Facilitators: Facilitators: Kit Cairns, WIITTS Kit Cairns, WIITTS Karen Navarro, University of WI Karen Navarro, University of WI Hospital & Clinics Hospital & Clinics Claudia Yoakum-Watson, WEA Trust and Claudia Yoakum-Watson, WEA Trust and CCRS CCRS Overview of 5010 and ICD-10: Definitions, Planning and Readiness
29
Embed
Facilitators: Kit Cairns, WIITTS Karen Navarro, University of WI Hospital & Clinics Claudia Yoakum-Watson, WEA Trust and CCRS Overview of 5010 and ICD-10:
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Facilitators:Facilitators:
Kit Cairns, WIITTSKit Cairns, WIITTSKaren Navarro, University of WI Hospital & ClinicsKaren Navarro, University of WI Hospital & ClinicsClaudia Yoakum-Watson, WEA Trust and CCRSClaudia Yoakum-Watson, WEA Trust and CCRS
Overview of 5010 and ICD-10: Definitions, Planning and Readiness
Introductions
Review of this afternoon’s sessions:
• Overview of 5010 and ICD-10• 5010 Working Session• ICD-10 Working Session
Welcome!Welcome!
Agenda for Overview SessionAgenda for Overview Session
50105010
ICD-10ICD-10
Implementation Implementation
ResourcesResources
QuestionsQuestions
5010 Questions5010 Questions
What is 5010 and why do we have to do this?
Who uses 5010?
EDI 5010 Overview
When does 5010 happen?
Where is 5010 used?
What is 5010?What is 5010?
• Started with requirement that the Secretary of the Department of Started with requirement that the Secretary of the Department of Health and Human Services (HHS) adopt standards for covered Health and Human Services (HHS) adopt standards for covered entities to use when they electronically conduct certain health care entities to use when they electronically conduct certain health care administrative transactions.administrative transactions.
• The Transactions and Code Sets final rule published on Aug. 17, The Transactions and Code Sets final rule published on Aug. 17, 2000, adopted standards for the statutorily identified transactions, 2000, adopted standards for the statutorily identified transactions, some of which were modified in a subsequent final rule published some of which were modified in a subsequent final rule published on Feb. 20, 2003.on Feb. 20, 2003.
• On January 16, 2009, HHS announced a final rule that replaces the On January 16, 2009, HHS announced a final rule that replaces the current Version 4010/4010A and NCPDP Version 5.1 with Version current Version 4010/4010A and NCPDP Version 5.1 with Version 5010 and Version D.0, respectively.5010 and Version D.0, respectively.
EDI 5010 Overview
What is 5010?What is 5010?
• Improvements in structural, front matter, technical, and data Improvements in structural, front matter, technical, and data content.content.
• More specific in requiring the data that is needed, collected, and More specific in requiring the data that is needed, collected, and transmitted in a transaction.transmitted in a transaction.
• Significant improvements for the reporting of clinical data, enabling Significant improvements for the reporting of clinical data, enabling the reporting of ICD–10–CM diagnosis codes and ICD–10–PCS the reporting of ICD–10–CM diagnosis codes and ICD–10–PCS procedure codes, and distinguishes between principal diagnosis, procedure codes, and distinguishes between principal diagnosis, admitting diagnosis, external cause of injury and patient reason for admitting diagnosis, external cause of injury and patient reason for visit codes. visit codes.
EDI 5010 Overview
Because of the Final Rule publishedBecause of the Final Rule published
by the US Department of Health andby the US Department of Health and
Human Services on 1/16/2009:Human Services on 1/16/2009:
• 837 P, I, and D claims (including 837 P, I, and D claims (including COB)COB)
• 835 health care payment and remittance 835 health care payment and remittance adviceadvice• 270/271 eligibility request/response270/271 eligibility request/response• 276/277 claim status request/response276/277 claim status request/response• 278 referral certification and authorization278 referral certification and authorization• 834 health plan enrollment/disenrollment• 820 health plan premium payment• NCPDP D.0, 5.1, and 3.0
ICD-10 QuestionsICD-10 Questions
What is ICD?
How is ICD used?
Why are we moving to ICD-10
When does ICD-10 happen?
How does ICD-10 differ from ICD-9
Who uses ICD-10?
EDI ICD-10 Overview
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
S52.311A Greenstick fracture of shaft of radius, right arm, initial encounter for closed fracture
S52.311AS52.311A Greenstick fracture of shaft of radius, right arm, initial Greenstick fracture of shaft of radius, right arm, initial encounter for closed fracture encounter for closed fracture
S52.3Ø1A S52.3Ø1A Unspecified fracture of shaft of right radius, initial encounter for closed fractureUnspecified fracture of shaft of right radius, initial encounter for closed fracture
S52.3Ø1GS52.3Ø1GUnspecified fracture of shaft of right radius, subsequent encounter for closed fracture with delayed Unspecified fracture of shaft of right radius, subsequent encounter for closed fracture with delayed
healinghealing
S52.321AS52.321A Displaced transverse fracture of shaft of right radius, initial encounter for closed fractureDisplaced transverse fracture of shaft of right radius, initial encounter for closed fracture
S52.325AS52.325A Non displaced transverse fracture of shaft of left radius, initial encounter for closed fractureNon displaced transverse fracture of shaft of left radius, initial encounter for closed fracture
S52.325GS52.325GNon displaced transverse fracture of shaft of left radius, subsequent encounter for closed fracture with Non displaced transverse fracture of shaft of left radius, subsequent encounter for closed fracture with
delayed healingdelayed healing
S52.341AS52.341A Displaced spiral fracture of shaft of radius, right arm, initial encounter for closed fractureDisplaced spiral fracture of shaft of radius, right arm, initial encounter for closed fracture
S52.364AS52.364A Non displaced segmental fracture of shaft of radius, right arm, initial encounter for closed fractureNon displaced segmental fracture of shaft of radius, right arm, initial encounter for closed fracture
S52.381AS52.381A Bent bone of right radius, initial encounter for closed fractureBent bone of right radius, initial encounter for closed fracture
Mapping of 813.21Mapping of 813.21There are 90 ICD-CM code possibilities for mapping of 813.21
X12 Presentation to NCVHS on 5010 changes:X12 Presentation to NCVHS on 5010 changes:http://www.ncvhs.hhs.gov/070730p4.pdfhttp://www.ncvhs.hhs.gov/070730p4.pdf