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.
Preparing for the Conclusion of ICD-10 Grace Period
2. 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.
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4. Claims Submitted Real-TimeTracking 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.
4ICD-10 ICD-9
5. 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.
ICD-9 vs. ICD-10 Denial Rate
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6. CureMD had established an ICD-10 help desk dedicated to deal
with a surge of ICD-10 queries.
242.25
161.5
158.1
127.5
76.5
114.75
157.25
195.5
416.5
170
136
119
93.5
85
59.5
34
55.25
51
42.5
25.5
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
ICD-10 Help Desk CallVolume
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7. Performance Metrics Remained onTrack
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OVERTHE LAST ONEYEAR
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
METRIC PRE 10/1 BASELINE POST 10/1
Claims EDI Rate 92.7% 93.3%
Front-end Rejection Rate 2.4% 2.8%
Back-end Denial Rate 6.2% 6.1%
First Pass Resolution Rate 92.8% 93.6%
8. 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.
PROVIDER FRIENDLY TERMINOLOGY
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9. ABOUT THE PRESENTER
Education
Bachelor’s of Science, Accounting – BrighamYoung 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
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10. New, revised and deleted codes
End of CMS ICD-10 flexibility
2017 ICD-10 CODING
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12. 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.
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13. 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
14. 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
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15. 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 SpecificAntigen (PSA).
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16. 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
17. “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
END OF FLEXIBILITY
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20. The condition (i.e. diagnosis),including:
The ICD-10 code range
The ICD-9 equivalent
(if a direct mapping exists)
Helpful information
HCC crosswalk (if applicable)
Summary of what to document
Terminology
Applicable guidelines at the level of the:
Chapter
Block
PROVIDER DOCUMENTATION GUIDES
3rd character
Documentation information
Category guidelines
4th, 5th, 6th, and 7th character
(if applicable)
Documentation information
Subcategory and code
guidelines
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21. TYPE 2 DIABETES MELLITUS WITH
NEUROLOGICAL COMPLICATIONS
ICD-10-CM:
E11.40 – E11.49
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25. 3rd character
Documentation information
Category guidelines
4th, 5th, 6th, and 7th character (if applicable)
Documentation information
Subcategory and code guidelines
PROVIDER DOCUMENTATION GUIDES
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The condition (i.e. diagnosis), including:
The ICD-10 code range
The ICD-9 equivalent
(if a direct mapping exists)
Helpful information
Definitions
Summary of what to document
Applicable guidelines at the level of the:
Chapter
Block
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.
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
28. 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
35. 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 consideringTriCor
(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.
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39. 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
40. 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
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41. New, revised and deleted codes
End of CMS ICD-10 grace period
2017 ICD-10 CODING
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