1. ICD-10 Increased Specificity Paves the Way for Increased Reimbursement
Barbie Hays, CPC, CPCO, CPMA, CPC-I, CFPC, CEMC

2. Learning Objectives
Distinguish the innate differences between unspecified, not elsewhere classified, etc., within the ICD-10 code set
Apply concepts to quickly assign common codes typical to family medicine
Recognize areas of specificity opportunity
Analyze how ICD-10 affects current reimbursement models

3. Alert!
CMS discontinued the “grace period” allowing non-specific ICD-10 codes as of
October 1, 2016.

4. CMS HCC Roadmaps

5. Hot off the Presses!

6. NOS: Not otherwise specified
Defining:
NOS: Not otherwise specified

9. NEC: Not elsewhere classifiable
Defining:
NEC: Not elsewhere classifiable

11. Conjunction Junction!

12. Applying concepts Disease due to… Timing (recurrent)
When did it happen, are you re-treating
Location, location, location
Type (Type I, Type II, Intrinsic, Osteoarthritis)

13. Applying concepts Simple, Mixed Mild, Moderate, Severe
Uncomplicated vs Exacerbated
Native vs Bypass
History of vs. Current
Acute vs. Chronic

14. Clinical concepts Type Temporal factors Caused by/Contributing factors
Symptoms/Findings/ Manifestations
Localization/Laterality
Anatomy
Associated with
Severity
Episode
Remission status
History of
Morphology
Complicated by
External cause
Activity
Place of occurrence
Loss of consciousness
Substance
Number of gestations
Outcome of delivery
BMI
Copyright AAPC

15. Does it have MEAT?
Monitored: Signs, Symptoms, Disease progression or regression
Evaluated: Test results, Medications effectiveness,
Response to treatment
Assessed: Ordering tests, Discussion, Review records,
Counseling
Treated: Medications, Therapies, Other modalities

16. Let’s sink our teeth into it

17. You code it
43-year old female presents with abscess. She has a history of diabetes-well controlled. Blood sugars are stable and she is compliant on Glucophage. She complains that her shoe continuously rubs the abscess. We will give her a script to be evaluated for shoes.

18. What did you get?
43-year old female presents with abscess. She has a history of diabetes-well controlled. Blood sugars are stable and she is compliant on Glucophage. She complains that her shoe continuously rubs the abscess. We will give her a script to be evaluated for shoes.

20. You code it
Pt presents with cough. Afebrile. Neg CXR. Ruled out GERD. Rx for albuterol inhaler and dextromethorphan OTC cough suppressant. Dx: Bronchitis w/ cough

21. What did you get?
Pt presents with cough. Afebrile. Neg CXR. Ruled out GERD. Rx for albuterol inhaler and dextromethorphan OTC cough suppressant. Dx: Bronchitis w/ cough

23. You code it
Patient presents today with complaints of trouble sleeping and feeling tired all day. He states he’s been trying to lose an excess of 120 pounds, but with no luck. We will set him up for a sleep study and refer to nutritional counseling.

24. What did you get?
Patient presents today with complaints of trouble sleeping and feeling tired all day. He states he’s been trying to lose an excess of 120 pounds, but with no luck. We will set him up for a sleep study and refer to nutritional counseling.

26. You code it
Pt presents with depression. Never suicidal. Taking medication as prescribed (Celexa 40 mg 1 po qd). Reports energy level is decreased. Reports sadness is less frequent. Pt is not exercising. Reports fatigue, but denies anxiety, loss of appetite, fever, or weight change.

27. You code it
Pt presents with depression. Never suicidal. Taking medication as prescribed (Celexa 40 mg 1 po qd). Reports energy level is decreased. Reports sadness is less frequent. Pt is not exercising. Reports fatigue, but denies anxiety, loss of appetite, fever, or weight change.

28. What did you get?
Pt presents with depression. Present for 8 years. Never suicidal. Taking medication as prescribed (Celexa 40 mg 1 po qd). Reports energy level is decreased. Reports sadness is less frequent. Pt is not exercising. Reports fatigue, but denies anxiety, loss of appetite, fever, or weight change.

31. Wrapping it up
MACRA-MIPS and APMs are still grey about how they will pay
We KNOW quality will be the key factor
How can you communicate quality in an electronic world?

32. Communication is Key
Use your ICD-10 and CPT codes to communicate what you did and what you subsequently documented!

33. Questions

34. Contact information
Barbie Hays, CPC, CPCO, CPMA, CPC-I, CEMC, CFPC Coding and Compliance Strategist