ICD-10 Physician Training in 45 Seconds Matthew Menendez

Goals for Today Why are we still talking about ICD-10? Big Picture – New ICD-10 Coding Concepts Know Your Data Work Top Down SSS Training Q&A

ICD-10 = Y2K

ICD-10 = A New Baby

Why are we still talking about ICD-10? CMS expected denials to increase 100%- 200% because of ICD-10 1 Denials did not increase at all 2 (1) (2)

CMS Claims Data on-cms-and-the-successful-implementation-of-icd-10/ MetricsHistorical BaselineQ4 CY 2015 Total Claims Submitted4.6 Million per day Total Claims Rejected2% of total claims submitted1.9% of total claims submitted Total ICD-10 Claims Rejected 0.17% of total claims submitted0.07% of total claims submitted Total ICD-9 Claims Rejected 0.17% of total claims submitted0.07% of total claims submitted Total Claims Denied10% of total claims processed9.9% of total claims submitted

Why are we still talking about ICD-10? CMS expected denials to increase 100%-200% because of ICD-10 1 Denials did not increase at all 2 Why? – ICD-10 was not as difficult as expected – Claims data much better than predicted – Real impact not seen yet (1) (2)

ICD-10 Scare Tactics

ICD-10 Specialty Impact Specialty ICD-9 Codes ICD-10 Codes Low Risk 1 to 1 Moderate Risk 2-10 High Risk 11+ Cardiology Family Practice2911, Internal Medicine3001, OBGYN2681, Ophthalmology2761, Orthopaedics1796, Pediatrics

What ICD-10 codes are you using? V95.40XA – Unspecified Spacecraft accident injuring occupant, Initial Encounter V91.07XD – Burn dues to water-skis on fire, subsequent encounter T14.8 – Other injury of unspecified body region

Risk of Unspecified Codes Short Term Risk (6-18 months) – Denied claims – Increasing AR – Physician productivity loss – Coding productivity loss – Georgia Medicaid Long Term Risk (2-5 years) – Value Based Reimbursement – Flat or declining revenue – Risk based models – financial penalties – Hierarchical Condition Categories (HCC) – ACO and Medicare Advantage

Data on Unspecified Code Use Frequency National Average – 31.50% White Plume Average – 10.72% Your Average - ????

Unspecified ICD-10 Analysis

3,906 Total Unique ICD-10 Codes Used 571 Total Unique Unspecified Codes Used Unspecified ICD-10 Analysis Family Medical Group 33.77% Unspecified Code Percentage – Family Medical Group 10/1/ /31/ % Unspecified Code Percentage – White Plume Clients 31.50% Unspecified Code Percentage – National Average Unspecified ICD-10 CodeICD-10 DescriptionFrequency # of Alternate ICD-10 Codes ICD-10 CodeICD-10 Description M25.519Pain in unspecified shoulder2,2632M25.511Pain in right shoulder M25.512Pain in left shoulder H66.90Otitis media, unspecified, unspecified ear1, H65.01Acute serous otitis media, right ear H65.02Acute serous otitis media, left ear H65.03Acute serous otitis media, bilateral H65.04Acute serous otitis media, recurrent, right ear H65.05Acute serous otitis media, recurrent, left ear

How Appropriate is the Unspecified ICD-10 Code? High Frequency Low Frequency Never OK Always OK

Unspecified Osteoarthritis of Unspecified Site? High Frequency Low Frequency Never OK Always OK Used Frequently More specific alternatives High Risk

Vitamin D deficiency, unspecified High Frequency Low Frequency Never OK Always OK Used Frequently No reasonable alternatives Low Risk

Work Top Down Prioritize Training Areas – High Usage – High Risk SSS Training – Short – Simple – Specific

M19.90 – Unspecified osteoarthritis, unspecified site 95 total ICD-10 codes Unspecified Code Example - Osteoarthritis

Alternate Osteoarthritis Codes M15.0Primary generalized (osteo)arthritis M15.1Heberden's nodes (with arthropathy) M15.2Bouchard's nodes (with arthropathy) M15.3Secondary multiple arthritis M15.4Erosive (osteo)arthritis M15.8Other polyosteoarthritis M15.9Polyosteoarthritis, unspecified M16.0Bilateral primary osteoarthritis of hip M16.11Unilateral primary osteoarthritis, right hip M16.12Unilateral primary osteoarthritis, left hip M16.2Bilateral osteoarthritis resulting from hip dysplasia M16.30Unilateral osteoarthritis resulting from hip dysplasia, unspecified hip M16.31Unilateral osteoarthritis resulting from hip dysplasia, right hip M16.32Unilateral osteoarthritis resulting from hip dysplasia, left hip M16.4Bilateral post-traumatic osteoarthritis of hip M16.50Unilateral post-traumatic osteoarthritis, unspecified hip M16.51Unilateral post-traumatic osteoarthritis, right hip M16.52Unilateral post-traumatic osteoarthritis, left hip M16.6Other bilateral secondary osteoarthritis of hip M16.7Other unilateral secondary osteoarthritis of hip M17.0Bilateral primary osteoarthritis of knee M17.11Unilateral primary osteoarthritis, right knee M17.12Unilateral primary osteoarthritis, left knee M17.2Bilateral post-traumatic osteoarthritis of knee M17.31Unilateral post-traumatic osteoarthritis, right knee M17.32Unilateral post-traumatic osteoarthritis, left knee M17.4Other bilateral secondary osteoarthritis of knee M17.5Other unilateral secondary osteoarthritis of knee M18.11Unilateral primary osteoarthritis of first carpometacarpal joint, right hand M18.12Unilateral primary osteoarthritis of first carpometacarpal joint, left hand M18.2Bilateral post-traumatic osteoarthritis of first carpometacarpal joints M18.31Unilateral post-traumatic osteoarthritis of first carpometacarpal joint, right hand M18.32Unilateral post-traumatic osteoarthritis of first carpometacarpal joint, left hand M18.4Other bilateral secondary osteoarthritis of first carpometacarpal joints M18.0Bilateral primary osteoarthritis of first carpometacarpal joints M18.51Other unilateral secondary osteoarthritis of first carpometacarpal joint, right hand M18.52Other unilateral secondary osteoarthritis of first carpometacarpal joint, left hand M19.011Primary osteoarthritis, right shoulder M19.012Primary osteoarthritis, left shoulder M19.021Primary osteoarthritis, right elbow M19.022Primary osteoarthritis, left elbow M19.031Primary osteoarthritis, right wrist M19.032Primary osteoarthritis, left wrist M19.041Primary osteoarthritis, right hand M19.042Primary osteoarthritis, left hand M19.071Primary osteoarthritis, right ankle and foot M19.072Primary osteoarthritis, left ankle and foot M19.111Post-traumatic osteoarthritis, right shoulder M19.112Post-traumatic osteoarthritis, left shoulder M19.121Post-traumatic osteoarthritis, right elbow M19.122Post-traumatic osteoarthritis, left elbow M19.131Post-traumatic osteoarthritis, right wrist M19.132Post-traumatic osteoarthritis, left wrist M19.141Post-traumatic osteoarthritis, right hand M19.142Post-traumatic osteoarthritis, left hand M19.171Post-traumatic osteoarthritis, right ankle and foot M19.172Post-traumatic osteoarthritis, left ankle and foot M19.211Secondary osteoarthritis, right shoulder M19.212Secondary osteoarthritis, left shoulder M19.221Secondary osteoarthritis, right elbow M19.222Secondary osteoarthritis, left elbow M19.231Secondary osteoarthritis, right wrist M19.232Secondary osteoarthritis, left wrist M19.241Secondary osteoarthritis, right hand M19.242Secondary osteoarthritis, left hand M19.271Secondary osteoarthritis, right ankle and foot M19.272Secondary osteoarthritis, left ankle and foot

M19.90 – Unspecified osteoarthritis, unspecified site 95 total ICD-10 codes Unspecified codes used on 11% of encounters with OA 198 Encounters in Q4 Additional Detail Required: – Unspecified type of osteoarthritis – Unspecified joint – Unspecified laterality Unspecified Code Example - Osteoarthritis

C – Malignant neoplasm of unspecified site of female breast 54 total ICD-10 codes Unspecified codes used on 51% of encounters 324 encounters in Q4 Additional Detail Required: – Unspecified site – Unspecified laterality Unspecified Code Example – Malignant Neoplasm of Breast

H66.90 – Unspecified otitis media, unspecified ear 80 total ICD-10 codes Unspecified codes used on 59% of encounters 456 Encounters in Q4 Additional Detail Required – Unspecified type – Unspecified laterality Unspecified Code Example – Otitis Media

ICD-10 Options Hire Certified Coders – Salary Range $47,421 - $64,807 + Benefits – Shortage of Coders + Increasing Demand – AAPC Recommends Hours of Training – 20% Decrease in Productivity in ICD-10 Mandate EHR Use for All Physicians – Too Many Clicks – Disliked by Physicians in ICD-9, Hated in ICD-10 – Fundamental Problem of Code Search Cheat Sheets, Cross Walk or Paper Encounter Forms – High utilization of unspecified codes Electronic Superbill – AccelaCAPTURE – Protects Physician Productivity – Improves Revenue Cycle Efficiency

Code Search Example - osteoarthritis

ICD-10 Superbill

Takeaways 1.ICD-10 is not over…it has just begun 2.Know Your Data – Unspecified Rate 3.Work Top Down – High Frequency and High Risk Diagnosis Codes 4.Provide SSS Training – Short, Simple and Specific

Contact Information Matthew Menendez VP, ICD-10 Specialist White Plume Technologies, LLC x 134