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For dates of service on and after October 1, 2015, entities covered under the HIPAA are required to use ICD-10 codes. The implementation of ICD-10 represents a significant code set change that impacts the entire health care community. Be sure you are ready.  

GLMS Resources:

2015 GLMS Multi-Payer Roundtable Questions and Answers

ICD-10 Hassle Form - For assistance with ICD-10 related issues, please fill out and submit the GLMS ICD-10 Hassle Form or contact 502-736-6350

ICD-10 Training Opportunities - 2015

Attention Certified Coders Recertification Requirements for Certified Coders - Must complete by December 31, 2015 

Business Impact of ICD-10 - ICD-10 Business Impact 10.4.12.ppt

GLMS discussed ICD-10 before it was delayed yet again in 2014. View the discussion here.

Payer ICD-10 Websites; Anthem, Humana, Medicaid, Medicare and United Healthcare:  Payer Resources  - August 31, 2015


ICD-10 Post-Implementation: Coding Basics Revisited

In this video, Sue Bowman from the American Health Information Management Association (AHIMA) and Nelly Leon-Chisen from the American Hospital Association (AHA) discuss the unique characteristics and features of the new coding system. Run time: 33 minutes.

  • What is a valid code
  • Guidelines for coding and reporting
  • Coding process and examples: 7th character, unspecified codes, external cause codes, laterality
  • How to submit coding questions
  • Resources for coders

Visit the Medicare Fee-For-Service Provider Resources webpage for a complete list of Medicare Learning Network resources on ICD-10.

ICD-10 Specialty Resources Guide
To help coders as they become more comfortable with ICD-10, CMS developed a new guide with resources for specialties and selected health conditions and services. The Specialty Resources Guide features coding and documentation information for common conditions and specialties, including:

  • Asthma
  • Cardiology
  • Diabetes
  • OB/GYN
  • Lab services

The guide also includes links to the CMS clinical concepts guides, interactive case studies, medical case studies,webcasts, and more. Visit the ICD-10 website and Roadto10.org for the latest news and official resources, including the ICD-10 Quick Start Guide and a contact list for provider Medicare and Medicaid questions.

Physician Orders for Lab, Radiology Services, and Other Services after ICD-10 Implementation 

CMS is not requiring the ordering provider to rewrite the original order with the appropriate ICD-10 code for lab, radiology services, or any other services after ICD-10 implementation on October 1, 2015, including Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). Products and services that require a diagnosis code on the order will use ICD-9-CM codes if written prior to October 1, 2015. If the order is for a repetitive service that will continue to be delivered and billed after October 1, 2015, providers have the option to use the General Equivalence Mappings (GEMs) posted on the 2016 ICD-10-CM and GEMs web page to translate the ICD-9-CM codes on the original order into ICD-10-CM diagnosis codes.

Visit theICD-10 Medicare Fee-For-Service Provider Resources web page for a complete list of Medicare Learning Network educational materials.

Visit the CMS website for the latest information on ICD-10 related articles and resources.

AMA - The beginner and expert’s guide to ICD-10 prep: Steps for September

August 12, 2015 AHIMA Documentation Tip Sheets
Among the most helpful tools for assisting providers through the transition to ICD-10-CM/PCS are documentation tip sheets detailing the specificity needed to assign accurate codes. Many companies are selling tip sheets, but if you are looking to save a few dollars, here’s a step-by-step method to create these tip sheets yourself:

  • Run a report of each provider’s top 10 to 20 diagnoses
  • Have an experienced coding or clinical documentation improvement professional (preferably an AHIMA-Approved ICD-10-CM/PCS trainer) evaluate these diagnoses to determine if there is additional or alternate documentation needed for ICD-10
  • Create tip sheets for any diagnoses requiring more accurate documentation
  • The tip sheets should include key words and concepts
  • Consider adding any other important points to the tip sheets, such as definitions, clinical indicators, common manifestations, etc.
  • Distribute the tip sheets to the providers and post them in key locations that will be seen

The tip sheets are intended to educate the providers, so they must be written in terms they use every day. The individual or team constructing the tip sheets should confer with the providers throughout the production phase to ensure that the tip sheets are written in “clinical” language, rather than “coding” language.

These tip sheets shouldn’t remain static. They will likely need to be modified over time per provider feedback and documentation gaps identified.

The tips could be printed on pocket-sized cards, laminated poster-size, or anything in between. Whatever will engage and educate the providers. Ask what would work best for them.

AHIMA has created some free ICD-10-CM/PCS Documentation Tips that might help you get started on this important project. Samples tip sheets from this document are pictured below.Transitioning to ICD-10 with a Multitude of Free Resources

AHIMA - Answering the Tough ICD-10 Questions

Health News Update: What Will ICD-10 Codes Mean In Quality Language?

ICD-10 Monitor - Talk Ten Tuesdays - live broadcasts with industry experts. Every Tuesday at 10amET (www.icd10monitor.com)

August 20, 2015 - ICD-10 Clinical Concepts Guides for Specialties 
CMS has launched the ICD-10 Clinical Concepts Series for Specialties to help physicians and other providers get up to speed. Each guide in the series compiles key information from the Road to 10 online tool in a PDF format that can be readily shared, emailed, posted to websites, and printed. The guides include common ICD-10 codes, clinical documentation tips, clinical scenarios, and links to interactive cases studies, in-depth webinars, and other Road to 10 features. 

Family PracticeInternal MedicineCardiologyOB/GYN Orthopedics Pediatrics

August 20, 2015 - Use of Unspecified Codes
CMS has a number of resources that explain unspecified codes and how they should be used in ICD- 10-CM: 

• MLN Matters® Article SE1518, “Information and Resources for Submitting Correct ICD-10 Codes to Medicare” 
• ICD-10 Basics MLN Connects National Provider Call - Call Materials from August22, 2013 
• More ICD-10 Coding Basics MLN Connects Call - Call Materials fromJune 4, 2014 
• ICD-10 Coding Basics MLN Connects Video - January 2014 
• Codingfor ICD-10-CM: More of the Basics MLN Connects Video - December 2014 


ICD-10 Resources for Medicare Providers

  • Medicare--CMS issues ICD-10 flexibility clarifications
    In a series of FAQs, the Centers for Medicare & Medicaid Services (CMS) clarified its earlier policy announcement regarding expanding flexibility for practices submitting Medicare claims containing ICD-10 diagnosis codes. CMS reiterated that all claims with dates of service of Oct. 1, 2015 or later must be submitted with a valid ICD-10 code and that ICD-9 codes will no longer be accepted for these dates of service. Additionally, in certain circumstances, a claim may be denied because the ICD-10 code is not consistent with an applicable policy, such as Local Coverage Determinations or National Coverage Determinations. This reflects the fact that current automated claims processing edits are not being modified as a result of the flexibility guidance. The permitted 12-month flexibility only applies to Medicare review contractors—they will not deny claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code, as long as a valid code from the right family of codes (defined now as the ICD-10 three-character category) was used.
Access the ICD-10 Code Set
You can access complete versions of both ICD-10-CM (diagnoses) and ICD-10-PCS (procedures), as well as the General Equivalence Mappings (GEMs) and Reimbursement Mappings on the 2016 ICD- 10-CM and GEMs and 2016 ICD-10-PCS and GEMs web pages.

List of Valid ICD-10-CM Codes
CMS has posted a complete list of the 2016 ICD-10-CM valid codes and code titles on the 2016 ICD- 10-CM and GEMs web page. The file is named icd10cm_codes_2016.txt. This file will be useful for physician offices and other providers who want to check to make sure that they are reporting all characters in a valid ICD-10-CM code. The codes are listed in tabular order (the order found in the ICD-10-CM code book). This list should assist providers who are unsure if additional characters are needed, such as the addition of a 7th character in order to arrive at a valid code.  A similar list of the 2016 ICD-10-PCS valid codes and code titles is available on the 2016 ICD-10 PCS and GEMs web page. The file is named icd10pcs_codes_2016.txt.

“General Equivalence Mappings Frequently Asked Questions” Booklet — Revised
The “General Equivalence Mappings Frequently Asked Questions” Booklet (ICN 901743) was revised and is now available in hard copy format. This booklet is designed to provide education on the conversion of International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) codes to International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) and the conversion of ICD-10-CM/PCS codes back to ICD-9-CM. It includes the following information: use of external cause and unspecified codes in ICD-10-CM; background; Frequently Asked Questions; and resources.

“ICD-10-CM/PCS ICD-10-CM/PCS Myths and Facts” Fact Sheet — Revised
The “ICD-10-CM/PCS ICD-10-CM/PCS Myths and Facts” Fact Sheet (ICN 902143) was revised and is now available in hard copy format. This fact sheet is designed to provide education on the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS). It includes the following information: ICD-10-CM/PCS compliance date; use of external cause and unspecified codes in ICD-10-CM; responses to myths on ICD-10-CM/PCS; and resources.

“ICD-10-CM Classification Enhancements” Fact Sheet — Revised
The “ICD-10-CM Classification Enhancements” Fact Sheet (ICN 903187) was revised and is now available in hard copy format. This fact sheet is designed to provide education on the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10- CM/PCS). It includes the following information: ICD-10-CM/PCS compliance date; use of external cause and unspecified codes in ICD-10-CM; benefits of ICD-10-CM; similarities and differences between International Classification of Diseases, 9th Edition, Clinical Modification and ICD-10-CM; new features in ICD-10-CM; additional changes in ICD-10-CM; and resources.

“ICD-10-CM/PCS The Next Generation of Coding” Fact Sheet — Revised
The “ICD-10-CM/PCS The Next Generation of Coding” Fact Sheet (ICN 901044) was revised and is now available in hard copy format. This fact sheet is designed to provide education on the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS). It includes the following information: ICD-10-CM/PCS compliance date; use of external cause and unspecified codes in ICD-10-CM; Current Procedural Terminology and Healthcare Common Procedure Coding System codes; ICD-10-CM/PCS — an improved classification system; ICD-10-CM/PCS examples; structural differences between International Classification of Diseases, 9th Edition, Clinical Modification and ICD-10-CM/PCS; and resources.

Get Ready Now: Assess How ICD-10 Will Affect Your Practice
With ICD-10 days away, now is the time to get ready. You can make sure your practice is prepared by following the ABCs of ICD-10: 

  • Assess how ICD-10 will affect your practice 
  • Be sure your systems are ready 
  • Contact your vendors

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 Guidance from Coding Associations
 Software Vendor ICD-10 Info/Readiness

 Assessment and Readiness Tools

 Planning Tools
 12/21/2015