This document discusses the implementation of ICD-10, which will replace ICD-9 and involves a significant increase in diagnosis codes from 14,000 to 69,000. It emphasizes the need for training and preparation among medical and dental practices, particularly larger ones with more complex coding requirements. Additionally, it highlights specific documentation changes and offers resources and training opportunities to aid in the transition, while outlining a copay assistance program for the ARESTIN medication.

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This article is a repeat of the information provided in the May 2014 newsletter. Due
to the approaching deadline for ICD-10 implementation, I felt that it would be helpful
to review that information in order to help you to be better prepared.
Medical and dental practices have been on track for the implementation of ICD-10
which is the diagnosis code set that is replacing ICD-9. This is quite an extensive
change due to ICD-9's 14,000 codes and ICD-10's 69,000 codes. On March 31,
2014 the legislature issued a delay in its implementation until October 1, 2015. The
advantage of that was that it provided an additional year to prepare.
Does this "prepare" aspect cause you to be concerned? Understandably, it does for
many. This change is more involved than just many additional codes. There are new
documentation requirements and convention changes necessary for the proper use
of this revised code set that do make it more complicated. In addition, all team
members need to learn about these changes in order to implement the code set
more effectively. This article will provide information that may alleviate some of
those concerns and help make your implementation easier.
The providers who are affected the most by this change to ICD-10 are the very large
providers such as hospitals and large clinics. Small practices such as solo
practitioners and also dentists who cross code don't have nearly as many new
codes to be familiar with. These larger institutions often have multiple areas of
specialty and diverse departments that don't always communicate well with each
other - what one doctor documents may not always be coded exactly as intended
due to this. Smaller practices tend to have much better communication which makes
coding simpler.
In either case, training will be required to understand the new dynamics of this code
set. There are resources available for this and I have such resources available for
dental practices which are available through my website.
For dental practices, I suggest that both the dentists and the coding staff become
familiar with the code set - but there is no need to be familiar with all 69,000 codes.
My suggestion is to find those codes that pertain to the procedures most commonly
performed in the practice. These codes can be entered in template format.
Templates such as these can be called encounter forms or charge slips and are
used in many medical practices. You may have noticed that, when you have an
appointment with your primary care provider, there is a paper encounter form with a
lot of codes on it. Obviously, there aren't 14,000 codes on the form. That practice
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has chosen their most commonly used codes.
This is what I advocate for dental practices. Encounter forms take care of most
communication problems when the dentist checks off codes on the encounter form.
That form is then used for check out and insurance processing. It is very efficient.
Dental practices can develop their own forms or can access different types of
encounter forms from my website, www.artofpracticemanagement.com.
Documentation requirements will also change with the use of ICD-10 and will
require much more specificity. Dentists and staff who document must learn about
the changes. Along with SOAP notes (subjective, objective, assessment, plan), the
following are the specific areas that need to be included in the documentation:
 Type of condition
 Onset - acute or chronic
 Etiology (cause)
 Anatomical location and laterality if laterality applies
 Severity - mild, moderate or severe
 Stages of healing
 Which episode of care (initial, subsequent)
 External causes of the condition
I suggest that dental practices obtain the ICD-10 codes now in order to become
familiar with them so that the practice will be prepared for the October 1
implementation. Take advantage of the ICD-10 resources available from my website
and watch for my emails alerting you to my webinars for ICD-10.
Keep in mind that these same diagnosis codes will be used on dental claim forms in
the future.
Take the measures to learn about how to use ICD-10 and develop or purchase
encounter forms to help with the new codes. Check out the special sale on ICD-10
resources that I am offering. You will be glad that you did.
Arestin® Copay Assistance Program
Colleen Rutledge, RDH
Treating multiple periodontal pockets as in many non-surgical cases, can be cost
prohibitive for many patients in dental practices that only offer single-site locally-
applied antimicrobial agents. In an effort to make it more affordable AND treat the
entire infection, a new program was developed by OraPharma to decrease (and in
some cases eliminate) the copay for Arestin when utilizing the Arestin Access
Program. It's called the ARESTIN® Copay Assistance Program which began this
February and continues until December 31, 2015. This approach not only yields
better clinical results by eliminating the entire infection but increases patient
compliance by making it more affordable.
Here are some basic facts about the program:
The offer is only valid for patients with private insurance. Commercially insured
patients whose insurance does not cover Arestin will pay more. Offer is not valid for
prescriptions fully or partially reimbursed under Medicaid, Medicare, or other federal
or state programs (such as medical assistance programs). Cash-paying patients or
discount card programs are not eligible.

3. The patient is responsible for reporting receipt of this offer to any health insurer,
health plan, or third-party payer. The patient also agrees not to submit a claim for
the prescription to a government payer. This benefit can be used only for an Arestin
prescription filled by Accredo Health Group specialty pharmacy and dispensed to
the dental office on behalf of the patient. The patient must be 18 years of age and
older.
If the patient has a health savings account (HSA), it is the patient's responsibility to
know how claims are processed and understand that amounts paid may be
automatically deducted from their benefits limit.
There are basically three ways to apply for this program: online
(www.RxAccessPortal.com), FAX or phone. Check out the links below to see if this
may be a fit for your hygiene program!
References:
1. http://arestinprofessional.com/rx-access
2. http://arestinprofessional.com/Portals/139/docs/ARESTIN_RxAccess_Patient_Eligibility_Form.pdf
3. http://arestinprofessional.com/rx-access/getting-started
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Dental – The requirement to opt in or opt out of Medicare has been postponed to
January 1, 2016. The process can take up to 90 days, so it is important to take the
appropriate steps for opting in or opting out. I will be presenting a webinar on this
topic on August 6th.
Medical – ICD-10 will require a higher level of patient encounter documentation. All
dentists who cross code need to be aware of the fact that medical claims require
diagnosis coding that is very specific. In order to comply with this requirement, the
documentation needs to reflect the specifics. Please pay special attention to the
detail in my article at the beginning of this newsletter that deals with what needs to
be included in patient encounter documentation.
January 1, 2015 – The updated cross coding is now available with the codes for
2015 in addition to instructions on completing the new medical claim form. Please
go to the following link to order your update: 2015 Code Update
January 1, 2015 – Updated CDT codes. If you haven't already purchased your
CDT manual, please do so ASAP. My recommendation is Coding with Confidence.
Coding with Confidence/Practice Booster Order Form.
October 1, 2015 – The beginning date for ICD-10 implementation.
January 1, 2016 (Postponement) – All physicians and eligible
professionals, including dentists, who treat Medicare beneficiaries and write
prescriptions, refer, or order for these patients must either enroll in the Medicare
program or opt out of it. Delaying your decision can be very problematic.
Time Line
Insurance Alert

4.  June 23, 2015 - Audio Conference on ICD-10 implementation for Dental
Practices- Register now
 August 6, 2015 - Webinar on Medicare Opt In or Opt Out for Dental
Providers
 August 14, 2015 - Atlanta, GA
 September 25, 2015 - New York, NY
 October 9, 2015 - Schaumburg, IL – Register now
 November 6, 2015 - Los Angeles, CA
 October 16, 2015 - Charlotte, NC
To register: 707-769-8887 or Register online
 October 17, 2015 - Raleigh, NC
To register: 707-769-8887 or Register online
 November 6, 2015 - Allentown, PA
To register: 707-769-8887 or Register online
 November 7, 2015 - Tinton Falls, NJ
To register: 707-769-8887 or Register online
Favorite Quotes:
Last year and this year have been a crazy time for me as I proceeded through the
steps to learn ICD-10 and incorporate it into my programs and products. I
personally have been amazed, surprised, and even astounded by some of the
new diagnosis codes. I happened upon a quote from someone who also found
some humor in these codes and I believe that you will get a good laugh from
these too. So this newsletter's quote from that individual is as follows:
"People in the coding profession are relieving their stress from the transition by
poking fun at the system, and the result is seriously funny! Here's a taste of some
very real codes...
R46.1 is "bizarre personal appearance"
R46.0 is "very low level of personal hygiene"
W22.02XA, "walked into lamppost, initial encounter
W22.02XD, "walked into lamppost, subsequent encounter"
V91.07XA, "burn due to water-skis on fire"
... and a few that are made-up.
C193.44. "Yelled fire when he fell into the chocolate."
R97.01 "Delusional, Severe. Thinks insurance company will cover her procedure."
Additionally, there are 312 animal codes, including "being bitten by turtle" and
"struck by turtle." Codes for a duck, macaw, parrot and even a turkey are part of
the package. Unbelievable? In some ways the new codes are, especially when
you see that one code for suturing an artery will become 195 codes. But in the
Marianne's Seminar Schedule for Dental Medical Billing
101 with ICD-10
Colleen's Seminar Schedule for 2015

5. scheme of things, we have humor to lighten the code load.
http://www.medicalcodingcourses.com/blog/funny-spin-on-icd-10-codes.aspx, accessed
May 11, 2015
Tips
The last two newsletters offered tips about acid erosion and this one continues
with information obtained by a study of 4000 adults by the Journal of Public Health
Dentistry and reported on the Wednesday Watch broadcast of the Dental News
Network. The study determined that the most significant factor in erosion is soft
drinks. 70% of soft drink consumers showed some degree of erosion. We often
think of the decay side of soft drink consumption but we need to also consider the
tooth erosion factor too and warn our patients about this also.
Points of Interest:
This newsletter has dealt with the impending change from ICD-9 to
ICD-10 fairly extensively. You may be interested to know a bit about the
history of diagnosis coding and be surprised by how long it has been
used. I was amazed to read that the diagnosis coding system began as
early as the 17th Century in England. "Statistical data was gathered
through a system known as the London Bills of Mortality, and arranged
into numerical codes.
These codes were used to measure the most frequent causes of death. Fast-
forward a few hundred years...
By 1937, this statistical analysis of the causes of death was organized into the
International List of Causes of Death. Over the years, the World Health
Organization (WHO) used this list more and more to assist in tracking mortality
rates and international health trends. The list was later developed into the
International Classification of Diseases, which is now in its ninth revision (ICD-9)."
MB Guide, History of Medical Coding, http://www.mb-guide.org/history-of-medical-
coding.html, accessed May 11, 2015
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The Art of Practice Management
2217 Fox Horn Road • New Bern, NC 28562 • Phone: 1-252-637-6259
www.artofpracticemanagement.com • a.p.m.1@suddenlink.net
Perio-Therapeutics & Beyond
724 Fitzwatertown Road • Glenside, PA 19038 • Phone: 267-241-5833
www.perioandbeyond.com • colleen@perioandbeyond.com
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