Overview of 5010 and ICD10 Definitions Planning and

Overview of 5010 and ICD-10: Definitions, Planning and Readiness Facilitators: Kit Cairns, WIITTS Karen Navarro, University of WI Hospital & Clinics Claudia Yoakum-Watson, WEA Trust and CCRS

Introductions Review of this afternoon’s sessions: • Overview of 5010 and ICD-10 • 5010 Working Session • ICD-10 Working Session

Agenda for Overview Session 5010 ICD-10 Implementation Resources Questions

EDI 5010 Overview 5010 Questions What is 5010 and why do we have to do this? When does 5010 happen? Who uses 5010? Where is 5010 used?

EDI 5010 Overview What is 5010? Started with requirement that the Secretary of the Department of Health and Human Services (HHS) adopt standards for covered entities to use when they electronically conduct certain health care administrative transactions. The Transactions and Code Sets final rule published on Aug. 17, 2000, adopted standards for the statutorily identified transactions, some of which were modified in a subsequent final rule published on Feb. 20, 2003. • On January 16, 2009, HHS announced a final rule that replaces the current Version 4010/4010 A and NCPDP Version 5. 1 with Version 5010 and Version D. 0, respectively.

EDI 5010 Overview What is 5010? • Improvements in structural, front matter, technical, and data content. • More specific in requiring the data that is needed, collected, and transmitted in a transaction. • Significant improvements for the reporting of clinical data, enabling the reporting of ICD– 10–CM diagnosis codes and ICD– 10–PCS procedure codes, and distinguishes between principal diagnosis, admitting diagnosis, external cause of injury and patient reason for visit codes.

EDI 5010 Overview Why do we have to do this? Because of the Final Rule published by the US Department of Health and Human Services on 1/16/2009: http: //edocket. access. gpo. gov/2009/pdf/E 9 -740. pdf

EDI 5010 Overview When does 5010 happen? December, 2010 Complete internal testing – able to send & receive compliant transactions January, 2011 Begin external testing with trading partners January 1, 2012 All covered entities must be in production

EDI 5010 Overview Who uses 5010 Covered Entities: • PROVIDERS (doctors, clinics, hospitals, psychologists, dentists, chiropractors, nursing homes, pharmacies – submitting information electronically for HHS standard transactions) • HEALTH PLANS (health insurance companies, HMOs, company health plans, gov’t health plans such as Medicare, Medicaid, etc. ) • HEALTH CARE CLEARINGHOUSES (entities that process non-standard health information from another entity into a standard or vice versa)

EDI 5010 Overview Where is 5010 used? Covered transactions include: • 837 P, I, and D claims (including COB) • 835 health care payment and remittance advice • 270/271 eligibility request/response • 276/277 claim status request/response • 278 referral certification and authorization • 834 health plan enrollment/disenrollment • 820 health plan premium payment • NCPDP D. 0, 5. 1, and 3. 0

EDI ICD-10 Overview ICD-10 Questions What is ICD? Who uses ICD-10? When does ICD-10 happen? How is ICD used? Why are we moving to ICD-10 How does ICD-10 differ from ICD-9

EDI ICD-10 Overview ICD-10 Code Structure The patient is in the office for the first visit because of a closed greenstick fracture of the right radial shaft. 813. 21 Fracture of shaft; radius alone S 52. 311 A Greenstick fracture of shaft of radius, right arm, initial encounter for closed fracture

EDI ICD-10 Overview Diagnosis Code Structure S 52. 311 A Greenstick fracture of shaft of radius, right arm, initial encounter for closed fracture Root Site Severity Etiology Extension S 5 2 3 1 1 A Injury, poisoning and certain other consequences of external causes Injuries to the elbow and forearm Fracture of Forearm Radial Shaft Greenstick Right Initial Encounter

EDI ICD-10 Overview Procedure Code Structure OTF 4 ZZZ Lithotripsy Section Body System Root Procedure Treatment Site Approach Device Qualifier O T F 4 Z Z Z No Device Noted No Qualifier Noted Medical Urinary Fragmentation Left Renal No Pelvis Approach Noted

EDI ICD-10 Overview Mapping of 813. 21 There are 90 ICD-CM code possibilities for mapping of 813. 21 S 52. 3Ø 1 A Unspecified fracture of shaft of right radius, initial encounter for closed fracture S 52. 3Ø 1 G Unspecified fracture of shaft of right radius, subsequent encounter for closed fracture with delayed healing S 52. 321 A Displaced transverse fracture of shaft of right radius, initial encounter for closed fracture S 52. 325 A Non displaced transverse fracture of shaft of left radius, initial encounter for closed fracture S 52. 325 G Non displaced transverse fracture of shaft of left radius, subsequent encounter for closed fracture with delayed healing S 52. 341 A Displaced spiral fracture of shaft of radius, right arm, initial encounter for closed fracture S 52. 364 A Non displaced segmental fracture of shaft of radius, right arm, initial encounter for closed fracture S 52. 381 A Bent bone of right radius, initial encounter for closed fracture

EDI 5010 and ICD-10 Implementation Tasks Phase 1 Awareness and Communication Begin impact assessments Create the structure/governance

EDI 5010 and ICD-10 Implementation Tasks Phase 2: Complete Impact Assessment Complete Budget Planning Determine business and technical strategies Define Functional Requirements

EDI 5010 and ICD-10 Implementation Tasks Phase 3: Complete System Development/ Get Vendor Updates Review contracts, reports, …

EDI 5010 and ICD-10 Implementation Tasks Phase 4: TEST – TEST - TEST

EDI 5010 and ICD-10 Implementation Tasks Phase 5: Communicate changes Analyze potential cash flow implications Go-live

Resources HIPAA COW: WEDI: CMS: www. hipaacow. com www. wedi. com www. cms. gov

Resources CMS Transactions & Codesets: http: //www. cms. hhs. gov/Transaction. Code. Sets. Stands/02_Tra nsactionsand. Code. Sets. Regulations. asp ICD 10 Final Rule: http: //edocket. access. gpo. gov/2009/pdf/E 9 -743. pdf 5010 Final Rule: http: //edocket. access. gpo. gov/2009/pdf/E 9 -740. pdf

Resources CMS HIPAA Standards Page (gap information links): http: //www. cms. hhs. gov/Electronic. Billing. EDITrans/18_5010 D 0. asp CMS ICD 10 Fact Sheet: http: //cms. hhs. gov/MLNProducts/downloads/ICD 10 factsheet 2009. pdf X 12 Presentation to NCVHS on 5010 changes: http: //www. ncvhs. hhs. gov/070730 p 4. pdf

Questions?

THANK YOU!

Contact Information: Kit Cairns catherine. cairns@deancare. com 608. 294. 6492 Karen Navarro KNavarro@uwhealth. org 608. 662. 0817 Claudia Yoakum-Watson CYoakumw@weatrust. com 608 -661 -6726 Or ccrsconsulting@tds. net 608 -289 -4974

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