Ingenix InSite User Group September 14, 2010 Approval Code: IN1009

© Ingenix, Inc. 2 Ingenix InSite User Group: Welcome Administrative Reminders:  This call is hosted in a listen only mode for participants until our Q&A segment.  Questions you may want to ask prior to the Q&A segment can be typed in our chat panel for the host to address  Please keep your phones on mute during Q&A.  The webex login password for this call is ‘insite’.  When logging into the webex please enter in your first and last name.  The user group presentation materials will be sent with the meeting minutes.  Ingenix InSite User Group Questions or Product Enhancement requests?  Ingenix InSite Website Questions? Call or the Ingenix Helpdesk or

© Ingenix, Inc. 3 Ingenix InSite User Group: Agenda  10:00 AM – 10:05 AM Welcome  10:05 AM – 10:10 AM InSite Operations Announcements  10:10 AM – 10:20 AM Data Flow/Timing from Plan to InSite  10:20 AM – 10:45 AM Focus on: New Codes for 2011  10:45 AM – 11:00 AM Q & A

InSite Operations Announcements Presented By Susan Rick InSite Business Operations Manager

© Ingenix, Inc. 5 InSite Operations Announcements  Data Refresh Update –InSite data was refreshed September 7th –Next data refresh is targeted for September 20th Data refresh may not impact all InSite users Mid-month data refresh will not replace the normal monthly data refresh –Next monthly data refresh is targeted for October 18th  August 30th 2010 – InSite Updates –September Ingenix Insider –Provider to Group Validation Enhancement New providers will now be loaded as unsuppressed when added to a provider group during an unexpired validation period. As a reminder, new providers are only added as part of a new monthly data refresh. Previously, our processes required new providers to be validated prior to a user having access to that provider’s member level data. This change will only impact new providers on a go forward basis.

Data Flow from Health Plan to InSite Presented By Jeremy Christianson Reporting Manager

© Ingenix, Inc. 7 Data Processing Schedule  Exact dates for the Reporting Platform and InSite data refresh vary by month, but typically are on or around the 10th of the month (+ 4 days)  The variation in the timeline is due to data issue research and reprocessing.

2011 ICD-9-CM Review Presented By Toni Toone, CPC, CPMA Provider Training & Development Consultant

© Ingenix, Inc ICD-9-CM Review Each year new, changed and deleted codes are released and become effective on October 1st for ICD-9-CM and January 1st for CPT and HCPCS code sets. Stay Compliant! There are 100s of changes which may affect the codes that you are currently using. Today our focus will be code changes for the senior population Let’s review…..

© Ingenix, Inc. 10 Category 237- Neoplasm Uncertain Behavior Neurofibromatosis (multiple) ◘ Schwannomatosis ◘ Specified type NEC

© Ingenix, Inc. 11 Category Disorders of Mineral Metabolism Hemochromatosis ◘ Diabetic, hereditary, primary idiopathic ◘ Due to repeated red blood cell transfusions ◘ Specified NEC ◘ Transfusion associated (red blood cell) ◘ Other disorders of iron metabolism Invalid Disorders of iron metabolism

© Ingenix, Inc. 12 Category ◘ Transfusion Associated Circulatory Overload (TACO) ◘ Fluid Disorders of Fluid, Electrolyte, and Acid-Base Balance Invalid Fluid overload

© Ingenix, Inc. 13 Category Overweight-Obesity- Hyperalimenation ◘ Obesity Hypoventilation Syndrome

© Ingenix, Inc. 14 Category 287- Primary Thrombocytopenia ◘ Post Transfusion Purpura (PTP) from whole blood (fresh) or blood products ◘ Other secondary thrombocytopenia Invalid Secondary thrombocytopenia

© Ingenix, Inc. 15 Category ◘ Aortic ectasia, unspecified site ◘ Thoracic aortic ectasia ◘ Abdominal aortic ectasia ◘ Thoracoabdominal aortic ectasia Aortic aneurysm has been revised to category 447 Disorders of Arteries

© Ingenix, Inc. 16 Category ◘ Code only confirmed cases of avian influenza (codes , , Influenza due to identified avian influenza virus) or novel H1N1 influenza virus (H1N1 or swine flu, code , ). ◘ Confirmation does not require documentation of positive laboratory testing specific for avian or novel H1N1 influenza. However, coding should be based on the provider’s diagnostic statement that the patient has avian or novel H1N1 (H1N1 or swine flu) influenza. ◘ If the provider records “suspected or possible or probable avian or novel H1N1 influenza (H1N1 or swine flu),” the appropriate influenza code from category 487 should be assigned. A code from category 488, Influenza due to certain identified influenza viruses, should not be assigned. Avian Influenza/H1N1

© Ingenix, Inc. 17 Category Influenza due to Certain Identified Influenza Virus  * Influenza due to identified avian influenza virus with pneumonia * Influenza due to identified avian influenza virus with other respiratory manifestations * Influenza due to identified avian influenza virus with other manifestations * Influenza due to identified novel H1N1 influenza virus with pneumonia * Influenza due to identified novel H1N1 influenza virus with other respiratory manifestations * Influenza due to identified novel H1N1 influenza virus with other manifestations Invalid 2011  488.0* Influenza due to identified avian influenza virus  488.1* Influenza due to identified novel H1N1 influenza virus

© Ingenix, Inc. 18 Category Intestinal Obstruction ◘ Fecal impaction

© Ingenix, Inc. 19 Category Disorders of Back ◘ Spinal stenosis, lumbar region, with neurogenic claudication Spinal stenosis-lumbar region Revised Spinal stenosis, lumbar region, without neurogenic claudication

© Ingenix, Inc. 20 Category General Symptoms ◘ Post traumatic seizures ◘ Febrile Non-Hemolytic Transfusion Reaction (FNHTR)

© Ingenix, Inc. 21 Category Symptoms Involving the Respiratory System ◘ Hemoptysis, unspecified ◘ Specified, NEC Invalid Hemoptysis-cough w/hemorrhage

© Ingenix, Inc. 22 Category 787- Symptoms Involving the Digestive System Abnormal feces-bulky stools ◘ Full incontinence of feces ◘ Incomplete defecation ◘ Fecal smearing ◘ Fecal urgency Invalid Incontinence of feces

© Ingenix, Inc. 23 Category Deficit ◘ Attention, concentration ◘ Cognitive communication ◘ Visuospatial ◘ Psychomotor ◘ Other signs/symptoms involving cognition

© Ingenix, Inc. 24 Category 999 ◘ ABO, Rh incompatibility reaction Invalid ABO incompatibility reaction Rh incompatibility reaction

© Ingenix, Inc. 25 V Codes BMI V85.41 Body Mass Index , adult V85.42 Body Mass Index , adult V85.43 Body Mass Index , adult V85.44 Body Mass Index , adult V85.45 Body Mass Index 70 and over, adult DOCUMENTATION TIP For the Body Mass Index (BMI),code assignment may be based on medical record documentation from clinicians who are not the patient’s provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient’s diagnosis), since this information is typically documented by other clinicians involved in the care of the patient (e.g., a dietitian often documents the BMI.) However, the associated diagnosis (such as overweight, obesity) must be documented by the patient’s provider. If there is conflicting medical record documentation, either from the same clinician or different clinicians, the patient’s attending provider should be queried for clarification. Invalid 2011 V85.4 Body Mass Index 40 and over, adult

© Ingenix, Inc. 26 Revised Codes  Recurrent pregnancy loss without current pregnancy  Recurrent pregnancy loss, unspecified as to episode of care or not applicable  Recurrent pregnancy loss, delivered, with or without mention of ante partum condition  Recurrent pregnancy loss, ante partum condition or complication  Spinal stenosis, lumbar region, without neurogenic claudication  Neurologic neglect syndrome  E017.0 Roller coaster riding  V07.51 Use of selective estrogen receptor modulators (SERMs)  V07.52 Use of aromatase inhibitors  V07.59 Use of other agents affecting estrogen receptors and estrogen levels  V07.8 Other specified prophylactic or treatment measure  V07.9 Unspecified prophylactic or treatment measure  V13.61 Personal history of (corrected) hypospadias  V13.69 Personal history of other (corrected) congenital malformations  V26.35 Encounter for testing of male partner of female with recurrent pregnancy loss

© Ingenix, Inc. 27 Invalid Codes  Disorders of iron metabolism  Fluid overload  Secondary thrombocytopenia  Influenza due to identified avian influenza virus  Influenza due to identified novel H1N1 influenza virus  Other anomalies of uterus  Hemoptysis  Incontinence of feces  Poisoning by other specified central nervous system stimulants  ABO incompatibility reaction  Rh incompatibility reaction  V25.1 Encounter for insertion of intrauterine contraceptive device  V85.4 Body Mass Index 40 and over, adult

© Ingenix, Inc. 28 Future InSite Topics: ◘ October - Vascular Disease,Toni Toone, CPC, CPMA ◘ November - Diabetes, Linda Ferrington, CPC, CPC-I ◘ December - Ulcers, Mary Jo Groome, CCS-P, CPC-H

© Ingenix, Inc. 29 Question and Answer