ICD-10 Ready or Not
Gayle Graber, Debra Bennitt,
Gayle Grabowski, Katie Fichtner
Brief Overview
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October 1st 2015 deadline
No grace period
All providers
Prior training participation
Where Should You Be
• All residents should be dually coded
• Utilizing ICD-10 manual
• Enhancing knowledge of ICD-10 coding by
practicing and coding
Verifying
• Reports in Matrix to check for ICD-10
coding
– ICD-9 Diagnosis Report
– ICD-10 Diagnosis Report
– General Equivalence Mapping Report
ICD-10 Resident Diagnoses Report
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Physician Orders Missing ICD-10
Diagnoses Report
AR and ICD-10
AR and ICD-10
– Before you create October Claims Compare the claims triple check
report with the ICD-10 diagnosis report
• Generate a Claims Triple Check report
• Reports, A/R Analysis Reports, Claims Triple Check
AR and ICD-10
– Generate an ICD-10 Diagnosis Report
• Reports tab, Resident reports, Resident Info, run an ICD-10 Diagnosis
Report. Select Sequencing by payer, change the dates to October 1-31,
select Both for the status, select the payer, or select all to review all payers,
run the report.
AR and ICD-10
• ICD-10 codes are pulled to the claim based on the dates of service
Bill Type
Facility Type/Service
Claims Processing
Requirement
Use FROM or THROUGH Date
21X
Skilled Nursing (Inpatient Part
A)
If the SNF claims has a
discharge and/or through
dates on or after 10/1/2015,
then the entire claims billed
using ICD-10
THROUGH
22X
Skilled Nursing Facilities
(Inpatient Part B)
FROM
23X
Skilled Nursing Facilities
(Outpatient)
Split Claims – Require
providers split the claims so
all ICD-9 codes remain on one
claim with dates of service
through 9/30/2015 and all
ICD-10 codes placed on the
other claim with DOS
beginning 10/1/2015 and
later
AR and ICD-10
The following question was taken from the CMS web-site;
Question 1: What should I do if my claim is rejected? Will I know whether it was
rejected because it is not a valid code versus denied due to a lack of specificity
required for a NCD or LCD or other claim edit?
Answer 1:
Yes, submitters will know that it was rejected because it was not a valid code
versus a denial for lack of specificity required for a NCD or LCD or other claim edit.
Submitters should follow existing procedures for correcting and resubmitting
rejected claims and issues related to denied claims.
Communities who submit claims and the Centralized Billing Office need to monitor
the October claims to ensure they are received at the payer and are processing.
Therapy and ICD-10
• Therapy will have to convert current
patients in Oct from ICD9 to ICD10
diagnoses in the Smart Therapy software
• Smart Therapy Software also has the
CMS GEM crosswalk available to assist
with converting the codes
Therapy and ICD-10
Matrix and Smart Diagnosis Codes
Should Match
• Therapists should use the ICD10 codes listed
in matrix to select their medical reason for
treatment
• If a diagnosis is not on the list, review
medical record to see if diagnosis has been
noted in past by a physician
• New diagnosis can be established with T.O or
MD signature for a new diagnosis
Communication is the Key to
Successful Coding and Sequencing
Communicating the Codes
• ICD Codes should be entered into matrix
promptly after admission
• Clinical Team should discuss to verify
accuracy of coding especially with moving to
ICD10
• Obtain any unlisted diagnosis from MD
• Clinical Team should prioritize codes for AR
sequencing to lay out order of codes in billing
AR Sequencing for Therapy Only
Bills (Part B, Insurance)
• Specific Therapy Encounter Codes (V57.XX in ICD9)
are no longer used for principle code for therapy
• ICD10 Codes identifying the medical reason that
therapy is necessary will be required
• This may or may not be the same as the reason the
resident requires ongoing residential care
• Some treatment will need specific ICD10 codes
(Example ST tx for swallowing-will need a dysphagia
diagnosis
Triple Check
• Triple Check requires Therapy, Nursing and
Business Office to make sure ICD codes
listed on UB04 are the same as those in
matrix and on the MDS
• This review helps verify processes are
accurate
• It also identifies if there is a problem and
need to improve at coding and sequencing
processes