In advance of the adoption of ICD-10 as the standard for documenting diagnoses, ComplyMD has reviewed its impact on users of our system. In this presentation, we show how (relatively) simple the cutover from 13,000 codes to 68,000 codes will be for users of ComplyMD Surgeon Notes.

1. ICD-10 Ready! ComplyMD’s migrationfrom ICD-9-CM to ICD-10-CMfor diagnoses

2. ICD What? The International Classification of Disease (ICD) Was created for mortality reporting Is expanded with “CM,” (clinical modification) in the United States  ICD-9-CM and ICD-10-CM Operates on a hierarchical rubric system, so that all codes begin with 3-digit categories, which group disease systems

3. ICD-9 vs. ICD-10 The World Health Organization (WHO) published ICD-9 in 1975 and ICD-10 in 1994 ICD-9 is over 20 years old ICD-9 is not always precise or unambiguous ICD-10 now used everywhere except Italy and United States ICD-10-CM will add capacity ICD-9-CM is running out of room First character is alpha, so instead of 10 choices, there are up to 26 Codes have up to seven characters Spaces reserved for growth

4. ICD-9-CM vs. ICD-10-CM Code Structure ICD-9-CM Alphanumeric: Numeric except for V and E codes Minimum: 3 digits Maximum: 5 digits Decimal point: yes,after third digit Dummy placeholder? ICD-10-CM Alphanumeric: All codes are alphanumeric Minimum: 3 digits Maximum: 7 digits(some chapters have 7th character extension Decimal point: yes,after third digit Dummy placeholder: “x”

5. ICD-10 Attributes First character is ALPHA, followed by up to6 characters Decimal point after 3rd character (like ICD-9) Valid codes can have 3, 4, 5, 6, or 7 characters From 13,500 ICD-9 codes to 68,000 (up to 120,000) ICD-10 codes Much greater specificity

6. ICD-10… Coming Soon (Finally) Final rule to Adopt Adopt ICD-10-CM and ICD-10-PCS published January 17, 2009. Calls for adoption of ICD-10-CM to replace ICD-9-CM diagnosis codes and ICD-10-PCS to replace ICD-9-CM Volume 3 (procedure codes) October 1, 2013 implementation Single implementation date for all covered entities Based on discharge date for inpatient services Based on date of service for outpatient and physician services

7. RAND Study Costs… Hardware and software changes, lost productivity, and training Transition estimated at $425MM to $1.15B for the first year,and $5MM to $40MM a year thereafter Assumes a simultaneous switch… if separate, add another$20MM to $170MM Benefits Harder to quantify, but appear to outweigh the costs Estimated between $700MM and $7.7B over 10 years Benefits Include: improvements to the quality of care and patient safety fewer rejected or questionable reimbursement claims improved information for disease management more accurate reimbursement rates for emerging technologies better understanding of the value of new procedures

8. Provider Impacts Documentation of diagnoses and procedures Codes must be supported by medical documentation ICD-10-CM codes are more specific Requires more documentation to support codes Expect a 15% increase in documentation time (per AAPC) Revenue Impacts of specificity Denials Additional Documentation Coverage and Payment New coding system will mean new coverage policies, new medical review edits, new reimbursement schedules Changes will be made to accommodate increase specificity May need to discuss changes with patients Expect increased reject, denials, and pends as both plans and providers get used to new codes Source: AAHM (June 2009)

9. What Will It Cost to Convert? Training - $195 per provider/admin staff and $1625 per coder Changes to superbills IT Costs – Much higher than transaction implementation Documentation – 15% increase in time Increases in claim inquiries, reduction in cash flow – 1% at a minimum Source: AAHM (June 2009)

10. ComplyMD is ICD-10 ReadyToday! ComplyMD’s migrationfrom ICD-9-CM to ICD-10-CMfor diagnoses

11. ICD-9 vs. ICD-10, a Comparison More Data… Same User Interface ICD-9 ICD-10

12. ICD-10 Within ComplyMD’s Application

13. ICD-9 vs. ICD-10, a Comparison Reports are almost identical ICD-9 ICD-10

14. ICD-10 Ready When You Are!