As of October 5, 2015 Superbill will only allow ICD-10 codes to be selected for dates of service on or after October 1, 2015. If you need further assistance or have any inquiries regarding this implementation, please call the ICD-10 Support Center at 646-NYP-9-2-10, or e-mail ICD-10Help@nyp.org. You can find additional information on the hospital’s transition from ICD-9 to ICD-10 on the ICD-10 AnTENna website.
As the transition heads into the week 2, Day 5 the rewards of preparation, teamwork, dedicated effort, and responsiveness continue to pay off. Many small but nonetheless, nagging items have been remedied and a combination of fixes and workarounds for our most significant item to be resolved have been placed into production and communicated. The Support Center’s monitoring and reconciliation activities appear to have adequately prepared NYP for successful ICD-10 inpatient and outpatient billing runs on October 6 and October 12 respectively. A summary of yesterday’s events is listed below and the full presentation from yesterday’s Daily Transition Update can be found here.
OVERALL IMPACT
Though early in the implementation, the ICD-10 transition has generated minimal to no disruption in patient care/patient experience activities. Financial and operating metrics remain largely stable indicating that the transition to ICD-9 has not necessarily impacted our or the insurance industry’s ability to continue processing in ICD-9.
ITEMS RESOLVED
Items of significance to be resolved include the application of error messaging and removal of Allscripts Health issues for which there is no applicable ICD-10 code. This will minimize if not eliminate patient encounters from NYP clinics from being coded with only ICD-9 codes. The OR Manager team has also expedited a fix to ensure our colleagues in the Cornell and Columbia Faculty Practice Organizations book surgical cases with ICD-10 codes. A minor issue with an Admitting Diagnosis field in our Eagle registration system similarly was identfieid and resolved within 30 minutes. An updated issues log can be found here.
SUPPORT CENTER ACTIVITY
The Support Center revised its operating hours for the week of October 5. Revised hours are now from 7:00 AM – 7:00 PM. It received 1 phone call and 4 additional e-mail inquiries while it continues a massive monitoring, auditing, and reconciliation effort at the encounter, transaction, and even data element level. In total the Support Center has logged 62 issues and 7 remain open. The ICD-10 AnTENna website recorded close to an additional 200 hits. Though, it appears as individuals stabilize in their understanding of ICD-10 and the practical idiosyncrasies of the transition, there is less need for material support. The Support Center continues to work with HIM experts to convert ICD-9 codes to ICD-10 on select population of patient encounters in advance of outpatient billing on October 12.
NEW & UPDATED RESOURCES
The Support Center has added an Allscripts reminder aid on adding Health Issues.
REMEMBER
HELP
For continued assistance and inquiry, please call the ICD-10 Support Center at 646-NYP-9-2-10 (646-697-9210), e-mail ICD-10Help@nyp.org, or visit the ICD-10 AnTENna webiste.
The second day of ICD-10 came with more rain, less inquiries to the ICD-10 Support Center and the same positive sense that NYP and the rest of the industry will navigate this transition successfully. With a full day of registration activity under our belts, staff and providers are beginning to see the results of the efforts. Although some new items have been identified, NYP is prepared to address them in real time and proactively remedy situations that place patient flow, billing, and payment at risk. A summary of yesterday’s events is listed below and the full presentation from yesterday’s Daily Transition Update can be found here.
Overall Impact
Though early in the implementation, the ICD-10 transition has generated minimal to no disruption to patient care/patient experience activities. Financial and operating metrics remain stable.
Items to be Resolved
The ICD-10 Support Center is monitoring sporadic yet continued assignment of ICD-9 codes on October dates of service. This includes physician practices booking surgical cases in OR Manager, electronic superbill enabled areas, and paper orders and requisitions. Remedies and workarounds vary from reinforcement and education to systemic changes required in applications to prevent ICD-9 selection. One vendor fix is being applied and expected to be resolved by Monday. Research is being conducted to confirm one potential interface issue and the Support Center is working with HIM experts to convert ICD-9 codes to ICD-10 in advance of outpatient billing on October 12. An updated implementation issues log can be found here.
Support Center Activity
The ICD-10 Support Center continued its 6 AM operating hours and fielded 7 additional phone calls and a 4 e-mail inquiries over the course of the day. The majority of inquiries related to code conversion activities and questions about idiosyncrasies in the Allscripts SCM electronic medical record including certain superbill presentations, health issues favorites, and its recently deployed documentation assistance widget, ICDx. In total the Support Center has logged 52 issues and 2 remain open. The ICD-10 AnTENna website recorded an additional 250 hits with many departments taking advantage of the two code conversion tools available. The Support Center team has initiated robust monitoring activities at the encounter and even the data element level to ensure the efficacy the cases prior to billing. Where necessary, code conversion activities have started to minimize the financial and operational impacts. An updated issues log can be found here.
New & Updated Resources
ICD-10 AnTENna will be adding an FAQ and job aid for Allscripts problem lists and an aid for the Eagle therapy record assignment on Saturday, October 3.
Reminders
Providers and staff experiencing any issues related to ICD-10 should continue to call the ICD-10 Support Center today during the hours of 6 AM and 10 PM (subject to change) or e-mail at ICD-10Help@nyp.org.
By most definitions, the first day of ICD-10 proved to be just another rainy Thursday offering little in the way of resistance and generally angering most of the vocal critics of the transition. That being said, the true impact of ICD-10 remains several days, if not weeks away as NYP begins to submit ICD-10 claims to insurance carriers next week and awaits its rightfully due payment. A summary of yesterday’s events is listed below and the full presentation from yesterday’s Daily Transition Update can be found here.
Overall Impact
Though early in the implementation, the ICD-10 transition has generated minimal to no disruption to patient care/patient experience activities. Financial and operating metrics remain stable.
Items to be Resolved
There are two open items. EPIC, the Cornell managed EMR and practice management system was observed to be generating unusual output on its electronic referrals instead of the appropriate ICD-10 code and is being investigated and a single report was observed to be producing some ICD-10 codes instead of ICD-9 codes. Both issues are with their respective technical expertise and are expected to be resolved today. An updated log of implementation issues can be found here.
Support Center Activity
The ICD-10 Support Center opened at 6 AM and fielded 17 phone calls and a single e-mail over the course of the day. The majority of inquiries related to code conversion activities and questions about idiosyncrasies in the Allscripts SCM electronic medical record including certain superbill presentations, health issues favorites, and its recently deployed documentation assistance widget, ICDx. In total the Support Center has logged 40 issues with all but 2 being resolved within a day. The ICD-10 AnTENna website recorded more than 300 hits with many departments taking advantage of the two code conversion tools available. Close coordination with our Faculty Practice Organization counterparts resulted in the identification and sharing of two issues, one at each campus respectively.
New & Updated Resources
ICD-10 AnTENna now includes some additional resources including two provider reference materials related to DSM-V, the classification system for behavioral health that maps to ICD-10 and a short video aid on how to add a family history from personal favorites health issues using ICDx. A training aid on proper medical necessity screening using First Comply Mediquant is also available.
Reminders
Providers and staff experiencing any issues related to ICD-10 should continue to call the ICD-10 Support Center today during the hours of 6 AM and 10 PM (subject to change) or e-mail at ICD-10Help@nyp.org.
NOTE: This article is being re-published to keep NYP staff appraised on the tools available to aid them in the ICD-10 transition. The code mapping tools for Cornell and Columbia can be found on the Support Center Page under the ‘Other Resources & Materials’ or by clicking here for Cornell and here for Columbia.
As we approach the October 1st, 2015 cutover date for ICD-10, many departments have requested the ICD-10 equivalents of their most commonly used ICD-9 codes. In response, the ICD-10 Project Management Office has built a dynamic tool that allows users to drill down into the campus, registration area, clinic ID, or even individual physician, view the ICD-9 codes for hospital-based outpatient services based on frequency, and see the ICD-10 codes to which each ICD-9 code can map.
There are two code mapping tools: one for Cornell and one for Columbia. The tools can be downloaded from the ICD-10 AnTENna website, and are available as links under the section on the right side of the page labeled “ICD-9 / ICD-10 Code Mapping Tool.”
The tools, built in Excel, have two main tabs. The “filters” tab is where the user selects the campus, registration area, clinic ID, and/or physician for which they would like to view results. After the selections are made, the table below updates to show the relevant ICD-9 codes and descriptions, sorted by volume. For each ICD-9 code, the table also displays the number of ICD-10 codes that ICD-9 code can map to. The more ICD-10 codes a given ICD-9 code can map to, the more additional documentation details will be required in ICD-10, and the more focus is warranted as we prepare for the transition. A summary table in the top right shows some key statistics for the selection.
In the “9 to 10 map” tab, users can see the specific ICD-10 codes that their current ICD-9 codes can map to. This report makes it clear which ICD-9 codes map to a single ICD-10 code vs. multiple ICD-10 codes, helping to illuminate the areas where the need for documentation enhancement is greatest. From looking at the descriptions of the ICD-10 codes, users can tell what additional documentation details will be needed in order to ensure that the correct ICD-10 code can be selected.
These tools are part of a larger arsenal of education and communication designed to arm departments with the information they need to be fully prepared for ICD-10. Please reach out to the ICD-10 Project Management Office at ICD-10help@nyp.org if you have any questions.
Billing, independent of ICD-10 is the conduit that converts delivered and documented patient care services into cash for the hospital. The bill generation and claim submission activity is largely an automated process that enables the translation of care into billable information capable of supporting accurate and timely payment. That billable information populates an electronic (or paper) claim form with numerous demographic, financial, and clinical data elements including ICD-9 diagnosis and procedure codes.
Beginning with dates of service/dates of discharge of October 1, 2015 billing will now include ICD-10 codes. The implementation guidance for billing is intended to provide direction on enablement of payer and/or service specific billing scenarios that are likely to manifest themselves during the ICD-10 transition period. Some of those scenarios may include but are not necessarily limited to:
Please review this guidance as you prepare you departments and staff for ICD-10. ICD-10 goes live October 1, 2015 – Are you ready?
As staff across NYP do final checks of their own ICD-10 readiness, the NYP project is busy placing the finishing touches on its final risk mitigation platform. On Monday, September 28 at 9 AM, the NYP ICD-10 Support Center will be open to address your ICD-10 readiness needs. The ICD-10 Support Center is designed to keep the organization informed of its ICD-10 implementation success and insulate the organization from any potential adverse impacts to the patient experience and of course, financial performance.
The Support Center will be staffed with a deep group of revenue cycle, coding, and documentation expertise and fully integrated with the IT Service Desk to coordinate technologial and application specific issues. ICD-10 related operating issues including scheduling, registration, financial clearance, medical necessity, and billing to code conversion activities, and provider assistance for documentation are capable of being addressed real time during business hours with on-call support available during off hours.
Inquires and questions can be directed to the ICD-10 Support Center Hotline at 646-NYP-9-2-10 (646-697-9210) or by e-mailing ICD-10Help@nyp.org. You may also visit the ICD-10 AnTENna website’s Support Center page for a calendar of operating hours, implementation guidance documents, training & readiness aids, provider reference materials and the NYP Code Converter - a real time ICD-9 to ICD-10 conversion tool for departments and staff to self-sufficiently perform their immediate code conversion needs.
ICD-10 goes live October 1, 2015 – Are You Ready?
Recurring services (alternatively known as Therapeutic Referred Ambulatory or TRA) are generally defined as outpatient settings in which a patient is repeatedly treated over multiple visits/encounters with a set of prescribed services to address a previously diagnosed condition. Recurring services may include but are not necessarily limited to:
Because these encounters may likel be associated with a plan of care that crosses the September/October time frame, it is essential that proper registration procedures are followed to support ICD-10 coding and billing for recurring service encounters after October 1, 2015. This may include creating new visit records or even entirely new registrations in the Hospital’s registration and billing system. Operating areas may additionally be required to work with providers to convert ICD-9 diagnosis codes and re-write orders and plans of care.
For more information about registering recurring services and ensuring your ICD-10 readiness, read the full guidance document here.
Code conversion is defined as an exercise to supply, replace, and/or update ICD-9 diagnosis and/or ICD-9 procedure codes with equivalent ICD-10 codes. Code conversion is a necessary ICD-10 transition period activity for a number of clinical, operational, and financial activities. The updating and/or conversion of ICD-9 codes to ICD-10 codes support the Hospital’s ongoing operations with an ICD-10 ready data infrastructure. NYP’s ability to define accurate ICD-10 codes supports among other things, medical necessity, financial clearance, patient population selections, pre-registration, and myriad reporting requirements both internally and externally.
The purpose of this guidance document is to provide direction for the situations, circumstances, and vehicles by which and for which it is considered acceptable and appropriate for NYP to engage in ICD-9 to ICD-10 code conversion activities. The ICD-10 transition across the continuum of care and multiple providers, vendors, payers, and regulatory agencies will present many complexities. As such, it is a practical reality that entities on which NYP may demonstrate varying levels of dependence for diagnosis code data and/or definition will span the spectrum of overall ICD-10 readiness. It is reasonable to assume that situations for which NYP requires ICD-10 data may in fact be presented by such upstream data providers in ICD-9 or even as narrative descriptions of patient condition and/or diagnostic criteria. Such examples demonstrate the need for NYP to engage in acceptable forms of code conversion so as to not disrupt hospital operations and patient experiences including wait times and access to care.
There are many different devices that are generally eligible for and may require code conversion activities including:
Should you have such devices, please review this guidance so as to ensure timely, accurate, and appropriate code conversion. Questions regarding the interpretation and/or implementation of this guidance may be directed to the Project Director for ICD-10 implementation or by e-mailing ICD-10Help@nyp.org. Effective September 28, 2015, employees may additionally call the ICD-10 Support center at (646) 697-9210. Additional information will be provided on the NYP ICD-10 AnTENna website at http://nyplearningcenter.org/apps/eLearning/cms/icd10/.
It is no coincidence that as we head into the Labor Day weekend, that it will take no less than a spirited and workman-like (work person-like) effort by thousands of NYP employees and clinical professionals to ensure our transition to the new ICD-10 coding system is seamless and successful. From previous updates, you are aware that much work has been done through the contributions of more than hundred core project team members and dozens of additional individuals focused on task specific activities to prepare for October 1. Many of those same individuals will be on call to support the Hospital through the ICD-10 transition period defined from September 1, 2015 through November 30, 2015. On behalf of the project and NYP, I extend my advanced appreciation and gratitude for those eventual efforts. However, as we embark on “changing the dictionary” that describes our patients’ conditions and the services we provide to treat those conditions, the ICD-10 project becomes an organization-wide opportunity to leverage an improved classification system for better data, better research, and some day – better patient care. So, with 30 days to go, here is your ICD-10 readiness checklist.
30. Understand changes to enterprise and department specific computer applications and how they impact your operation.
29. Confirm that reports, forms, documents and other data capture vehicles that leverage ICD-9 codes as criteria have been updated to include equivalent ICD-10 codes.
28. Confirm with your IT colleagues that data is interfacing both to and from applications used by your department.
27. Identify equivalent ICD-10 codes for clinical orders spanning the September/October time frame.
26. Communicate and promote the documentation assistance tools available in Crown, Allscripts SCM (ICDx), and Epic (Diagnosis Calculator) with physicians and other providers.
25. Promote and provide the inclusion of additional specificity in clinical documentation including items like acuity, anatomic site, laterality, root procedures, related conditions, disease status and stage, association with medications and/or drug use, causative agents, and significance of abnormal lab values… just to name a few.
24. Encourage physicians and other providers to download the Precyse University apps, ICD10 Doc Talk and ICD10 Mobile Documentation Guide to have valuable ICD-10 information at their fingertips (yes, they’re FREE)!
23. Promote the www.roadto10.org website for physicians. This CMS website is filled with valuable information on specialty specific documentation and coding information including ICD-10 Clinical Concept “cheat sheets”.
22. Review Medicare coverage (e.g. – LCD, NCD) policies for any ICD-10 impact of department/service specific procedures, drugs, tests, and exams.
21. Reduce unbilled receivables focusing on encounters most likely to generate accelerated cash for the Hospital.
20. Ensure appropriate data is available to financially clear cases according to their date of service/date of discharge – Remember, September: 9th month – 9 codes, October: 10th month – 10 codes!
19. Coordinate with non-NYP physicians and providers to ensure ICD-10 codes are provided on referrals.
18. Recognize the visual and structural difference between and ICD-9 and an ICD-10 code.
17. DON’T become a coder – but DO become familiar with codes that are common to your service and your patients.
16. Confirm that registries and external entities with whom you may exchange ICD-10 information are ICD-10 compliant and ready to accept NYP data.
15. Keep an eye out for transition period operating guidance related to revenue cycle operating activities for recurring services (e.g. – physical therapy, behavioral health, chemotherapy, radiation oncology, etc.)
14. Visit the Hospital’s official ICD-10 website, ICD-10 AnTENna often for updates, guidance, and support.
13. Encourage all staff to watch the ICD-10 organizational awareness video, ‘ICD-10: A New Language in Healthcare” available on their transcripts in the NYP Learning Center.
12. Use ICD-10Help@nyp.org to submit inquiries, questions, and issues to the ICD-10 Support Center.
11. Call the ICD-10 Support Center Telephone number: (646) NYP-9-2-10 (or 646-697-9210) – effective September 28, 2015.
10. Leverage code conversion tools to identify potential ICD-10 options to ICD-9 codes. DO NOT use them to code encounters.
9. DO NOT INCLUDE decimal points when entering ICD-10 codes into the EAGLE registration and billing system.
8. Be prepared to dual code inpatients covered under Medicare part B benefits only that span the September/October time frame (OK – this one is pretty small).
7. Move all interfaces, functionality, and reporting, and operating contingencies into production environments.
6. Integrate ICD-10 conversation into team meetings, staff huddles, and other communication devices – Broad based awareness is our greatest asset.
5. Think through resources and coverage for potential issues that may require remediation such as new registrations, re-entry of codes, re-writing of orders, correction of billing errors, and resubmission of insurance claim denials.
4. Set up monitoring tools to ensure orders, documentation, coding, billing, and payment are producing expected outcomes in ICD-10.
3. Prepare to leverage more specific data on our patients to improve quality, safety, delivery, length of stay, patient flow, costs, meaningful use, medication management, population health, and a lot of other stuff.
2. Be Flexible – issues will arise. It’s how we communicate, triage, troubleshoot, and revolve them that counts.
1. Prepare to celebrate a successful ICD-10 implementation!