Lifepoint User Conference 2014

ICD-10 Implementation: A Roadmap for Labs Laura Schaffer

Charlette Curtis

Senior Developer Lifepoint Informatics

Product Specialist Lifepoint Informatics

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What is the ICD-10 Directive from CMS? Per CMS: “Claims for all services and hospital inpatient procedures performed on or after 10/1/2014 must use ICD-10 diagnosis and inpatient procedure codes. Claims that do not use ICD-10 diagnosis and inpatient procedure codes cannot be processed. It is important to note, however, that claims for services and inpatient procedures provided before the compliance date of 10/1/2014 must use ICD-9 codes.”

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What is included for ICD-10 Compliance?

o You must use an ICD-10 code for Dates of Service on or after 10/1/2014. o You will need to update your DG1 segment to send/receive the ICD information in the DG1:3 segment. • The old DG1 segment DG1|index|ICD9|DxCode|DxName|date&time||||| • The new DG1 segment DG1|index||DxCode^DxName^DxICDVersion||date&time|||||

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What is Lifepoint doing to helps our clients be ICD-10 Compliant in the Portal? o Lifepoint will automatically load all ICD-10-CM (Clinical Modification) codes to your database, and allow them to co-exist with the current ICD-9 codes. This will allow you to use ICD-9 codes prior to 10/1/2014, and ICD-10 codes on or after 10/1/2014. • The ICD-10 codes currently being loaded to Test are from the CMS website and are not the final version. CMS has not yet released the final version of the ICD-10 codes. The latest update from CMS is that they will be released sometime this summer. Lifepoint will load the final ICD-10 codes to client sites when they become available. • If you would like the ICD-10- PCS (Procedure) codes loaded to your site, you will need to make the request to your Account Manager or Lifepoint Support by 7/1/2014. o Lifepoint will automatically load the ICD-10 NCD file to your site. It will co-exist in the database with the ICD-9 NCD file, so that ABN checking can be done for either ICD-9 or ICD-10 codes.

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o Lifepoint is providing the ability to define whether a user has access to ICD-9 codes, ICD-10 codes or both. This allows a user to do ICD-10 testing at any time, without having to switch to a different user or environment.

o ‘ICD-9 Only’ will be the default when the ICD-10 functionality is loaded. o ‘ICD-10 Only’ is what users will be switched to on 10/1/2014. o ‘ICD-9 and ICD-10’ can be used for testing, or if a user needs to have access to both. o A user will need to log out and log back in to see the changes.

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o Lifepoint is providing an ICD-9 to ICD-10 Crosswalk Tool. o Once the user has been given access to ICD-10, a Crosswalk Popup Tool will be available in both User Mode and Admin Mode.

o This tool opens in a new window to allow the user to perform their normal functions, and still have access to the Crosswalk Tool whenever needed. The search can be by Diagnosis Code or Description.

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o Lifepoint is providing a tool in Admin Mode to define a default ICD-10 code for an ICD-9 code. o These defaults will be used to update the Common Diagnosis screens of all users. They will also be used to update patient’s Standing Diagnosis codes, and orders that were created with an ICD-9 code, but could be collected on or after 10/1/2014.

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o Lifepoint is providing a tool to update the Common Diagnosis screens of all users using the default ICD-10 previously defined.

o These ICD-10 codes will co-exist with the ICD-9 codes. On 10/1/2014 the users will be switched from ICD-9 users to ICD-10 users and their screens will automatically display the pre-selected ICD-10 Codes.

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o Lifepoint is providing a tool to pull a list of the items below that have an ICD-9 code associated with them, and to pre-select an ICD-10 code to be used for a DOS on or after 10/1/2014:

• Standing Diagnosis Codes • Quick Orders • Standing/Future Orders • Orders created with a future collection date on or after 10/1/2014

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o To allow for the different needs of our clients, a user will have the ability to select the replacement ICD-10 individually for each patient, or to select to update all patients in an account with the default ICD-10 codes that were previously defined. The Lab or the physician office will be able to make these changes. Printed reports can be pulled to allow the user to have a physician office verify the changes to be made. o An Audit will be available to track what was done and by whom.

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What does the client need to do to be ICD-10 Compliant in the Portal? o A client will need to request that the ICD-10 functionality be loaded to their NV Test environment. o A client will need to test the functionality in their Test environment and determine their strategy for preparing for the Oct. 1, 2014 deadline. o A client will need to have an Enhancement Update (EU) to Lifepoint Version 14.1 to move the ICD-10 functionality to Live. Version 14.1 will be released 5/1/2014. o Users will be set to ‘ICD-9 Only’ after the EU, so that they will continue to function as normal. Users will be able to change that setting whenever they wish to ICD-10 so that they can prepare for the 10/1/2014 deadline. o The ICD-10 Common Diagnosis Screens of all users will automatically be updated with all 1:1 matches during the EU. The Common Diagnosis Tool can then be used by an Admin User to update any ‘1:Many’ matches, and to update any Common Diagnosis screens that have been added or updated after the EU was performed. It is highly recommended that the client run this tool one last time close to the cutoff to catch any last minute changes that were made. The Common Diagnosis screen of any user can also be updated manually using the existing Edit User functionality. 11

o The client will need to use the Patient and Orders Update Conversion Tool to update all existing Standing Diagnosis codes, Quick Orders, Standing/Future Orders, and orders scheduled to be drawn on or after 10/1/2014 that contain an ICD-9 code, and to assign a replacement ICD-10 code that can be used if the order is collected on or after 10/1/2014. It is highly recommended that the client run this tool one last time close to the cutoff to catch any last minute changes that were made.

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What is Lifepoint doing to helps our clients be ICD-10 Compliant in the Orders Interface? o To be ICD-10 Compliant, clients with an Orders Interface will need to have the DG1 segment updated to send the ICD information in the DG1:3 segment. (Currently it is being sent in the DG1:2 segment) o For Lifepoint to make this change the Lab will need to be ready to accept the new DG1 segment. Therefore Lifepoint will not make the change until a request is received from the Lab to do so. o Once the request is received from the Lab, Lifepoint will update the DG1 segment in Test. Once confirmed to be working correctly in Test, Lifepoint will then make the change to Live.

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What does the client need to do to be ICD-10 Compliant in the Orders Interface? o Since the new DG1:3 holds and identifies either an ICD-9 or an ICD-10 code, this change can be made any time after you are ready to receive the new DG1 segment. o To have Lifepoint make this change, you will need to make a request to your Account Manager or Lifepoint Support. To allow enough time, this request should be made by 8/1/2014. If a request is not received, the change will not be made. o Once the change has been made to your Test environment, you will need to verify it is working correctly. Once tested and approved in Test, it will then be moved to Live.

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What is Lifepoint doing to help our client’s EMR be ICD-10 Compliant? o Lifepoint has sent a questionnaire to all of our EMR vendors regarding their readiness for the ICD-10 Conversion. From the questionnaires returned, EMR vendors are handling the change in a multitude of ways.

o Since we do not want to wait, or be dependent on the EMR sending the updated DG1:3 segment, Lifepoint will update all EMR Orders Processors to accept ICD-9 or ICD-10 codes in either location. Lifepoint will then verify the code, and send the ICD code and ‘I9‘ or ‘I10’ identifier in the correct location. o Lifepoint will automatically be updating all EMR Orders Processors in Test over the next couple of months. Once verified internally to be working correctly in Test, the change will be made to Live. This should be completed by mid-summer.

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What does a client need to do for their EMR to be ICD-10 Compliant? o Nothing! Lifepoint will be doing it for you.

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Does Lifepoint have a timetable for the ICD-10 Conversion? o The following are the deadlines for items to be done in the conversion: • The ICD-10 Portal functionality will need to be loaded to Test – 7/1/2014 • Notify Lifepoint if they want the ICD-10-PCS loaded to Test – 7/1/2014 • Request to have the DG1 segment updated to the new format in Test – 8/1/2014 • Have an Enhancement Update to Lifepoint Release 14.1 to move the ICD-10 functionality to Live – 9/1/2014.

*Please note that the 14.1 Release containing the ICD-10 Functionality will be available 5/1/2014. An Enhancement Update can be done anytime after 5/1/2014 to move the ICD-10 Functionality to Live. Please plan ahead to avoid the possibility of not having enough time to move the functionality to Live and prepare for the 10/1/2014 deadline. You can have the ICD-10 Functionality moved to your test environment now, so that you can begin testing and making plans for the conversion. You will then be ready on 5/1/2014 to begin the EU for a move to Live. Lifepoint will be extending the length of time allowed for testing in LOT to 90 days, to allow our clients enough time for testing prior to moving to Live. 17

Thank You!

We will be available all day and this evening for any questions or comments

Laura Schaffer

Charlette Curtis

Senior Developer Lifepoint Informatics [email protected] 877-522-8378 x711

Product Specialist Lifepoint Informatics [email protected] 877-522-8378 x731 18