Begin Transitioning to ICD-10 in 2013 - NPC 04/18/13

Published on Jun 12, 2013

On September 5, 2012, CMS published a final rule that delays the ICD-10 compliance date from October 1, 2013 to October 1, 2014. Are you ready to transition to ICD-10? Now is the time to prepare. Learn how to prepare in 2013 for the transition. CMS Subject matter experts review basic information on the transition to ICD-10 and discuss implementation planning and preparation strategies.


0:01 Leah Nguyen: Welcome to this video slide-show presentation from the
0:04 National Provider Call on Begin Transitioning to ICD-10 in 2013. This
0:08 educational call was hosted by the CMS Provider Communications Group
0:12 within the Center for Medicare on Thursday, April 18, 2013.
0:15 I am Leah Nguyen from the Provider Communication Group here at CMS, and
0:19 I will serve as your moderator today. I would like to welcome you to
0:25 this National Provider Call, Begin Transitioning to ICD-10 in 2013.
0:29 Today's National Provider Call is brought to you by the Medicare
0:33 Learning Network, your source for official information for health care
0:37 professionals. On September5th,2012, CMS published a final rule that
0:42 delayed the ICD-10 compliance date from October 1st, 2013, to October
0:47 1st, 2014. Are you ready to transition to ICD10? Now is the time to
0:53 prepare. Join us to learn how to prepare in 2013 for the transition.
0:59 CMS subject-matter experts will review basic information on the
1:02 transition to ICD10 and discuss implementation planning and preparation
1:07 strategies. A question-and-answer session will follow the presentation.
1:12 Before we get started, I have a few announcements. This call is being
1:47 recorded and transcribed. An audio recording and written transcript
1:51 will be posted soon to the National Provider Calls and Events section
1:54 of the MLN National Provider Calls Web page.
1:59 And last, please be aware that continuing education credits may be
2:02 awarded by professional organizations for participation in MLN National
2:07 Provider Calls. A list of participating organizations and additional
2:11 information is located on slide 33. If you have any questions regarding
2:16 the awarding of credits for this call, please contact your
2:19 organization. We encourage you to retain your presentation materials in
2:23 confirmation emails.
2:25 At this time, I would like to turn the call over to Pat Brooks from the
2:29 Hospital and Ambulatory Policy Group of the Center for Medicare for an
2:33 update on ICD-10 codes and ICD-10 MS-DRGs. Pat Brooks: Thank you, Leah.
2:40 I will be giving some Web sites today where you can find additional
2:44 information on updates to ICD-10 codes and also information on the
2:48 ICD10 MSDRG.
2:51 If you look at slide 6, you'll see that we are just over a little bit
2:55 over a year away from the October 1st, 2014, implementation date for
3:01 ICD-10. Those of you who want information on updates to ICD-9-CM codes
3:05 or ICD-10 codes, I've provided Web sites links to Web sites where you
3:13 can get those updates.
3:14 In June of this year, we will post any updates to the ICD-9-CM codes
3:19 and to the ICD10 codes. We have not had many codes in the last year
3:28 because of the partial code freeze, but there is a possibility for code
3:31 updates to both systems, and you will find that information out in
3:34 June. For details on the partial code freeze, use the link on slide6.
3:37 Turning to slide 7, we will discuss the ICD-9-CM Coordination and
5:18 Maintenance Committee. This committee is the public forum to discuss
5:20 updates on ICD-9-CM and ICD-10 codes. If you've never attended one of
5:23 these meetings, I would urge you to do so because you'll learn a great
5:27 deal about the thought that goes into these requests and the reasons
5:30 for the requests.
5:31 Our March 5th, 2013, meeting was presented through a webcast; it was
5:34 the first time we have done that. If you did not participate in that
5:37 meeting, we have the video posted. You can review the handouts and the
5:40 webcast material for that March 5th meeting. Many people use this as a
5:44 way to get free CEUs from their organization.
5:46 Our next meeting of the Coordination and Maintenance Committee will be
5:48 September18th through 19th, 2013, and online registration for this
5:51 meeting, if you want to attend in person, will be August the 16th. We
5:54 will webcast that meeting again so that if you have limited travel
5:57 funds or time you will be able to participate in that meeting. And once
6:01 again, we've given you the Web site for more information.
6:03 Moving to slide 8: We've had a multiple-year project of converting the
6:06 inpatient payment system, the MS-DRG, from ICD-9 codes to ICD-10 codes.
6:09 We now have posted version 30 of the ICD-10 MS-DRGs, the Definitions
6:12 Manual, the Medicare code edits, and this is the same version that we
6:15 use an ICD-9 version currently in hospitals.
6:17 So for those of you who have not seen this work, we've given you a link
6:21 to the Web site for additional information. And just a reminder that
6:24 the final fiscal year 2015 version of the ICD-10 MS-DRG, which will be
6:27 version 32, will be subject to formal rule-making.
6:29 For slide 9, I will provide more information that we have now made
6:32 available, mainframe and PC versions of the software for ICD-10 MS-DRG.
6:35 So we provide you links on this Web site for you, if you want to get
6:39 that and test it and see the impact for your own hospital.
6:42 On slide 10, we've posted links to information on the ICD-10
6:45 implementation and MLN article matters and the code freeze.
6:47 On slide 11, we've given you links to information for resources on the
6:50 Web page and also the teleconferences. Many of you have maybe listened
6:53 to earlier versions, and I would urge you, if you want to know more
6:57 information about ICD-10, to go to this link and listen to some of the
7:00 earlier teleconferences we've had because the information is still quite
7:02 valuable.
7:03 On slide 12, we give you links to resources that are available. We've
7:06 had some very good ICD-10 fact-sheets through these links, and we've
7:09 taken those down a couple of days ago, were updating them, and well be
7:13 re-posting them very soon, within May, with updated fact-sheets that I
7:15 think you will find to be quite valuable.
7:17 My last slide is slide 13, and were providing these links to two
7:21 organizations should you want information about resources in the
7:23 community other vendors, consultants, whatever. WEDI and HIMSS are
7:25 maintaining lists of organizations that provide ICD10 resources. And I
7:27 turn it back over to Leah.
7:29 Leah Nguyen: Thank you, Pat. I will now turn the call over to Sarah
7:32 Shirey-Losso from the Provider Billing Group of the Center for Medicare
7:35 for a presentation on Medicare fee-for-service claims processing,
7:37 billing, and reporting guidelines for ICD-10.
7:38-10:20 ??
10:21 Sarah Shirey-Losso: Hello. Since the last time we presented at the
10:23 November 17th, 2011, National Call, the Medicare fee-for-service claims
10:26 processing systems have come quite a long way. All of our
10:28 behind-the-scenes systems work is expected to be complete by October
10:31 the 1st of 2013. It is to ensure that the Medicare fee-for-service has
10:34 1year of internal systems testing to be ready to accept your ICD-10
10:37 claims on October the 1st of2014.
10:39 To prepare for our ICD-10 conversion, basically all of our claims
10:41 processing systems and this includes FISS, which processes the Medicare
10:44 fee-for-service institutional claims; MCS, which is the system that
10:46 processes professional claims; VMS, which processes supplier claims;
10:48 and the Common Working File, which houses a lot of beneficiary-type
10:51 claims edits were scanned for ICD-9 codes. Each and every one of those
10:54 ICD-9 scenarios and/or edits were sent to us, and working with the
10:57 various payment policy components, these were converted to ICD-10 using
10:59 GEMs and our policy expertise.
11:00 Our behind-the-scenes changes have included converting well over 200
11:03 individual claims processing edits, various tables, and all internal
11:05 files and screens were expanded to account for the expanded number of
11:08 digits in an ICD-10 code.
11:09 On slide 15 we wanted to highlight MLN 7492, which was published in
11:12 conjunction with CR (change request) 7492 on August 11th, 2011. The
11:15 link is included on the slide. This Medicare fee-for-service
11:17 instruction highlights the decisions we made in regard to handling
11:19 fee-for-service claims.
11:20 I wanted to clarify as well, as I received a handful of questions, that
11:24 some of our articles and CRs refer to the prior ICD-10 implementation
11:27 date of October 1st, 2013. Because a lot of our instructions were
11:30 released prior to the official change in the date, we made a decision
11:33 not to reissue each and every change request and memo and article
11:36 already published, since the date change applied to all prior
11:39 instructions. We also included a link to all previously issued MLN
11:41 articles and change requests to the official notification of the change
11:44 in the implementation date to October the 1st of 2014.
11:47 Slide 16 highlights some general rules and assumptions for claims in
11:49 with ICD10. Basically, ICD-9 codes are no longer accepted for claims
11:52 after October 1st, 2014. ICD10 codes will not be recognized or accepted
11:55 on claims prior to October 1st, 2014. Claims cannot contain both ICD-9
11:58 codes and ICD-10 codes. Institutional claims, should there be an error
12:01 in an ICD-10 code, will be returned to provider, and professional and
12:04 supplier claims will return as un-processable.
12:05 On slide 17, we highlighted a few claim types and how to handle those
12:09 that cross over the September 30th, 2014, and October 1st, 2014, dates.
12:12 Outpatient claims should be split, and well use the from date, and
12:15 inpatient claims will continue to be processed using the through date,
12:18 or the discharge date.
12:19 Please refer to the table in the MLN Matters article 7492again, the
12:22 link to that is on slide 15which covers all of the Medicare
12:25 fee-for-service service claim types, including professional and
12:26 supplier claims.
12:27 In addition, we recently received a request for claim examples on the
12:30 splitting of claims. We have done so, and please look for an upcoming
12:33 special edition MLN article very shortly, in the next few weeks. That
12:36 will highlight specific claim examples.
12:37 Thank you so much for your time today. Leah? Leah Nguyen: Thank you,
12:41 Sarah. Our next presenter is Janet Anderson Brock from the Coverage and
12:44 Analysis Group of the Center for Clinical Standards and Quality, with
12:46 an update on national coverage determinations and ICD-10.
12:48 Janet Anderson Brock: Thank you, Leah. As slide 18 tells you, I am
12:52 Janet Anderson Brock. I am the director of the Division of Operations
12:55 and Information Management in the Coverage and Analysis Group, which is
12:57 part of the Center for Clinical Standards and Quality here at CMS.
13:00 One of the things I want to start with is by directing you to slide 19,
13:04 where you'll see I talk about local coverage determinations. The reason
13:07 I want to start with local is that I want to explain what were not
13:11 going to cover today in this discussion.
13:13 We do two types of coverage determinations here at CMS: local coverage
13:16 determinations and national coverage determinations. Our local coverage
13:18 determinations are actually created and implemented by our MACs, our
13:20 Medicare administrative contractors. And the local coverage
13:22 determinations are going to be translated, again, by those MACs,
13:24 specific to their jurisdictions. And the time-line that they've been
13:27 given and that they've worked through with CMS for systems changes at
13:30 the local level they will be completed by October 1st, 2013, which
13:33 coincides with what Sarah just told you for our shared systems; and for
13:36 non-systems changes, our MACs are converting their ICD-9 codes to ICD-10
13:39 codes by the implementation date for ICD-10October 1, 2014.
13:41 On slide 20, you'll see that the national coverage determinations that
13:44 we are translating are those decisions that we made here central at
13:47 CMS. These decisions span a range of coverage that's been implemented
13:49 over decades of the Medicare program, and these are specific to
13:52 Medicare only.
13:53 And like any good vintage, we have some that are drinkable and some
13:56 that aren't, I guess, to use the analogy. So what we've had to do is
14:00 really look at the historical selection of NCDs that we have, take them
14:03 in context, and figure out those that are most appropriate for
14:06 translation. The criteria that we used in part for deciding which NCDs
14:09 were appropriate for ICD-9-to-ICD-10 translation you will find on slide
14:11 20, and I want to take you through some of the top ones.
14:14 If the NCD really dealt with a non-coverage of an item or service, and
15:19 that non-coverage employed edits in our shared systems space on a HCPCS
15:22 code rather than a diagnosis code, there was really no point in putting
15:25 it through a translation process, and therefore we put that to the
15:28 side. Older NCDs that dealt with technologies that had very low
15:31 utilization in our program or were generally considered outdated also
15:33 were put to the side. And then we have policy that were currently
15:36 looking at. So anything that's on an open NCD we similarly put to the
15:40 side because, as we complete our decision process around those
15:42 policies, we will translate based on whatever the revived policy is and
15:45 put that out for the public as well.
15:47 So out of the 330 NCDs that you'll find in our National Coverage
15:51 Determination Manual, we've translated approximately 90 of those NCDs.
15:53 This includes lab NCDs and Part A/Part B items and services NCDs. There
15:56 are some national coverage determinations that deal with durable
15:58 medical equipment or are related to durable medical equipment. Because
16:01 of the highly collaborative relationship we have with our DME MACs,
16:04 we've found it most appropriate to not translate those NCDs, and instead
16:07 work collaboratively with the MACs to make sure that the appropriate
16:10 edits are in the system as they're translated at the local level.
16:13 CMS has determined which of our NCDs should be translated, as Ive
16:19 described to you, and we are actually finished with the large-scale
16:23 translation of the policies we found most appropriate for ICD-9-to-10
16:28 translation. Our largest and final omnibus CRand you'll see on the next
16:33 few slides what I mean by omnibus: CRs that are holding 10 to 40 NCD
16:40 information in the CRwill be published soon. This doesn't mean that were
16:46 finished with translating ICD-10. Were finished with the work for the
16:53 NCDs that we've done historically. Any new policy that we create from
16:57 this point forward will get a similar translation, and that translation
17:01 will be published alongside with its contemporary ICD-9 codes that are
17:05 being implemented for that policy.
17:06 So you get sort of two bangs for the buck. You'll see ICD-9, but you'll
17:11 also know what's coming for ICD-10 when we put those CRs out. And this
17:15 is something that we've actually been doing over the last 2 years. When
17:18 we put out new policy we try to tell you what you're getting now and
17:21 what's coming.
17:22 So I'm going to direct you to slide 21. We've been putting the
17:29 information out for the public to see not only through transmittals,
17:34 which sometimes don't catch the eye, but also through MLN Matters
17:37 articles. This is our primary vehicle to communicate information
17:42 regarding our NCD translations. And it can help you greatly in
17:46 understanding what we've done with the translation and also finding
17:49 spreadsheets that show you where we've gone from -9 to -10, and what to
17:54 expect come October 1st, 2014.
17:59 The feedback that we've gotten thus far is that these spreadsheets are
18:03 very helpful. They you will find that they are mostly in PDF form. I
18:10 know some people would rather be able to manipulate them
18:14 electronically, but we've found that that can actually inject a certain
18:19 amount of error into the system, so we are not translating them into
18:24 anything other than PDFs. I do hope that you find them useful in the
18:28 way that we put them out.
18:32 The place that you can send your questions generally about NCD
18:36 translations is the e-mail address you'll find on slide 21,
18:41 We ask that you please put ICD-10 in the
18:47 subject line.
18:48 I will also specifically ask that if you have a question about what I
18:52 have presented to you today, that you address it to the e-mail box on
18:56 slide number 34 so that we kind of have a holistic view of the
19:00 questions that came out of this call, and Leah is going to go over that
19:04 e-mail address again at the end, but its on slide 34.
19:07 I'm going to wrap up here with the sort of the meat of the
19:13 presentation, if you will. I think this is what everyone really wants
19:16 to hear me talk about anyway, which is what we've actually done. So
19:20 slide 22 and 23we tried to compile for you a comprehensive list of
19:23 links for places you can go to get information about the NCDs that we've
19:29 translated and those attachments that I explained to you that show you
19:34 the translation from -9 to -10, by code. So what you'll see on these two
19:41 slides is we give you the transmittal link. Occasionally people find
19:46 that more helpful than the MLN Matters article because you can see some
19:51 of the business requirements or some of the logic that we've put around
19:54 the translations, also some of the messaging that you may incur when
19:58 putting in claims for these items and services related to these NCDs.
20:03 The issue date may be helpful for you. I think most helpful is in the
20:08 area of the chart where you see the word Subject, you can actually see
20:27 the physical NCD numbers. These correlate to the numbers of the NCD
20:30 manual for the policies that we've translated. The CR number is listed
20:33 there and also the links to the CR attachments, and that's, as I
20:36 suggested, the spreadsheets that give you the actual translations. You
20:38 also get a link to the MLN Matters article where those apply.
20:41 I wanted to thank 3M, a contractor that we've been working with very
20:45 closely, for pulling this information together for us. We found it
20:47 incredibly useful; I hope you find it similarly useful, and we will
20:50 continue to update this information and find a home for it on the Web
20:54 so that you can have this at fingertips all the way up until
20:56 implementation.
20:57 And with that, Im going to turn it back over to Leah. Leah Nguyen:
21:01 Thank you, Janet. I will now turn the call over to Denesecia Green from
21:04 the Administrative Simplification Group of the Office of E-Health
21:07 Standards and Services for a presentation on ICD-10 implementation.
21:09 Denesecia Green: Thank you, Leah. Good afternoon, everyone. Again, my
21:12 name is Denesecia Green with the office of E-Health Standards and
21:15 Services. Id like to talk with you today a little bit about ICD-10.
21:21 Internally at CMS weve developed a comprehensive ICD-10 implementation
21:27 strategy that includes coordination across all areas of CMS, including
21:32 Medicare and Medicaid. And weve been conducting extensive outreach to
21:36 the industry, especially to small provider groups, small physician
21:41 practices; working closely with industry groups like the AMA, WEDI,
21:47 HIMSS, AAPC, PAHCOM, ANA, and others. And its really to collaborate on
21:54 a successful transition.
21:55 Slide 25: The compliance deadline for ICD-10-CM and PCS is October 1,
22:04 2014. And I state that because we are really getting out to the industry
22:10 and letting everyone know that this date is firm. As a matter of fact,
22:14 recently at a HIMSS conference in March, our administrator Marilyn
22:18 Tavenner announced that the ICD-10 compliance date is October1 and it
22:23 is firm, and her speech just affirmed to everyone that the time to
22:28 transition is now.
22:31 Im turning to slide 26. So this is the time-line, and you may be asking
22:37 yourself, where should I be today? And so for small-to-medium practices
22:42 and we also have this for large practices as well, but the time-frames
22:46 are very much the same. So were asking everyone from now through the
22:50 end of the year to start your internal testing.
22:53 As you're conducting your systems chang-eover any type of updates also
23:00 begin that internal testing to ensure that you have all pieces in
23:03 place. We also want you to take a look at October 1, 2013, to October
23:10 2014 to conduct your external testing. This means working with your
23:15 business partners, your trading partners, and ensuring that you have a
23:19 good working relationship with them, and all systems are go.
23:23 I also want to mention here that if you are a provider and you're
23:27 working on the 4010 platform, that ICD-10 wont be able to be executed
23:36 on that platform you have to convert to 5010, which is the newer
23:41 version, the upgrade; and that clearing-houses wont be able to convert
23:46 your 4010 ICD-9 claim to an ICD-10. So you really need to start those
23:53 conversations with your vendors and to ensure that you have the proper
23:57 systems in place.
23:58 Slide 27: I want to talk to you a little bit about some of the best
24:06 practices that we've found, and this actually came out of our State
24:09 Medicaid agencies. They looked across the board to see if there were
24:13 any conditions that were most important to them, and found these 30
24:17 here that they've developed from best practices around, and its useful
24:21 to everyone. Wed be more than happy to share additional information on
24:25 this, but it does give you some best practices to use in terms of some
24:32 of your major issues you have diabetes on here, you have heart
24:35 failure some of those major conditions that may be of interest to you in
24:39 terms of coding.
24:42 Slide 28: And this talks about our CMS ICD-10 Web site. It is really a
24:46 rich source of information. And we have a host of tools, resources,
24:49 training you name it. And its really broken down by which group you
24:52 would be a part of. So in this case there is a provider resource
24:55 section that's just dedicated to you, having all of the information that
24:58 you need there. So please check it out.
25:00 Next slide: And so this slide, I really want to focus on this because
25:04 its been very popular, and we always like to get the information out
25:07 here. Its our free CME training for physicians, and anyone can take it.
25:10 So nurses, office staff, billers, coders can take it. But the CMEs are
25:13 offered to physicians, and its free. It talks all about ICD-10, and
25:16 just getting ready, and what steps you need to take to do just that.
25:20 Next slide: And here are our provider and payer Implementation Guides,
25:23 and these guides help you to navigate your implementation from A to Z.
25:26 And it really has worked well. We are developing some other tools based
26:01 on some feedback from provider groups, to get something a little bit
26:05 handier. This is probably a 60-page guide, so we want to kind of give
26:09 you something a little bit more interactive, perhaps something online,
26:13 that you can work with and just get those very quick implementation
26:15 tips.
26:16 Next slide: So were on slide 31, and here we just want to talk a little
26:24 bit about CMSs end-to-end testing pilot. You'll see some time-lines here,
26:29 and you'll see some comparison between what our OESS office is working
26:36 on in terms of end-to-end, and also what the HIMSS/WEDI ICD-10 National
26:41 Pilot is doing.
26:44 So let me talk today about a little bit of both. So CMS is
26:48 collaborating with the HIMSS and WEDI ICD-10 National Pilot Program,
26:53 and this program is to identify synergies and best practices for
26:56 end-to-end. And part of that and CMSs role is, really were looking at
27:01 developing sort of a process and methodology, and some materials we
27:06 hope that would be of value to you in your testing. And that will
27:11 contain a check-list and some other materials to help you with that
27:13 process.
27:14 I also want to tell you a little bit about what we expect to get from
27:21 this. Its really about bringing industry together, kind of hearing from
27:25 you what would be helpful. We have about 18 industry what we call
27:29 collaboration partners that were meeting with on a weekly basis, and
27:33 they're really going through some of the challenges and difficulties
27:36 they're having with testing. And so were kind of distilling all of that,
27:40 processing that, and developing helpful a check-list for you all to use
27:46 in that process. All of this information will be shared with HIMSS and
27:49 WEDI as they move forward with their end-to-end testing pilot.
27:55 And with that, I will turn it over to Leah. Thank you. Leah Nguyen:
27:59 Thank you, Denesecia.
28:03 And your first question comes from the line of Rose Bruton.
28:07 Rose Bruton: Yes. Can you hear me?
28:14 Leah Nguyen: Yes, we can.
28:16 Rose Bruton: OK. This is Rose with Five Rivers Medical Center. I'm
28:19 sorry. On slide 30, it shows provider and payer Implementation Guides,
28:23 and you talked about them being useful. Where do we get those guides?
28:27 Denesecia Green: Those guides are located on our ICD-10 Web site, and
28:34 its right on slide 28, so that would be
28:43 Rose Bruton: On slide 28.
28:44 Denesecia Green: Yes, .
28:45 Rose Bruton: OK, thank you.
28:47 Leah Nguyen: Thank you.
28:48 Denesecia Green: Denesecia Green.
28:49 Operator: Your next question comes from the line of Sharon Allen-McCoy
28:53 Sharon, your line is open.
29:02 Sharon Allen-McCoy: OK, can you hear me now?
29:06 Operator: Yes, go ahead.
29:07 Leah Nguyen: Yes, we can, thank you.
29:09 Sharon Allen-McCoy: Throughout this ICD-10 translation process, I hear
29:16 you referencing Medicare fee-for-service and Medicaid. What about
29:20 Medicare Advantage plans and programs? Is the expectation going to be
29:27 that they are all transitioning to ICD-10 also?
29:32 Leah Nguyen: Can you hold for one moment?
29:34 Denesecia Green: Yes, hi. This is Denesecia Green with OESS. And yes,
29:45 this compliance date applies to everyone. So everyoneMedicare, Medicare
29:53 Advantage, Medicaid all industry would have to transition from ICD-9 to
30:01 ICD-10.
30:02 Sharon Allen-McCoy: Thank you.
30:03 Denesecia Green: Thank you.
30:04 Operator: And your next question comes from the line of Julie Scholl.
30:15 Julie Scholl: Yes, we had a question on implementation guide. Would we
30:19 be better off were 24-hour group home care, also do therapy services to
30:24 get the small and medium practice or small hospital guide?
30:32 Denesecia Green: To be quite honest this is Denesecia Greento be quite
30:35 honest, I think both of them would be helpful, either one. Many of them
30:39 have the same exact information. Were going through and working with
30:43 groups like yourself to tailor those a little bit more. So perhaps you
30:47 could share your information with Leah here or others, and then we can
30:53 follow up with you to get some real input on developing some more
30:57 tailored guides for you.
30:59 Leah Nguyen: Yes, actually if you would like to, you can send that to
31:02 the e-mail address listed on slide 34, and Ill go ahead and get that
31:07 out to the right people.
31:08 Operator: And the next question comes from the line of April Williams.
31:18 April Williams: Yes, Im with Coastal Carolina Radiation Oncology, and
31:22 we bill patients at the end of their treatments, and they may have 20
31:28 treatments. And the question being, with the implementation date being
31:33 October 1st, is that based on date of service or date of billing?
31:37 Sarah Shirey-Losso: This is Sarah Shirey-Losso with the Provider
31:43 Billing Group. And that is date of service.
31:45 April Williams: Date of service, OK. So we need to split-bill. Thank
31:47 you.
31:48 Operator: Your next question comes from the line of Kathy Wilhelmsen.
31:51 Kathy Wilhelmsen: Hi, my question is for Denesecia Green. On slide 27,
31:54 did you say you had more information you could share with us on the
31:57 best practices?
31:58 Denesecia Green: Absolutely. Were actually moving many of those
32:00 additional documents to our Web site. Well be having some policy briefs
32:03 come out as well on some coding practices that we've heard back from the
32:07 States on. So, yes, please take a look out there on our Web site;
32:10 they'll be posted within the week. And as were developing others, you'll
32:41 see additional ones being posted as well.
32:43 Kathy Wilhelmsen: Thank you.
32:44 Leah Nguyen: Thank you.
32:45 Denesecia Green: Sure, thank you.
32:46 Operator: And your next question comes from the line of Rebecca Flora.
32:49 Mark Flora: Yes, my name is Dr. Flora. Im in private practice in North
32:52 Carolina. You stated previously that all entities were required to
32:56 implement, and Im wondering if this includes workman's comp.
33:03 Denesecia Green: This is Denesecia Green and, no, it does not include
33:05 workers comp.
33:06 Mark Flora: So it doesnt include all entities.
33:09 Denesecia Green: Well, it does not include workers comp or auto, if
33:15 that helps. And paper bills.
33:19 Leah Nguyen: Thank you.
33:20 Operator: Your next question comes from the line of Mary Ankeny.
33:27 Mary Ankeny: Hi, Im Mary Ankeny from Vero Radiology. The question that
33:35 I wanted to ask was just previously asked, about workers comp.
33:38 Leah Nguyen: All right, thank you.
33:42 Mary Ankeny: Thank you.
33:43 Operator: Your next question comes from the line of Naomi Fox.
33:47 Naomi Fox: Hi, Im Naomi Fox from Vantage Health System. I was
33:50 wondering, regarding the implementation guides, will there be one
33:53 leaning towards a helpful guide for those who use DSM-V and -IV codes
34:01 now? Because were having a hard transition from DSM to ICD-10 for
34:06 behavioral health.
34:07 Pat Brooks: This is Pat Brooks. I believe that CDC is working with the
34:12 American Psychiatric Association, coordinating efforts between
34:15 ICD-10-CM and DSM. At this point we don't have anything to announce, but
34:20 I think that the CDC will be making some announcements in the future.
34:24 Naomi Fox: Great. Thank you.
34:25 Leah Nguyen: Thank you.
34:26 Operator: Your next question comes from the line of Donna Walaszek.
34:30 Donna Walaszek: Hi, this is Donna from Northampton Area Pediatrics. I'm
34:36 calling regarding the anticipated changes, if any, to the standard 1500
34:42 form for any claims that may need to be sent on paper. Have we heard
34:46 whether the 1500 forms will typically take the new standard ICD-10
34:51 format with up to seven digits?
34:54 Leah Nguyen: Can you hang on for one moment?
34:56 Sarah Shirey-Losso: Yes, hi, this is Sarah Shirey-Losso from the
35:21 Provider Billing Group. And yes, that is anticipated. I would suggest
35:27 looking for something later this year.
35:31 Donna Walaszek: OK, thank you.
35:32 Operator: And your next question comes from the line of Pauline
35:38 Huntley.
35:39 Pauline Huntley: Hi. Can you hear me? This is Pauline Huntley.
35:43 Leah Nguyen: Yes, we can. Go ahead.
35:45 Pauline Huntley: My question is back to the implementation guides. We
35:51 work with several different kinds of practices, and Im trying to
35:56 understand what comprises a large practice versus a small-to-medium
36:02 practice? Same thing with hospital: What is a small hospital versus a
36:07 larger hospital?
36:09 Denesecia Green: Hi, this is Denesecia Green, and yes, these are very
36:13 these are broad categories. So we do know that there are some
36:17 differences in the way that small provider practices, especially the
36:23 groups that are one- to two-person shops versus your larger
36:27 organizations.
36:28 So the ones with the smaller groups, they're going to have more in them
36:34 to help them work through the process a little bit more. Were hearing
36:38 that some of the larger provider groups and practices, especially the
36:42 ones that are tied into hospitals, have it a little easier than some of
36:47 the others.
36:49 So if you have any questions on sort of how to navigate the
36:53 implementation and how to use the guides, please send that into our
36:59 mailbox here. Wed be more than happy to follow up with you one-on-one.
37:02 Pauline Huntley: But you're saying a small group is one to two providers
37:07 versus 20 providers, or 40 providers, or 60 providers, right?
37:11 Denesecia Green: Its a range, its a range, and it depends on the group
37:15 and how their organization is structured. Are you yes, so its no fixed
37:23 parameters. So wed be more than happy to work with you to figure out
37:27 where you would fit in and the guide that would be best for you.
37:30 Pauline Huntley: OK, so I can e-mail you with that?
37:33 Denesecia Green: Yes, and again, that address is on slide 34.
37:36 Pauline Huntley: OK, thank you.
37:37 Leah Nguyen: Thank you.
37:38 Operator: Your next question comes from the line of Kathy Brady.
37:44 Kathy Brady: Yes, can you hear me?
37:46 Operator: Yes, go ahead.
37:47 Kathy Brady: I was wondering: On slide 31, is Medicare going to be
37:52 ready for testing with physician groups and/or hospitals?
38:01 Leah Nguyen: Hold on for one moment.
38:03 Sarah Shirey-Losso: Hi, this is Sarah Shirey-Losso with the Provider
38:13 Billing Group. And providers currently they can test through the front
38:20 end, and they'll be able to do so with 5010, and you can work with your
38:25 MAC to do that. As far as testing, you know, a claim, I would say,
38:31 through adjudication that level of testing cannot be accomplished.
38:40 Kathy Brady: Is there going to be any type of check-list that will be
38:44 available to us?
38:48 Denesecia Green: So yes, this is Denesecia Green, and I mentioned that
38:51 in the testing pilot that OESS is working on, were developing a
38:54 check-list to help groups walk through that end-to-end testing process.
38:57 And that information is being shared with HIMSS and WEDI, and as part
39:00 of their effort it will be included in there to kind of help industry
39:04 overall complete their end-to-end testing.
39:05 Kathy Brady: And well have access to that?
39:07 Denesecia Green: Absolutely. Its going to be shared broadly.
39:09 Kathy Brady: OK, great. Thank you very much.
39:11 Leah Nguyen: Thank you.
39:12 Operator: Your next question comes from the line of John McKivergan.
39:15 John McKivergan: Good afternoon. My question actually follows up to
39:17 this on testing with CMS, and I just want to verify what I think I
39:21 heard. The way to test do our end-to-end testing with CMS is through
40:26 the national pilot program. That's the only mechanism, is that true?
40:28 Denesecia Green: So let me this is Denesecia Green let me clarify. So
40:32 CMSs role in the HIMSS/WEDI pilot is to really garner some support and
40:35 information and best practices from industry on a check-list that would
40:38 help people walk through that process themselves. HIMSS and WEDI does
40:40 have a national pilot where they are bringing groups together across
40:43 the U.S. to offer end-to-end testing. So that is very much ? that is
40:47 very different than testing directly with a MAC or something like that,
40:49 yes.
40:50 John McKivergan: So how so to test with CMS wed test through the MAC?
40:53 Leah Nguyen: Would you hold for one moment?
40:55 Stewart Streimer: Hi, this is Stewart Streimer with the Provider
40:58 Billing Group in CMS. CMS for Medicare fee-for-service will not be
41:01 doing end-to-end testing with providers. I think Sarah made it very
41:03 clear that a provider that wishes to test their front end with the MACs
41:07 to make sure that the claim can be received is between the provider and
41:10 the Medicare claims administration contractor. Other than that, there
41:14 will not be end-to-end testing. CMS has already a vigorous testing plan
41:22 in place to test our ability to handle a properly filled out claim from
41:27 the front end to the back end. But we will not be testing claims from
41:32 the providers.
41:33 John McKivergan: OK, thank you.
41:34 Leah Nguyen: Thank you.
41:35 Operator: Your next question comes from the line of Tara Robicheau.
41:42 Tara Robicheau: Hi. I just wanted to verify what I had heard earlier.
41:47 Were a small practiceIm with James F. Reppert, M.D.and we have a
41:51 clearing-house that converts our claims from 4010 to 5010. Is it did I
41:57 hear correctly that with ICD-10 we will not be able to have that
42:01 function?
42:04 Denesecia Green: Yes. This is Denesecia Green, and, yes, so we've
42:08 actually have conducted extensive listening sessions with many of the
42:13 clearing-houses, and so no, they will not be able to take your 4010
42:21 claim and translate that and add in the ICD-10 code for you.
42:28 Tara Robicheau: OK, thank you.
42:29 Denesecia Green: Yes.
42:30 Leah Nguyen: Thank you.
42:31 Operator: And your next question comes from the line of Carol Hall.
42:36 Carol Hall: Yes, hi. This Carol Hall from XIFIN, and I just wanted to
42:43 clarify: The date that the MACs are supposed to have their LCD policies
42:48 translated was that October 1st of 2013?
42:51 Janet Anderson Brock: There are actually this is Janet Brock there are
42:57 actually two dates that are important to note. The first is for systems
43:00 changes so, all of the things that the MACs have in their local systems
43:05 that actually adjudicate the claim, what we commonly call edits. That
43:10 date is October 1st, 2013. Anything that is not system related that
43:16 could be, like, articles, the ICD polices themselves the translations
43:19 for those don't have to be out until October 2014. Now, many of the MACs
43:28 are looking into their own internal processes and thinking about
43:32 whether they want to put the information out earlier, but they are not
43:35 required to do so.
43:36 Carol Hall: Alrighty. Thank you for the clarification, I appreciate it.
43:43 Operator: Your next question comes from the line of Cheryl Brooks.
43:46 Cheryl Brooks: Yes, my question is: Is there going to be an elimination
43:51 of the condition codes which are used for ambulance and ambulette
43:55 providers, or is there going to be a new listing that is published?
43:59 Pat Brooks: This is Pat Brooks. I don't believe we have anybody from the
44:04 ambulance policy area here to respond to that question. You could send
44:09 that in to the address on slide 34.
44:11 Cheryl Brooks: OK, thank you.
44:12 Operator: And your next question comes from the line of (Maureen
44:18 Power).
44:24 Operator: (Maureen,) your line is open. . . . We will move on from that
44:32 question, and your next question comes from the line of Claire Testa.
44:39 Claire Testa: Hi, I'm Claire Testa. I have audio only. Is there any
44:42 place I can get a copy of the slides?
44:45 Leah Nguyen: Yes, they're on our call Web page. If you go to
44:49, and then on the left-hand side you will select
44:57 National Provider Calls and Events, and from there you will see a list
45:01 of calls, and you can select the April 18th call, and its listed under
45:04 the Call Materials.
45:05 Leah Nguyen: Thank you.
45:06 Operator: And your next question will come from the line of K. Joiner.
45:13 K. Joiner: Hi, my question is sort of a two-part question. How will
45:19 retrospective claims for provider services rendered prior to October
45:23 1st, 2014, but submitted for processing after October 1st be handled in
45:31 terms of the type of codes used and the CMS forms that those claims
45:36 will need to be submitted on?
45:40 And then the second part is: If they will be submitted on the current
45:45 ICD-10 using the current IPD-10 codes and the current CMS 1500 form,
45:50 then how long will those retrospective claims be accepted in this
45:55 current ICD-9 format?
46:00 Sarah Shirey-Losso: This is Sarah Shirey-Losso from the Provider
46:02 Billing Group. Im not sure if I caught all of your question. But the
46:06 use of ICD-10 is based on dates of service. The claim forms themselves
46:12 are expected to be updated. The UB-04 institutional form has already
46:16 been updated.
46:19 I refer you to slide 15, where we discuss MLN Matters article 7492,
46:25 which basically goes through each and every institutional type of bill
46:31 as well as professional claims and supplier claims, and it gives you an
46:36 example of how to bill that.
47:54 Leah Nguyen: Thank you.
47:55 K. Joiner: OK, thank you.
47:56 Operator: And your next question will come from the line of Isabel
47:58 Dalama.
47:59 Isabel Dalama: Yes, can you hear me?
48:01 Leah Nguyen: Yes, we can.
48:02 Isabel Dalama: OK. My question would be for the physicians. I noticed
48:05 that on slide 29 there's going to be free training for them. Is there
48:09 going to be some kind of system in place after implementation, where
48:12 these physicians can if they have any questions, or any further, I
48:15 guess, questions, not only about implementation but once the
48:17 implementation happens anybody that they can actually talk to, like
48:19 maybe another physician group or somebody from our MAC that they can
48:22 direct their questions to?
48:23 Pat Brooks: This is Pat Brooks. Always you could discuss issues with
48:26 your MAC. But if your question is if they have a coding question with
48:30 ICD-10 for a particular case, then the national process we use now, and
48:33 will continue to be used, is if you wanted to send a copy of a medical
48:37 record illustrating the question to the American Hospital Associations
48:39 Coding Clinic and its going to be renamed Coding Clinic for ICD-10then
48:42 if you send in that medical record and say, Help me understand the
48:45 correct code. Is it this code or that code? then that coding clinic
48:49 board will have a look at that and provide assistance. Sometimes we
48:52 publish those so that everybody knows the answer, if its one of
48:55 interest to a broad number of people. And if its more narrowly focused,
48:58 they may simply respond to the individual question. But they don't like
49:01 hypotheticals; you'll see that on the Web site. They want to have a real
49:04 record illustrating the issue.
49:05 Isabel Dalama: OK. And in reference and I should only ask one
49:08 question, but I do have in reference to the spreadsheetsI didn't get
49:11 the information of where we can find those spreadsheets, that
49:14 transition the ICD-9 . . .
49:15 Janet Anderson Brock Are you referring to the NCD translation
49:16 spreadsheets?
49:17 Isabel Dalama: Yes, I think, slide 23, is it?
49:20 Janet Anderson Brock: Yes, 22 and 23 both. On the right-most column
49:23 you'll see its a column marked Downloads. Those are the links to the
49:26 actual file that contains the spreadsheets that show you a column for
49:29 ICD-9 and the ICD-10 translation we've decided is most appropriate.
49:31 Those translations are based on the GEMs but also include a clinical
49:34 review, so that it was absolutely appropriate to our policy.
49:37 Isabel Dalama: Beautiful. Thank you so much.
49:39 Janet Anderson Brock: You're welcome.
49:40 Operator: Your next question comes from the line of Jill Hlavaty.
49:43 Jill Hlavaty: Hi, this is Jill speaking. I had a general question. If
49:46 in general as were transitioning over from the ICD-9s to the -10 codes,
49:49 is there any anticipation of any changes on coverage requirements?
49:52 Janet Anderson Brock: That's an interesting question. This is Janet
49:54 Brock. Im going to see if Im interpreting it correctly, so Im going to
49:58 repeat it back to you. Are you asking if coverage will change for an
50:01 item or service as part of this process?
50:03 Jill Hlavaty: Correct.
50:04 Janet Anderson Brock: No. Our intent with the translation process and
50:06 this is consistent with our NCD process as a wholew as merely to
50:09 translate the instructions that weve given on current policy that's
50:12 found in the NCD manual and in the related change requests that have
50:15 come out of those policies.
50:16 If we were to review policy for a modification in coverage whether that
50:19 be an expansion, some kind of change in the conditions, or even a
50:23 rescission of coverage that would require us to open the NCD and follow
50:27 our NCD process, and that's outlined in regulations. We are opening
50:34 NCDsnot everyday, but certainly every month. And when we go through
50:40 that NCD process it will result in a CR that will show both ICD-9 and
50:44 ICD-10 translations for the new policy.
50:46 Jill Hlavaty: OK. Thank you. Leah Nguyen: Thank you.
50:48 Operator: Your next question comes from the line of William Verret.
50:54 William Verret: Good morning. Hi, this is William Verret with the State
51:02 of Oregon. In I9 there are only two procedure codes that indicate
51:08 they're combination codes. Has CMS indicated which I-10-PCS codes are
51:15 going to be combination codes?
51:17 Pat Brooks: This is Pat Brooks, and I don't understand enough of your
51:23 question to respond to that. I don't know if you're talking about MS-DRG
51:30 policy where we use codes in conjunction, or the structure of ICD-9
51:34 codes that sometimes you have to report multiple codes to convey one
51:38 thing. ICD-10-PCS is built entirely differently, so sometimes there's
51:43 more information in an ICD-10-PCS code.
51:44 The best advice I can give you, maybe, is to browse ICD-10-PCS and see
51:50 how its formulated, and then if you have a particular coding question
51:55 on a procedure, if you wanted to send that in with a copy of the OR
52:00 report to the American Hospital Association Coding Clinic, well try to
52:05 give you better advice. Its a little hard for me to respond to that
52:08 generic question.
52:09 William Verret: OK, thank you very much.
52:16 Operator: And your next question comes from the line of (Cindy Selby).
52:18 (Cindy Selby): OK, my question is: We have been using the GEMs file. We
52:31 started using that to start looking at translations, so we wouldn't even
52:38 need to use that any more right? with the NCDs you're coming out with.
52:44 Janet Anderson Brock: Well, I would this is Janet BrockI would suggest
52:50 that you continue to use the GEMs, and I say that because only really
52:54 15 to 20 percent of Medicare coverage is actually spelled out in a
52:57 National Coverage Determination. The vast majority of items and
53:02 services covered under Medicare are actually covered through LCDs or
53:06 covered on a case-by-case basis. So those GEMs are going to be your
53:09 best friend for probably a pretty long time.
53:11 Pat Brooks: And this is Pat Brooks. If I can add one more thing:
53:17 Sometimes you don't need to look things up in a GEM; sometimes you'll
53:20 find it easier if you just open an ICD10-CM book and look up at the
53:24 index. You might find that saves you a whole lot of time and that you
53:27 can be quite pleasantly surprised that you can find the diagnosis you're
53:30 looking for, depending on what you're doing. I personally use both
53:32 approaches.
53:33 (Cindy Selby): OK, thank you.
53:35 Operator: And your next question comes from the line of Sabrina Wooten.
53:47 Sabrina Wooten: Yes, my name is Sabrina Wooten, and Im from MedFirst
53:50 Immediate Care and Family Practice, and the question was already
53:52 answered, I believe, previously in regards to workers comp. So I have
54:00 the answer that I was looking for.
54:01 Leah Nguyen: Thank you.
54:02 Operator: And your next question comes from the line of Peggy Wiley.
54:12 Peggy Wiley: Yes, I have more of a comment or looking for other people
54:16 to confirm for me. Workers comp is not an issue for us in Northwest,
54:23 but for those who are facing workers comp agencies that are saying they
54:29 don't have to switch, the law may say they dont have to, but I believe
54:34 you have the right to set either billing instruction or whatever kind
54:39 of instructions that you establish. As an entity, you have that right.
54:45 So you may require it. And workers comp agencies are going to have to
54:49 deal with more than just your entity, and so they're pretty much going
54:54 to be forced, I believe, to have to switch as opposed to you trying to
55:00 modify your systems to continue to accept 9 codes. And I just wondered
55:06 what other people are
55:10 Leah Nguyen: Could you hold for just one moment? OK, thank you. Do you
55:14 want to just send your suggestion in to our e-mail on slide 34?
55:27 Peggy Wiley: OK, I can do that.
55:32 Leah Nguyen: Thanks.
55:33 Operator: Your next question comes from the line of (Dawn Rogers).
55:43 (Dawn Rogers): Yes, Im with Physician Support Services in Tulsa, and
55:47 when we I'm in their IT department and when we tested for 5010, there
55:52 was a Web site that listed payers by CP-ID that showed if they were
55:57 currently testing or accepting both. Do you know if that's going to be
56:00 something that will happen for ICD-10 as well or . . . ?
56:05 Leah Nguyen: Hold on for one moment OK, were going to ask you to send
56:21 that question in to our resource box on slide 34.
56:23 (Dawn Rogers): OK.
56:24 Leah Nguyen: Thank you.
56:25 (Dawn Rogers): Thank you.
56:26 Operator: And your next question comes from the line of Farzad Tabib.
56:32 Farzad Tabib: Hi, this is Dr. Tabib. A question regarding the
56:41 billing first of all, regarding the paper bill: Did you say that we have
56:44 to use ICD-9, and all the insurance companiesI believe they have to
56:51 switch to ICD-10. Is that correct?
57:01 Stewart Streimer: This is Stewart Streimer from the Provider Billing
57:04 Group. All insurance, all payers will have to switch to ICD-10 under
57:08 the HIPAA legislation. I think the reference earlier about paper bills
57:11 was that HIPAA if a covered entity is paper entity you know, deals with
57:20 paper they are not legally obligated to follow the HIPAA requirement,
57:26 but if the payer requires it, then they would have to follow the payers
57:30 rules so that they can get their claims paid.
57:33 Farzad Tabib: Thank you.
57:34 Leah Nguyen: Thank you.
57:35 Operator: Your next question comes from the line of Lauren Cole.
57:40 Kirsten Costanzo: Will there be hello, this is Kirsten Costanzo with
57:45 the Pain Center of Arizona, and I was curious if there was a deadline
57:51 within the CMS for adjudicating claims prior to the implementation of
57:57 ICD-10.
57:58 Sarah Shirey-Losso: This is Sarah Shirey-Losso with the Provider
58:04 Billing Group, and our adjudication deadline will not change with the
58:08 conversion to ICD-10. The normal time-frames apply.
58:11 Kirsten Costanzo: OK.
58:12 Leah Nguyen: Thank you.
58:13 Operator: And your next question comes from the line of Janet Herbold.
58:24 Janet Herbold: Yes, for inpatient rehabilitation providers, when will
58:27 the list of ICD-10 codes that are used for determining comorbid
58:32 conditions that affect our tiers our tier level of CMG, be available,
58:38 or are they already available?
58:41 Pat Brooks: This is Pat Brooks, and I don't believe theyre available
58:44 now. It may be they will be made available through formal rule-making.
58:47 But if youll send in your question, well forward it to that part of CMS
58:51 that works on it. But I believe that the only advanced work that was
58:54 shared has been the ICD-10 MS-DRGs, and that was an advanced project to
59:01 help show the rest of the agency and the rest of the country how you
59:05 could conduct a big conversion project, and that's why we were out
59:08 several years early. But the other parts of the agencies are converting
59:11 their payment policies, and theyll update them and release them to
59:15 formal rule-making.
59:18 Janet Herbold: Thank you.
59:19 Operator: And your next question comes from the line of Jill Rauber.
59:27 Jill Rauber: Hello. Aside from the free CME provider training that you
59:31 are offering, will CMS be creating any provider documentation tools
59:35 that can help them adapt to the new specificity in ICD-10?
59:38 Denesecia Green: Hi, this is Denesecia Green, and yes, were taking any
59:41 type of suggestion on tools that will be helpful to you. So we ask that
59:45 you send that suggestion in so we explore it a little bit more. Thank
59:48 you.
59:49 Jill Rauber: OK. Thank you.
59:50 Operator: And your next question comes from the line of Joanne Tate.
60:07 Joanne Tate: Yes, hello. I was just wondering, again, about the
60:11 implementation guides, and what would be the best one for a national
60:15 hospice provider to refer to?
60:18 Denesecia Green: I would definitely take a this is Denesecia Green
60:24 again I would definitely take a look at the large guide and follow
60:29 that as a good rule. And if you have any additional questions, we do
60:34 have on our Web site there's an opportunity there to send some things
60:37 in some questions in, as well. And you can also share it at this
60:42 forum.
60:43 Joanne Tate: All right, thank you so much.
60:45 Leah Nguyen: Thank you.
60:46 Operator: Your next question comes from the line of (Karen Cole).
60:51 (Karen Cole): Yes, hi. Can you hear me?
60:55 Leah Nguyen: Yes, we can.
60:56 (Karen Cole): OK, my question isI just want to make sure I heard this
61:02 correctly on the MLN Matters it says that the ICD-10 codes may only be
61:06 used for services provided on or after October 1st, but did I hear one
61:12 of you say that the time to switch is now? So that because I was
61:18 thinking that I want to gather my PTs and have them start using the
61:22 ICD-10. So that's wrong?
61:24 Denesecia Green: Hi, this is Denesecia Green. And the MLN Matters
61:32 article is correct, and I what we meant by that is its a good time to
61:38 start preparing if you haven't already.
61:41 (Karen Cole): OK, but we cannot use it until October 1st, 2013.
61:46 Denesecia Green: That is correct. You cant use an ICD-10 code today.
61:49 (Karen Cole): OK, thank you.
61:51 Operator: And your next question comes from the line of Jason Vollmer.
61:57 Jason Vollmer: Good afternoon. Is there I know that CMS is responsible
62:02 for the NCD mapping. Is there a you mentioned the partial code freeze.
62:06 Is there a target time-frame to nail down the MACs for the LCDs?
62:14 Janet Anderson Brock: This is Janet Brock. Those time-frames for the
62:16 MACs are the ones that we described. For systems changes its October
62:23 1st, 2013. For non-systems changes so that's sort of the paper and policy
62:26 products: articles, LCDs, things like that its October 1st, 2014. We do
62:31 believe that they'll get it out before October 1, 2014, but they are not
62:37 required to do so.
62:39 Jason Vollmer: Will they be subject to change after that, or is that a
62:43 hard freeze, so we can rely on that moving forward?
62:45 Janet Anderson Brock: Are you asking about the partial code freeze, or
62:49 are you asking about policy translation?
62:50 Jason Vollmer: Policy translation.
62:51 Janet Anderson Brock: Yes, OK, so for policy translation, like we've
62:54 done with all the other policies, especially LCDs since you're
62:56 interested in the local coverage, they will be updated as codes change.
63:01 Currently the ICD-9 codes are updated quarterly for LCDs, and because
63:06 sometimes a little code sneaks in, or at the very least its every 6
63:11 months. Most of the large changes happen annually, and that will
63:19 continue.
63:20 Jason Vollmer: I appreciate it.
63:21 Pat Brooks: And this is Pat Brooks. If I can just add one more bit of
63:25 reassurance: We used to have, like, hundreds of code updates a year.
63:28 For last year, for 2013, we only had a handful only one procedure code
63:31 for ICD-9, and for ICD-10 we only had one diagnosis code and two
63:35 procedure codes. So I think the impact on converting policies is
63:41 minimized with this partial code freeze. You'll discover in June if we
63:44 have more or less codes updated in June. Thank you.
63:47 Leah Nguyen: Thank you. Holley, we are ready to take our next question.
63:57 Operator: All right. And your next question will come from the line of
64:02 K. Joiner.
64:03 Leah Nguyen: Holley, can we take the next one, please?
64:16 Operator: Yes, ma'am. Hold one moment. Your next question comes from the
64:25 line of Alicia Nesvacil.
64:26 Alicia Nesvacil: I think I have a question around GEMs. We are finding
64:33 kind of a challenge as far as how to use the GEMs. I understand kind of
64:37 the purpose of it, but can you kind of give an overview as far as what
64:41 really the value is? Because I think earlier in your presentation, you
64:44 had indicated that, really, going into the books and doing an I10
64:49 coding is really the best way to do it, rather than the mapping. So can
64:52 you kind of give some background on that?
64:54 Pat Brooks: Ill give you a few resources and then a brief overview. If
64:58 you look at slide6, in the middle I give a link where you can get
65:03 ICD-10 updates. Among those updates each year we have a GEMs user
65:08 guide. I think that will be good for you to read, and it talks about
65:12 how to use them and when to use them.
65:14 Also, on slide 11, for the CMS-sponsored ICD-10 teleconferences we
65:21 actually did a presentation on how to use the GEMs and when its
65:26 appropriate. If I were you and I had a list of codes I was just
65:30 interested in, and say you work in a providers office and you just were
65:34 curious about what codes would be used for the new one, I think you'll
65:37 learn a lot now if you simply open up your ICD-10-CM code book and look
65:42 up an index and then see the page and see the codes involved you can do
65:46 all that. If you have trouble and you find it complicated, maybe
65:49 because you haven't had any training in ICD-10 yet, the GEMs are also a
65:54 tool that help you get there. But the GEMs are a better tool if you've
65:58 got massive amounts of codes to convert. But for small lists, you know,
66:03 I really wouldn't start there; I would just simply open up a code book.
66:07 And this is Pat Brooks.
66:08 Leah Nguyen: Thank you.
66:09 Operator: Thank you, and your next question will come from the line of
66:12 Kathy Hallock.
66:13 Kathy Hallock: Yes, can ya'll hear me?
66:15 Leah Nguyen: Yes, we can.
66:16 Kathy Hallock: OK, I was just curious if you had heard anything about
66:19 the CDC saying that they are going to you know, they've always used
66:22 ICD-9 codes for their surgical site infections, and recently it came
66:25 out this week that they have said that they were going to use CPT codes
66:29 and not ICD-10 codes, which are not used on the inpatient side, CPTs.
66:32 Have you heard anything about that?
66:34 Pat Brooks: This is Pat Brooks. And Donna Pickett from CDC is
66:37 addressing that issue now; it was just brought to her attention. You
66:40 know, its a big organization, CDC, and she had some phone calls
66:43 involved. I don't believe anything is worked out yet, but it has been
66:46 brought to their attention, and they will be discussing it.
66:48 Kathy Hallock: Thank you. OK.
66:50 Leah Nguyen: Thank you.
66:51 Operator: And your next question comes from the line of Angie Arduin.
66:54 Angie Arduin: Hi. My question relates to skilled nursing facility
66:56 codes. We have a swing bed unit here at our hospital, and I'm wondering
67:00 if there is going to be changes to the RUG codes that we code on the
67:03 bills.
67:04 Pat Brooks: This is Pat Brooks. We don't have anybody from that policy
67:07 area, but I would assume, just like every other policy area, when
67:10 annual updates made to the payment system and ICD-10 codes are
67:13 involved, that will all be going through formal rule-making.
67:15 Angie Arduin: OK, thank you.
67:16 Operator: And your next question will come from the line of Laura
67:19 Prine.
67:20 Laura Prine: Hello. Can you hear me OK?
67:22 Leah Nguyen: Yes, we can.
67:23 Laura Prine: I was a little surprised. I guess I'm a little behind. I
67:26 thought that all insurance companies would use and there's been some
67:29 conversation back and forth about auto, workmans' comp, and paper
67:32 claims. But I just want to make sure that I understand correctly, like
67:35 in the example for a Medicaid claim for a sterilization procedure, we
67:38 normally would drop that claim to paper because we need to send it
67:41 along with a sterilization consent form. I would still use the ICD-10
67:44 code on that paper claim, correct?
67:46 Pat Brooks: This is Pat Brooks, and you will, yes. You will report to
68:44 Medicaid and Medicare and other health insurance companies any service
68:49 that occurs on or after October 1st, 2014; you will use ICD-10 codes.
68:54 Laura Prine: Are those paper or electronic?
68:57 Pat Brooks: Yes, and Stewart clarified for you the issue of maybe its
69:01 not required to be on a paper claim, but the payersMedicare,
69:04 Medicaidthey require for payment purposes that you move to ICD-10.
69:13 Laura Prine: OK, so there'll be a need to keep an ICD-9 book just for
69:17 those odd workmans' comp or auto issues?
69:23 Pat Brooks: This is Pat Brooks. I cant respond to that except to say
69:27 Denesecia has brought up how they may not be mandated, but let me say
69:31 one thing: We are not going to maintain ICD-9-CM any further after
69:36 ICD-10 is implemented. There'll be no updates, there'll be no refinements
69:39 to it. So I don't know how long if some workmans' comp or auto dealers
69:47 agencies keep mandating ICD-9-CM, I don't know how long they could do
69:51 that viably, since we will not maintain ICD-9-CM any further. But I
69:55 believe the suggestion was to send in your comment.
69:57 Laura Prine: Thank you very much.
69:59 Operator: And your next question comes from the line of Molly Kilby.
70:18 Leah Nguyen: Can we take the next question?
70:20 Molly Kilby: Oh, can you hear me?
70:22 Leah Nguyen: Yes, we can.
70:23 Operator: Yes, go ahead.
70:24 Molly Kilby: This is Molly. I have a question regarding slide number
70:27 16, Claim Submission or actually yes, Claims Submissions. If claims
70:32 are denied or rejected, claims that were submitted prior to October
70:38 1st, 2014, do they then have to be recoded when they're re-submitted
70:44 after October 1st, 2014, with ICD-10s?
70:50 Sarah Shirey-Losso: This is Sarah Shirey-Losso from the Provider
70:53 Billing Group. And the coding of ICD-9 or ICD-10 is based on the date
70:57 of service.
70:58 Molly Kilby: OK, thank you.
71:00 Operator: And your next question comes from the line of Stacey Dano.
71:11 Stacey Dano: Hello.
71:12 Leah Nguyen: Hello.
71:13 Stacey Dano: OK my question is: I'm hearing a lot of, like, procedures
71:18 and helpers for physicians. I work for physical therapy and speech
71:22 therapy, and Im wondering: Is there training just for that subject, or
71:29 what can I do?
71:31 Pat Brooks: This is Pat Brooks. There are a number of professional
71:34 organizations that give training, and there is a wide variety of it.
71:38 You could, if you chose to, look at a specialty group that you're
71:42 interested in, and find out what kind of training they're giving. You
71:45 could also look for groups such AHIMA (A-H-I-M-A) or AAPC, and find the
71:51 type of training that suits you. Some of this may be in person, some
71:54 may be online, some may be books. But there is a wide variety, based on
71:58 your own needs, that you can look at on the Web site.
72:01 Also, the slide we gave, slide 13, WEDI and HIMSSI imagine many of the
72:08 people who do education probably list their products on those Web sites
72:15 also.
72:16 Stacey Dano: OK, and have you heard I was told that our procedure
72:19 codes would stay the same, just our diagnose codes would change. Do you
72:22 know if that's correct?
72:23 Pat Brook: Yes, this is Pat Brooks. For ambulatory and outpatient
72:27 services, you will continue to use HCPCS and CPT. The only ones that
72:32 will move to ICD-10-PCS are inpatient hospitals.
72:36 Stacey Dano: OK, so we keep the same procedure and same HCPCS. Just our
72:41 diagnose change, correct?
72:42 Pat Brooks: That's absolutely correct. Everyone moves to ICD-10-CM in
72:45 every setting for services provided on or after October 1st, 2014.
72:48 Stacey Dano: OK. Now, we handle a lot of Medicare patients with
72:51 physical therapy, and they're talking about the G-codes. Is there
72:53 training just for the G-codes?
72:54 Pat Brooks: That's outside the purview of this call today. So I think
72:58 you would need to send that question in and you could get referred.
73:01 Leah Nguyen: Thank you.
73:02 Stacey Dano: OK, thank you, ma'am, so much.
73:04 Operator: And your next question comes from the line of Catherine
73:06 Schneider.
73:07 Catherine Schneider: Hi, my question was already answered, about the
73:09 1040 and the 1050 platform. Thanks.
73:11 Leah Nguyen: OK, thank you.
73:12 Operator: Your next question will come from the line of (Patricia
73:14 Derus).
73:15 (Patricia Derus): Yes. Will there be a possibility for personal
73:38 in-house training for physicians and staff?
73:40 Pat Brooks: This is Pat Brooks. If you wanted some training now on
73:47 ICD-10-CM issues in-house, then a good resource I can show thats free,
73:50 if you could look at slide 11, the CMS-Sponsored ICD-10
73:57 Teleconferences. I would suggest you go to the presentation on March
74:03 23rd, 2010, which is basic introduction to ICD-10-CM. That really is an
74:09 excellent in-house one.
74:10 And in August of this year we plan to have a repeat update of that very
74:16 basic information, so, as a national teleconference. That's very
74:19 valuable and its totally free.
74:21 (Patricia Derus): Thank you very much.
74:22 Denesecia Green: Hi, this is Denesecia Green. I would also add to
74:27 continue to take a look at our Web site, We have a
74:35 number of webinars and information that will be posted, so stay tuned.
74:40 Leah Nguyen: Thank you.
74:41 Operator: And your next question comes from the line of Victoria
74:47 Stewart.
74:49 Victoria Stewart: Hi. Can you hear me?
74:51 Leah Nguyen: Yes, we can.
74:52 Victoria Stewart: Oh, great. Hi, this is Victoria Stewart at Dr. David
74:55 Parks office in St. Louis. Thanks for this presentation. Everything
74:57 about ICD-10 is awesome. Page 27: I have a question on slide 27, or the
75:05 slide page 27. Im looking at the different diagnoses that are listed,
75:09 that are most common, and I highlighted the ones that we use quite
75:13 frequently. Now, my question is: Is this slide presented to give us the
75:18 opportunity to look at in advance what the conversions are going to be
75:23 for these particular diagnosis codes that are going to be most common?
75:26 Is this just something helpful you're handing out, or is there something
75:30 else specific about this page that Im missing?
75:36 Denesecia Green: Hi, this is Denesecia Green, and I mentioned earlier
75:40 that these were developed by the States, State Medical Aid agencies,
75:45 along with a certified coder and physician. And so these are best
75:51 practices; they can be useful and helpful to your organization.
75:57 Again, we will be sharing additional information on our Web site about
76:00 these. Well also have some policy briefs on other health conditions. So
76:04 use it as a resource, but, of course, its not the absolute official
76:10 guide, but it is a great source, as you're conducting that mapping and
76:15 cross-walking.
76:16 Victoria Stewart: All right, so what I would do is then what you have
76:20 here is like a heading, like AIDS/HIV, since we specialize in that area
76:24 anyway. I would look that up in the ICD-10 book or on the mapping, on
76:31 the GEMs? Is that my title to look up for searching?
76:36 Denesecia Green: Im sorry, yes, there is some additional information
76:40 behind this, and so well be able to share that with you through this
76:44 listserv.
76:45 Pat Brooks: And this is Pat Brooks another resource you might want to
76:51 consider: We know that many physician specialty groups are working on
76:57 lists of very common diagnosis sort of like a superbill list . . .
77:00 Victoria Stewart: Right, yes, that's what I'm trying to get them to do,
77:02 yes.
77:03 Pat Brooks: That's a good thing to do. So ask if they have done it
77:07 already, because you may find that many of them have already started
77:09 doing that.
77:10 Victoria Stewart: Well, Im the billing manager; it would be me. Im
77:13 trying to get to that point where I can get them to realize this
77:17 conversion is coming.
77:21 Pat Brooks: That's the physicians society say, for internal medicine or
77:24 pediatrics, or whatever. If you contact the physician specialty group
77:29 that represents your specialties, they may have done the work.
77:33 Victoria Stewart: You mean our billing service?
77:36 Pat Brooks: No, I mean the actual physician specialty, like the
77:39 American College of Surgeons may have one.
77:41 Victoria Stewart: Oh, I understand. OK, so I can like, for example,
77:44 the HIV/AIDS, I can contact the HIV Web site, or whatever, or the
77:52 medical Web site or something, and they may already have this
77:55 converted. Is that what you're saying?
77:56 Pat Brooks: The American College of Internists may have a list. It may
78:00 be that as a resource that you could look to the physician specialty
78:05 group to see if they have one.
78:07 Victoria Stewart: I see. Awesome. Thank you very much. Every bit of
78:10 information is helpful for this. I appreciate it. Thank you, ladies and
78:12 gentlemen.
78:13 Leah Nguyen: Holley, we have time for one final question.
78:16 Operator: All right, and your final question will come from the line of
78:19 Cathryn Smith.
78:20 Cathryn Smith: Hi. Can you hear me OK?
78:22 Leah Nguyen: Yes, we can.
78:23 Cathryn Smith: OK, quick question: There is in the ICD-10 Planning and
78:26 Assessment, on that Training Segment 1 from CMS, one of the listed
78:29 issues on provider impacts is that we do need to do some additional
80:32 documentation. We do already document, obviously, like, the laterality
80:35 and the area of the body. But if the LCDs don't come out until October
80:38 2014, I'm still a little unclear as to how were going to know how to
80:42 document specificity, like in the case of a glassblowers cataract or
80:45 advanced glaucoma how do we know how to document that if the LCDs don't
80:48 come out until 2014?
80:49 Pat Brooks: This is Pat Brooks, and I can talk generically about
80:52 improving documentation. It may be forget the LCDs and what else, if
80:55 you just look at your common diagnoses and then look up the codes, then
80:59 you can see the kind of detail that's available in ICD-10 for your top
81:02 say, pick, next week, the top 10, and look at the codes and see how
81:06 much detail is available. That will give you some indication whether,
81:09 if you applied additional documentation, it would change the code or
81:11 not. As you know now, many times a physician doesn't know a lot of
81:15 details about the exact diagnosis when they first see them. And so now,
81:18 currently, you would apply a code thats rather non-specific, and that
81:21 would be OK because its all you'd know. The same thing will occur with
81:24 ICD-10-CM. Ill turn it over to Janet, if there is any other advice.
81:28 Beyond that, generally improving your documentation is a good thing for
81:30 a lot of reasons.
81:31 Janet Anderson Brock: The requirements around coverage, local or
81:34 national, is not changing. The requirements for documentation will
81:36 remain as they've been policy. Much of that documentation, when it is
81:39 described specifically, national coverage that's what I want to speak to
81:41 directly usually requires medical records transmission to either into
81:43 CMS or, if its local coverage, into the MAC. That's really outside of
81:47 the ICD-10 diagnosis translation anyway, and that's not going to change.
81:49 I think we always prefer the most specific documentation possible. But
81:52 this is especially true for things like DME which your question was
81:55 around PT, right?
81:56 Cathryn Smith: This would be for ophthalmology.
81:58 Janet Anderson Brock: Ophthalmology, sorry. I'm trying to think of what
82:00 documentation we've asked for above and beyond ICD-10 for ophthalmology.
82:03 Cathryn Smith: Well, like, it would be different. Like in with
82:06 glaucoma, weve got our glaucoma patients, but now were coding it in
82:09 terms of how advanced the disease is. And, like, with (inaudible)
82:11 disease and, like, with cataracts we are specifying, like, if its a
82:14 glassblowers cataract.
82:15 Janet Anderson Brock: Yes, I heard you say glassblowers cataract, and
82:18 we don't have any national coverage specific to for example, cataracts
82:20 is going to be local. I would work directly with your MAC to make sure
82:24 that you understand the documentation requirements they have for your
82:26 jurisdiction.
82:27 Cathryn Smith: Gotcha. OK, that's cool.
82:28 Leah Nguyen: Thank you.
82:29 Cathryn Smith: Thank you. Leah Nguyen: Unfortunately, that is all the
82:32 time we have for questions today. If we did not get to your question,
82:36 you can e-mail it to That address is
82:38 also listed on slide 34.
82:40 I would like to thank everyone for participating in this National
82:42 Provider Call, Begin Transitioning to ICD-10 in 2013. Before we end the
82:45 call, for the benefit of those who may have joined the call late,
82:49 please note that continuing education credits may be awarded by
82:51 professional organizations for participation in MLN National Provider
82:52 Calls.
82:53 Please see slide 33 for more details. If you have any questions
82:56 regarding the awarding of credits for this call, please contact your
82:59 organization. An audio recording and written transcript of today's call
83:01 will be posted soon to the CMS MLN National Provider Calls Web page.
83:02 Again, my name is Leah Nguyen, and its been my pleasure serving as your
83:04 moderator today. I would also like to thank our presenters, Pat Brooks,
83:05 Sarah Shirey-Losso, Janet Anderson Brock, and Denesecia Green. Have a
83:06 great day, everyone.
83:06 Thank you for viewing this ICD-10 video slideshow presentation. The
83:07 information presented in this presentation was correct as of the date
83:08 it was recorded. This presentation is not a legal document. Official
83:09 Medicare program legal guidance is contained in the relevant statutes,
83:10 regulations, and rulings.


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