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.
2

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

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
5

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
6

7. Performance Metrics Remained onTrack
7
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
8

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
9

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

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

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.
12

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
14

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).
15

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
17

18. 18

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

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
20

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

22. 22

23. 23

24. 24

25.  3rd character
 Documentation information
 Category guidelines
 4th, 5th, 6th, and 7th character (if applicable)
 Documentation information
 Subcategory and code guidelines
PROVIDER DOCUMENTATION GUIDES
25
 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

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

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

29. 29

30. 30

31. 31

32. 32

33. 33

34. 34

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.
35

36. 36

37. 37

38. 38

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
40

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

42. Q & A
42

43. 43