codes on the bill you provide to your patient, because some patients may submit claims to
their insurance company on their own behalf. Under healthcare reform, there is a focus on accuracy of
data so that data mining can occur for research purposes and for population health analyses. Uniform use
of ICD-10 allows more detailed specificity and consistency in claims data analyses.
Q: Are the ICD-10 codes replacing Current Procedural Terminology
(CPT) coding?
A: No. The change to ICD-10 diagnoses codes will not impact CPT coding for outpatient procedures.
Though, clinics are encouraged to keep an eye out for new, revised, and deleted CPT codes that may
become available every year on January 1; this should be a normal process in your clinic.
Q: What benefits are there for non-covered Entities to transition to
ICD-10?
A: After ICD-10-CM is implemented, ICD-9-CM will no longer be maintained by the World Health
Organization. Because of this, even non-covered entities may find that it is best to begin using ICD-10.
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ICD-10 FAQ
The Centers for Medicare & Medicaid Services (CMS) are also going to work with non-covered entities to
encourage their use of ICD-10. Even though ICD-10 may not be required of non-covered entities such as
providers who do not bill electronically or workers’ compensation carriers, it may be mandated by state
regulation. In addition, providers who do not bill insurance carriers may find that their patients turn in bills
for reimbursement from their insurance company. Continued use of ICD-9, a code set that will be
outdated, may present significant problems for providers.
According to American Health Information Management Association (AHIMA), there are several benefits
for non-covered entities and notes that CMS plans to work with these organizations to encourage ICD-10
use. These benefits include the increased detail in ICD-10 that provides significant value to non-covered
entities. For example, the expanded injury codes will be useful to automobile insurance and workers'
compensation programs. Non-covered entities stand to achieve the same benefits of using more detailed,
up-to-date code sets as covered entities, including better data for:
•
Measuring the quality, safety, and efficacy of care
•
Designing payment systems and processing claims for reimbursement
•
Conducting research, epidemiological studies, and clinical trials
•
Setting health policy
•
Operational and strategic planning and designing healthcare delivery systems
•
Monitoring resource utilization
•
Improving clinical, financial, and administrative performance
•
Preventing and detecting healthcare fraud and abuse
•
Tracking public health and risks
In addition, ICD-9-CM will no longer be maintained once ICD-10 is implemented; meaning the usefulness
of the ICD-9-CM code set will rapidly decline. ICD-9-CM products and resources also will become
increasingly difficult to obtain. Those non-covered entities that continue to use ICD-9-CM after the ICD-10
compliance date will compromise their ability to compare data with covered entities.
Q: I am a solo practitioner, what do you suggest to best prepare for
the ICD-10 transition?
A: As a one-physician operation, consider seeking suggestions from your peers, local and state medical
societies, other smaller-practice physician offices, your vendors and clearinghouses. One good place for
smaller practices to start is the CMS roadto10.org website.
Q: Are there factors to consider when referring patients to other
providers for services rendered after the deadline?
A: If you refer patients to other providers, or write orders for other providers, consider if the referral or
order will involve dates of service on or after October 1st. If so, you may need to send a new referral or
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ICD-10 FAQ
order containing the appropriate IDC-10 code to the receiving provider. Consider adding both IDC-9 and
IDC-10 codes to your referrals and orders if you are not sure when the service date will occur.
Q: When will Emdeon be testing end to end with Insurance?
A: Emdeon is not conducting end-to-end testing with any payers. The testing will come down to the
specific payer themselves.
2. Software
Q: Will Pulse Systems automatically convert our current ICD-9 codes
in the chart, on billing forms, and so on to ICD-10?
A: No. Pulse has provided a mapping tool, located in the EHR, to assist you with your ICD-10
documentation. If you do not have the EHR, you will still be required to manually build your ICD-10
Charge Forms in PulsePro. Please visit the reference materials in PACE for comparison details of ICD-9
versus ICD-10 functionality in the Pulse software. For additional information, visit the Pulse Complete
EHR and PulsePro Diagnoses User Guide located in PACE.
Q: If I only utilize Practice Management and not an EHR, will I be
required to create new paper charge forms?
A: Yes. If your practice utilizes paper Charge Forms or Charge Tickets to capture patient visit details,
then you will be required to create new ICD-10 Charge Forms. ICD-9 and ICD-10 diagnosis cannot be
created on the same Charge Form. You will want to retain your current ICD-9 Charge Forms, do not
mark with a delete status, for utilize of a patient visit with a Non-HIPAA entity payer, such as Workman’s
Compensation or Auto Liability. The Non-HIPAA covered entity is not required to comply with ICD-10;
however is encourage implementing ICD-10 as the ICD-9 code format will no longer be supported.
Q: Is there a statistics report we can run for Top Diagnosis Codes or
only the Top 100 by Encounter report for viewing my top ICD-9 codes
I am currently using?
A: Yes. The Top 100 by Encounter will allow you to review the top diagnosis by provider. We encourage
you to contact your Account Manager for assistance with this report.
Q: Will both my EHR and Practice Management solutions be able to
support ICD-10?
A: Yes. All of Pulse’s fully-integrated Practice Management and EHR solutions will be ICD-10 compliant
well before CMS’ October 1, 2015 deadline.
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ICD-10 FAQ
Q: Am I going to be able to use the same templates and content that I
currently have or will I need to re-customize them all for the new ICD10 compliant software?
A: Yes. You can use the same templates and content that they currently use today, there is no need to recustomize templates for Pulse’s ICD-10 compliant software.
Q: Will I need new hardware to accommodate your ICD-10 upgrade?
A: No. Pulse clients can use the same hardware that operates Pulse’s Practice Management and EHR
software today.
Q: What diagnoses will display in my diagnosis field while prescribing
a medication?
A: Active diagnoses will display for the patient. This will allow a user to indicate a specific diagnosis for
the medication being prescribed.
Q: Will I need to make any changes to my Lab interfaces?
A: No. Pulse has worked with the Lab vendors and made all necessary changes to the interfaces to
accommodate ICD-10 code format exchange.
Q: What is the ICD-10 Tab/ICD-10 Mapper used for?
A: The ICD-10 Tab/ICD-10 Mapper has two primary functions.
1. Provides an opportunity to map ICD-10 codes to the appropriate and equivalent ICD-10 codes for
a patient’s visit.
2. Provides the user with an option to add the selected ICD-10 codes to the Patient’s Problem List.
Q: Do I have searching capabilities within the ICD-10 tab or Mapper?
A: Yes. Located at the top of the coding section, a search box is available. I can perform a text search in
this text box which will display my ICD-10 results below.
Q: Are there additional resources for me to access to assist with my
ICD-10 transition?
A: Yes. Pulse has created many ICD-10 education tools and user guides located on our website at
www.pulseinc.com and on PACE at https://pace.pulseinc.com. Additionally, the Center for Medicare and
Medicaid Services (CMS) has many resources, including a discussion and frequently asked ICD-10
questions location on their website at www.cms.gov.
Copyright 2014 Pulse Systems, Inc.
pulseinc.com + 1.800.444.0882
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ICD-10 FAQ
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