Production Database ICD10 Follow Us..We ll Get You There!

Transcription

1 Production Database ICD10 Follow Us..We ll Get You There!

2 Blast Sent 7/29/15

3 Mandatory Upgrades for Everyone All databases have mandatory upgrades to certain hot fixes prior to 10/1/15 Have PM & EHR? You will have two hot fixes! You can be on any of these three databases for ICD10 Must have decimal points in the ICD9 codes Create a Client Support ticket..now. We cannot guarantee any last minute requests Once hot fix is applied do the gem mapping again choose create new mappings (unmapped codes only) with 10/1/15-12/31/2099 date range NextGen Database Hot fix 5.8 = released 8/3/ UD1 = (or higher) 5.8 UD2 = (or higher)

4 Steps in File Maintenance File Maintenance > System Master Files > ICDCM Codes How can I tell what the expiration date is for my ICD9 codes? Search & then open the code expiration date should be 9/30/15 if you changed it last year when ICD10 was delayed

5 ICDCM Codes, continued.. How can I tell what the effective date is for my ICD10 codes? Search & then open the code effective date should be 10/1/15 ICD10 codes were imported with effective date of 10/1/15

6 ICDCM Codes, continued.. Are the ICD9 codes set to expire on 9/30/15? Verify! How to expire them:

7 Known Issue When Expiring ICD9 s When choosing the Exp Date Only you may receive a warning message that new expiration date cannot be less than effective date Use the option Both with the date range 9/30/70 thru 9/30/15 Search for a few ICD9 codes and verify that they are expired on 9/30/15

8 Diagnosis Code Library Add the ICD-10 codes into the Diagnosis Code Library

9 Diagnosis Code Library Choose ICD10 Need a specific range of codes? (see the next slide) Import codes effective on 10/1/15 Overwrite with master file. do not need to check this box The ICD10 codes are now in the Diagnosis Library

10 Diagnosis Code Library Do you use a small specific Diagnosis Code Library with only your specialty codes? Use the ICD range to add your codes to the Diagnosis Library

11 Diagnosis Code Library Add the ICD9 codes into the Diagnosis Code Library as it may have been some time since the full code set was added

12 Diagnosis Code Library Choose ICD9 Need a specific range of codes? If not, do not choose any codes here Import codes effective on Use today s date & only codes active right now will be imported Overwrite with master file. do not need to check this box The ICD9 codes are now in the Diagnosis Library

13 Small Subset of ICD9 codes Have you always used a small subset of ICD9 codes in your Diagnosis Library? Have you always manually added them to the ICDCM master file & then into the Diagnosis Library? You should not have to add any ICD9 codes now Look at your small subset of ICD9 codes in the ICDCM master file Is the box specificity indicator checked? In order for the ICD9 codes that are active & specific to be searchable, the box for specificity indicator needs to be checked. I ve tested this on an ICD9 code without specificity indicator checked and could not search in charge entry to map it to the ICD10 code!

14 What Does Gem Mapping do? EPM function only for ICD10 EHR uses CDL (Clinical Data Loader) for ICD10 Maps the ICD10 codes back to their matching ICD9 codes ICD9 code goes on the claim for non-hipaa compliant payers (Work Comp, Auto, Property & Casualty) if they desire to continue using ICD9 codes No payers that will be using ICD9 codes? Map now or later Gem mapping would need to be done if adding a payer in the future that uses ICD9 codes

15 GEMs Update in the Diagnosis Code Library Gem mapping will map the ICD10 code back to the 1:1 match of the ICD9 code.

16 GEMs Update in the Diagnosis Code Library MUST use date range of 10/1/15-12/31/2099

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18 Many States still undecided if using ICD10 for Work Comp claims Check your State s web page or call Payers

19 Payers Build a Payer report using financial class. For the non-hipaa compliant Payers (Work Comp, Auto, Property & Casualty) do they have their own financial class? Do you build your Work Comp Payers from a generic WC paper claims and then add the Payer name & address in the patient s insurance maintenance screen? Do the Payers want ICD9 codes on the claim OR are they going to use ICD10 codes on the claim? Work Comp Payers with an address in Minnesota will be using ICD10 codes The Payers listed above using ICD9 codes will need to be flagged after billing is run on 9/30/15 OR the morning of 10/1/15 prior to adding any charges, billing or rebilling encounters. On the Payer s Default 2 Tab:

20 Claim Edit Libraries Do you have a separate library for Work Comp or do you only use Commercial? What about Auto Insurance or Liability? Your libraries could look like this: Do you have some Work Comp Payers that will be using ICD9 codes? Do you have some Work Comp Payers that will be using ICD10 codes? Separate libraries need to be created & then attached to the Payers Right click > COPY the appropriate library

21 Claim Edit Libraries Commercial using ICD9 codes or Work Comp using ICD9 codes..enable edit #278 with required severity now! Edit # 278 this Payer only accepts ICD9 codes Attach to the appropriate non-hipaa Payer > Practice Tab > Library subtab Edit #279 this Payer only accepts ICD10 codes Enable this in all claim edit libraries for Payers that will be using ICD10 codes after billing runs on 9/30/15 & not before! Set severity to WARNING (need to evaluate before claim is released) If using the BBP the claims will be released.

22 Claim Edit Libraries.continued Example of Work Comp Payer that will use ICD9 codes Attach the Work Comp using ICD9 codes Claim Edit Library to the Payer > Practice Tab > Libraries sub-tab Example of Work Comp Payer that will use ICD10 codes Attach the Work Comp Claim Edit Library to the Payer > Practice Tab > Libraries sub-tab

23 Claim Edit Libraries.continued Have never built a separate Work Comp Library but use Commercial Library instead Create a Commercial Using ICD9 Codes Claim Edit Library Attach the library to the non-hipaa compliant Payer who will be using ICD9 codes Is the Commercial Claim Edit Library your default? You will not need to attach the Commercial Claim Edit Library to all of the Work Comp Payers using ICD10 codes because the library is set as the Default in Practice Preferences.

24 Tasks, Reports, Claim Edits Using ICD9 Codes? Claim edit for specific ICD9 code? Add the appropriate ICD10 code to the edit Reports that include specific ICD9 code? Add the appropriate ICD10 code to the report

25 Diagnosis Categories & Fee Tickets Diagnosis categories have been used for EHR Add the ICD10 codes ~New for PM Can create a diagnosis category that represents your fee ticket Attach to User, who enters charges, in their User > General Preferences Charge entry search is now your fee ticket If you forget to add an ICD10 code then you will not find it in the search! Using a Fee Ticket? Update with ICD10 codes

26 IMPORTANT: Add ICD10 codes to the Diagnosis Library codes effective on 10/1/15 Do this NOW so future copies of Prod to Test will not wipe out your testing database set-up Gem mapping effective/expiration date range is 10/1/15-12/31/2099 Do this NOW so future copies of Prod to Test will not wipe out your testing database set-up Non-HIPAA compliant payers do not flag the Default 2 tab until after billing is run on 9/30/15 OR prior to adding any charges, billing or rebilling encounters the morning of 10/1/15 Claim edit #279 do not turn this on in the libraries for Payers that will be using ICD10 codes until after the billing is run on 9/30/15 OR prior to adding any charges, billing or rebilling encounters the morning of 10/1/15 Severity set to Warning

27 Additional Information: Register for the August 18 th EHR webinar How many Work Comp Payers do you have that you will need to change the Default 2 Tab on 9/30/15? Hundreds? NextGen has a cloud based Payer Diagnosis Mappings VTalk Utility The Utility will mark the Default 2 tab for the non-hipaa compliant payers that will still be using ICD9 codes Open a ticket with Client Support if you are interested in the Utility.

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