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Preparing for the Conclusion of ICD-10 Grace Period

Within CureMD the diagnosis search box now recognizes provider specific abbreviations and aliases for diseases. You can now use common terms or abbreviations to describe a clinical condition and the system will bring forth the desired ICD-10 code.

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Preparing for the Conclusion of ICD-10 Grace Period

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  1. AGENDA  CureMD ICD-10 Progress Report  New Feature for ICD-10  Dr. Gwilliam’s Presentation  Q/A session - 15 minutes If we are unable to take your questions due to paucity of time, please forward them to webinars@curemd.com today or tomorrow and we will relay them to Dr. Gwilliam. 2

  2. ICD-10 PROGRESS REPORT You’re in good hands!

  3. Claims Submitted Real-Time Tracking Data Claims Submitted From the beginning, CureMD customers had to code in ICD-10 only. If a payer wasn’t ready – which we tracked – we adjusted codes in ICD-9 for clients. 4 ICD-10 ICD-9

  4. ICD-9 vs. ICD-10 Denial Rate Denial rate The average denial rate for CureMD practices remained consistent throughout the year. Only a slight increase was seen in the week after the Oct 1, 2015 transition. 5

  5. ICD-10 Help Desk Call Volume CureMD had established an ICD-10 help desk dedicated to deal with a surge of ICD-10 queries. 416.5 242.25 195.5 157.25 161.5 158.1 170 127.5 114.75 136 119 93.5 76.5 55.25 85 59.5 42.5 51 25.5 34 34 9/21 9/22 9/23 9/24 9/25 9/28 9/29 9/30 10/1 10/2 10/5 10/6 10/7 10/8 10/9 10/12 10/13 10/14 10/15 10/16 10/19 6

  6. Performance Metrics Remained on Track METRIC Claims EDI Rate Front-end Rejection Rate Back-end Denial Rate First Pass Resolution Rate PRE 10/1 BASELINE 92.7% 2.4% 6.2% 92.8% POST 10/1 93.3% 2.8% 6.1% 93.6% OVER THE LAST ONE YEAR 93.6% of all electronically billed claims were paid on first submission 2.8% of all electronically billed claims were rejected and routed back to practices 7

  7. PROVIDER FRIENDLY TERMINOLOGY Within CureMD the diagnosis search box now recognizes provider specific abbreviations and aliases for diseases. You can now use common terms or abbreviations to describe a clinical condition and the system will bring forth the desired ICD-10 code. 8

  8. ABOUT THE PRESENTER  Education  Bachelor’s of Science, Accounting – Brigham Young University  Master’s of Business Administration – Broadview University  Doctor of Chiropractic, Valedictorian – Palmer College of Chiropractic  Certifications  Certified Professional Coder (CPC) –AAPC  Nationally Certified Insurance Coding Specialist (NCICS) – NCCT  Certified Chiropractic Professional Coder (CCPC) –AAPC  ChiroCode Certified Chiropractic Professional Coder (CCCPC) – ChiroCode  Certified Professional Coder – Instructor (CPC-I) –AAPC  Medical Compliance Specialist – Physician (MCS-P) – MCS  Certified Professional Medical Auditor (CPMA) –AAPC, NAMAS  Certified ICD-10 Trainer –AAPC 9

  9. 2017 ICD-10 CODING  New, revised and deleted codes  End of CMS ICD-10 flexibility 10

  10. CODE CHANGES  2000 new codes  400 revised codes  300 deleted codes 11

  11.  Chapter 1 (Infections) – one addition A92.5 ZikaVirus  Chapter 2 (Neoplasms) – seven new codes for stromal tumors and revisions to lymphomas  Chapter 3 (Blood) – nine new codes plus revisions for post-procedural complications  Chapter 4 (Endocrine) – further specificity of diabetic retinopathy (proliferative vs. non-proliferative, severity, and laterality)  Chapter 5 (Mental) – twelve new codes for hoarding, various obsessive- compulsive disorders, and social pragmatic communication disorder  Chapter 6 (Nervous) – new codes for bilateral carpal tunnel, tarsal tunnel, and various lesions of specific nerves. 12

  12.  Chapter 7 (Eye) – new codes for central occlusion of the retinal vein, macular degeneration, stages of glaucoma, hemorrhage and hematomas  Chapter 8 (Ear) – new codes for tinnitus and postprocedural complications  Chapter 9 (Circulatory) – new codes for cerebral infarction, deficits due to hemorrhage and cardiovascular disease, dissection of arteries, post-procedural complications  Chapter 10 (Respiratory) – four new codes for postprocedural complications and a few revisions  Chapter 11 (Digestive) – many new dental codes, specific colitis, intestinal infections, pancreatitis, and postprocedural complications 13

  13.  Chapter 12 (Skin) – five new codes and a few revisions to postprocedural complications  Chapter 13 (Musculoskeletal) – new codes for bunion, bunionette, pain in joints of the hand, temporomandibular joints, cervical disc disorders at specific levels, atypical femoral fractures, and periprosthetic fractures  Chapter 14 (Genitourinary) – new codes for urinary incontinence, prostatic dysplasia, testicular and scrotal pain, erectile dysfunction, ovarian cysts, fallopian tube problems, complications of the urinary tract  Chapter 15 (Pregnancy) – new codes for ectopic pregnancy, revisions to eclampsia and diabetes, fetal deformities, placenta previa 14

  14.  Chapter 16 (Perinatal) – many revisions to affects on newborns from conditions of the mother, two new codes for newborn weight relative to gestational age  Chapter 17 (Congenital Malformations) – new codes for aorta abnormalities, and vaginal septum, and metatarsal problems  Chapter 18 (Symptoms, Signs) – new codes for NIHSS stroke scores, microscopic hematuria, micturition issues, Glasgow Coma Score, bacteriuria, abnormal radiologic findings on diagnostic imaging, and expansion of abnormal Prostate Specific Antigen (PSA). 15

  15.  Chapter 19 (Injuries, Poisoning) – New codes for skull fractures, jaw dislocations and sprains, deletions of concussion codes, addition of a hyphen to Salter-Harris, revision to forearm nerve injury codes, new foot fracture codes, revisions to complications involving prosthetic devices, new stenosis of cardiac stent codes, urethral catheter and urinary implant complications, vaginal mesh problems, revisions and additions to neurostimulator complications  Chapter 20 (External Causes) – changes to vehicular collisions fixed objects, new codes for contact with paper or sharp objects, overexertion, and an activity of the choking game  Chapter 21 (Health Status) – new codes for observation of newborn, hormone malignancy status, prophylactic medications, encounter for contraceptives, conversion of endoscopic procedures to open, a few history codes 16

  16. END OF FLEXIBILITY “As of October 1, 2016, providers will be required to code to accurately reflect the clinical documentation in as much specificity as possible”  Avoid unspecified codes, if documentation supports a more detailed code.  Figure out what documentation is required for your most commonly used codes 17

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  18. TWO TOOLS  Provider Documentation Guides  Diagnostic/Problem Statement 19

  19. PROVIDER DOCUMENTATION GUIDES  The condition (i.e. diagnosis), including:  3rdcharacter  Documentation information  Category guidelines  The ICD-10 code range  The ICD-9 equivalent (if a direct mapping exists)  4th, 5th, 6th, and 7thcharacter (if applicable)  Documentation information  Subcategory and code guidelines  Helpful information  HCC crosswalk (if applicable)  Summary of what to document  Terminology  Applicable guidelines at the level of the: 20  Chapter  Block

  20. TYPE 2 DIABETES MELLITUS WITH NEUROLOGICAL COMPLICATIONS ICD-10-CM: E11.40 – E11.49 21

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  24. PROVIDER DOCUMENTATION GUIDES The condition (i.e. diagnosis), including:  The ICD-10 code range  The ICD-9 equivalent (if a direct mapping exists)  3rdcharacter  Documentation information  Category guidelines   4th, 5th, 6th, and 7thcharacter (if applicable)  Documentation information  Subcategory and code guidelines Helpful information  Definitions  Summary of what to document  Applicable guidelines at the level of the:  Chapter  Block  25

  25. TWO TOOLS  Provider Documentation Guides  Diagnostic/Problem Statement 26

  26. 1. Diabetes mellitus type II, A1c improved with increased doses of NPH insulin. Doing self-blood glucose monitoring with values in the morning between 100 and 130. Continue current regimen. Recheck A1c on return. 2. Hyperlipidemia, at last visit, he had 3+ protein in his urine. TSH was normal. We will get a 24-hour urine to rule out nephrosis as the cause of his hypertriglyceridemia. In the interim, both Dr. X and I have been considering together as to whether the patient should have an agent added to treat his hypertriglyceridemia. Specifically we were considering TriCor (fenofibrate). Given his problems with high CPK values in the past for now, we have decided not to engage in that strategy. We will leave open for the future. 27

  27. 1. Diabetes mellitus type II: A1c improved with increased doses of NPH insulin. Doing self-blood glucose monitoring with values in the morning between 100 and 130. Continue current regimen. Recheck A1c on return. 28

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  34. 2. Hyperlipidemia: at last visit, he had 3+ protein in his urine. TSH was normal. We will get a 24-hour urine to rule out nephrosis as the cause of his hypertriglyceridemia. In the interim, both Dr. X and I have been considering together as to whether the patient should have an agent added to treat his hypertriglyceridemia. Specifically we were considering TriCor (fenofibrate). Given his problems with high CPK values in the past for now, we have decided not to engage in that strategy. We will leave open for the future. 35

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  38. 1. Diabetes mellitus type II, A1c improved with increased doses of NPH insulin. Doing self-blood glucose monitoring with values in the morning between 100 and 130. Continue current regimen. Recheck A1c on return. 2. Hyperlipidemia, at last visit, he had 3+ protein in his urine. TSH was normal. We will get a 24-hour urine to rule out nephrosis as the cause of his hypertriglyceridemia. In the interim, both Dr. X and I have been considering together as to whether the patient should have an agent added to treat his hypertriglyceridemia. Specifically we were considering TriCor (fenofibrate). Given his problems with high CPK values in the past for now, we have decided not to engage in that strategy. We will leave open for the future. E11.9 - Type 2 diabetes mellitus without complications Z79.4 - Long-term (current) insulin use E78.5 - Hyperlipidemia, unspecified 39

  39. Diagnostic Statement: Patient has Type 2 diabetes mellitus without complications, current insulin use, and unspecified hyperlipidemia • Were there really no diabetic complications, or was it just not stated? • Was the patient taking insulin temporarily, or long-term? • Is it possible that the hyperlipidemia could have been defined more accurately? • E78.1 Pure hyperlipidemia includes • Elevated fasting triglycerides • Endogenous hyperglyceridemia E11.9 - Type 2 diabetes mellitus without complications Z79.4 - Long-term (current) insulin use E78.5 - Hyperlipidemia, unspecified 40

  40. 2017 ICD-10 CODING  New, revised and deleted codes  End of CMS ICD-10 grace period 41

  41. Q & A 42

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