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Do you understand how ICD-10 will impact your practice and the way you document patient encounters? Learn about the four steps you need to take to ensure that you and your practice are ready to make the transition to ICD-10 on October 1, 2015. This CME-accredited webinar provides the tools you need to get prepared. You’ll learn: • What ICD-10 is and why the change is happening • What the four steps are you need to take now to transition to ICD-10 • How to improve your documentation to ensure ICD-10 success The event is presented by Tom Giannulli, MD, MS, and CMIO at Kareo and Abhinav Gautam, MD, CMO, and Cofounder of Nexus Clinical.
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PAGE 1 PAGE 1
What Physicians Need to Know
PAGE 2
Your Hosts Today…
Tom Giannulli, MD Chief Medical Information Officer, Kareo
Abhinav Gautam, MD Chief Medical Officer, Nexus Clinical
PAGE 3
Our Schedule for Today…
1 Introduction & Welcome
2 ICD-10: What Physicians Need to Know
3 Discover ICD-10 Resources
4 Answer Questions
PAGE 4
Participate via Social
Facebook.com/GoKareo
Twitter.com/GoKareo
Linkedin.com/company/Kareo
We’ll be live tweeting during today’s webinar! How to participate:
1. Follow @GoKareo on Twitter
2. Follow @DrTom_Kareo on Twitter
3. Join the conversation using #KareoTip
4. Join Building Best Practices group on LinkedIn
PAGE 5
Tom Giannulli, MD, MS
Chief Medical Information Officer at Kareo and designer of Kareo EHR
15 years experience in mobile technology and medical software development
Previously CMIO at Epocrates, founder of Caretools, VP of Advanced Research for Data Critical, and founder and CEO of Physix
Practicing physician in internal medicine
M.S. in biomedical engineering
M.D. from University of Texas, Houston
PAGE 6
Abhinav Gautam, MD
Co-founded Nexus @ 27 Chief Medical Officer at
Nexus Clinical Also Assistant Professor of
Clinical Anesthesiology @ University of Miami
Completed residency in Anesthesiology from the University of Miami
Published numerous peer reviewed articles in anesthesiology, surgery, and bio semiotics
Inventor with patents pending
PAGE 7
Our Schedule for Today…
1 Introduction & Welcome
2 ICD-10: What Physicians Need to Know
3 Discover ICD-10 Resources
4 Answer Questions
PAGE 8
Breaking News
PAGE 9
What We’ll Cover Today
1. ICD-10: What Is It & How Is It Different?
2. 4-Step Plan for Success
3. The Role of Technology
4. Questions
PAGE 10 PAGE KAREO | CONFIDENTIAL
Why Engage Patients?
Why Change to ICD-10?
ICD-9 is outdated and out of room. U.S. is last
major country not to make the change.
PAGE 11
ICD-10 Overview
A number of other countries have already put ICD-10 in practice, including:
United Kingdom (1995);
France (1997);
Australia (1998);
Germany (2000);
Canada (2001)
PAGE 12
ICD-10: How It Differs
ICD-9 ICD-10
Diagnosis Codes are 3-5 characters Codes are 3-7 characters
Approximately 14,000+ codes 69,000+ codes
First character is numeric or alpha (E or
V) 2-5 are numeric
First character is alpha, characters 2
and 3 are numeric, 4-7 are alpha or
numeric
Difficult to analyze data due to
nonspecific codes
Expanded to allow more specificity and
accuracy resulting in improved data
analysis
PAGE 13
ICD-10: How It Differs
ICD-10-CM Code format
Comparison ICD-10 (7 characters)
to ICD- 9 CM (5 digits)
ICD-9 Code format
X X X X X X X X X X X X
category Category
etiology,
extension
anatomic site
Example: S91.321A :
2cm laceration of the
right foot with foreign
body
severity etiology,
anatomic site,
manifestations
Example: 892.1 is the
same diagnosis,
without laterality
PAGE 14
ICD-10: New Features
Laterality: Left, Right, Bilateral
ICD-9 ICD-10
374.84 Cyst of Eyelids H02.821 Cysts of right, upper eyelid
H02.822 Cysts of right, lower eyelid
H02.824 Cysts of left, upper eyelid
H02.825 Cysts of left, lower eyelid
371.01 Minor Opacity of Cornea H17.811 Minor Opacity of Cornea, right eye
H17.812 Minor Opacity of Cornea, left eye
H17.813 Minor Opacity of Cornea, bilateral
PAGE 15
ICD-10: New Features
Combination Codes:
Certain conditions and common associated symptoms and manifestations.
Poisonings and their associated external causes.
Example
K57.21 Diverticulitis of large intestine with perforation
and abscess with bleeding
Example
T42.3x2S Poisoning by barbiturates, intentional self-
harm, sequela
PAGE 16
ICD-10: New Features
Combination Codes, con’t.:
Obstetric Codes: Identifies trimester instead of episode of care
ICD-9 ICD-10
646.11 Edema or excessive
weight gain Antepartum
O26.01 Excessive weight gain in pregnancy,
first trimester
O26.02 Excessive weight gain in pregnancy,
second trimester
O26.03 Excessive weight gain in pregnancy,
third trimester
PAGE 17
ICD-10: New Features
Fill in the Character: Character “x” is used as a character placeholder to all for future expansion
ICD-9 ICD-10
679.11 Fetal comp from in utero
procedure, delivered first
trimester
O35.7xx1 Maternal care for damage to fetus
by other medical procedure, fetus 1
O35.7xx2 Maternal care for damage to fetus
by other medical procedure, fetus 2
O35.7xx3 Maternal care for damage to fetus
by other medical procedure, fetus 3
PAGE 18
ICD-10: New Features
Exclusions:
Exclude Type 1: Indicates the excluded codes that should never be used with the selected diagnosis code (do not report codes together). Example: Congenital Hydrocephalus
ICD-10 Type 1 Excludes
Q03.0 Congenital Hydrocephalus
Malformations of aqueduct of Sylvius
Q07.0_ Arnold-Chiari Syndrome, Type II
G91._ Acquired Hydrocephalus
P37.1_ Hydrocephalus due to congenital
Toxoplasmosis
Q05.0_
to Q05.4 Hydrocephalus with spina
bifida
PAGE 19
ICD-10: New Features
Exclusions, con’t.:
Exclude Type 2: Indicates that the condition excluded is not part of the condition represented by the selected diagnosis code. Patient may have the condition(s) excluded and, in this case, both codes may be reported to capture both conditions. Example: Dermatitis due to Substances Taken Internally
ICD-10 Type 2 Excludes
L27.2 Dermatitis due to ingested food T78.0_
to T78.1_ Adverse food reaction, except
dermatitis
L23._
to L25._ Contact dermatitis
L56.1 Drug photoallergic response
L56.0 Drug phototoxic response
L50._ Urticaria
PAGE 20
Additional changes for ICD-10
New concepts in ICD-10
There are 21 chapters in ICD-10 each one beginning with a letter except for ‘U’ .
Tabular Index is divided in chapters and subdivided into blocks.
The term “Sepsis” is being replaced with the term “Septicemia” in Chapter 1 of ICD-10.
In some cases multiple codes are still needed. For example, a patient diagnosed with a malignant left ovarian tumor, major weight loss, and situational depression (C56.2, R63.4, F32.9).
PAGE 21
ICD-10: New Features
Other Changes:
Injuries are grouped by anatomical site rather than injury type.
Category restructuring and code reorganization occur in a number of ICD-10 chapters. This has resulted in a different classification of certain diseases and disorders than ICD-9.
Certain diseases are reclassified to different chapters or sections to reflect current medical knowledge.
New code definitions (i.e., definition of acute myocardial infarction is now 4 weeks instead of 8 weeks).
ICD-9 V codes and E codes are now incorporated into the main classification.
PAGE 22
What We’ll Cover Today
1. ICD-10: What Is It & How Is It Different?
2. 4-Step Plan for Success
3. The Role of Technology
4. Questions
PAGE 23
4-Step Plan: Code Mapping
Code Mapping adds five (5) key benefits to your practice.
It enables you to gain an understanding of the structure of the ICD-10 codes specific to your specialty.
It helps you understand the equivalent ICD-10 codes and determine if more specific documentation is required.
Once you start using ICD-10, it will improve the accuracy of your billing.
It guides changes to documents and forms.
It helps you plan and customize your staff training.
PAGE 24
4-Step Plan: Code Mapping
Ranking ICD-9 Codes ICD-9
Diagnosis
Description
ICD-10 Codes ICD-10
Diagnosis
Description
1 401.9 Unspecified
essential
hypertension
I10 Essential
(Primary)
Hypertension
2 414.00 Coronary
atherosclerosis
of unspecified
type of vessel,
native or graft
I25.10 Atherosclerotic
heart disease of
native coronary
artery w/o
angina pectoris
3 427.31 Atrial fibrillation 148.0
148.2
148.91
Paroxysmal
atrial fibrillation
Chronic atrial
fibrillation
Unspecified
atrial fibrillation
PAGE 25 PAGE KAREO | CONFIDENTIAL
Why Engage Patients?
PAGE 26
4-Step Plan: Documentation
Improving documentation is your #1 priority and responsibility in the ICD-10 transition!
Start documenting in more detail now! The expectations for detail will be higher with ICD-10. An EHR will help.
Know your codes. Code mapping can provide a head’s up on what codes you will use most after October 1, 2014.
Get some help. Consider hiring a Clinical Documentation Improvement (CDI) specialist to help.
PAGE 27
4-Step Plan: Documentation
Initial encounter: Indicated by an ‘A’ as the 7th character Example: T22.111A: Burn of first degree of right forearm, First or Initial encounter
Subsequent encounter: Indicated by the letter ‘D’ Example: T22.111D: Burn of first degree of right forearm, Subsequent encounter
Sequela: Indicated by the letter ‘S’ as the 7th character Example; T22.111S : Burn of first degree of right forearm, Sequela
PAGE 28
4-Step Plan: Documentation
Examples of Specialty Changes:
Surgeons: Note combination codes for digestive conditions. Certain digestive conditions are now combination codes that require specific information for coding.
OB/GYN: Document the specific trimester. Many of the codes in Chapter 15 require coders to report the specific trimester of the patient’s pregnancy.
Orthopedics: Site specificity is a common theme in ICD-10-CM, and many of the orthopedic diagnoses will require this information.
PAGE 29
4-Step Plan: Documentation
Examples of Primary Care Changes:
Headaches: Lots of new codes for headaches. For migraine (code G43), physicians must specify common, hemiplegic, persistent, chronic, ophthalmologic, abdominal, or menstrual.
Ear Infections: Various codes to denote specific forms of a middle ear infection. These codes are grouped in H65-H67 and distinguish between forms of otitis media: Serous, Allergic, Mucoid, Nonsuppurative, Suppurative, Tubotympanic suppurative, Atticoantral suppurative.
PAGE 30 PAGE KAREO | CONFIDENTIAL
Why Engage Patients?
PAGE 31
PAGE 32
4-Step Plan: Training
Physician training for ICD-10 may vary depending on the complexity of changes for your specialty:
Online and in-person options. Cost will vary based on needs.
May need clinical documentation training through certified ICD-10 trainer, EHR and template training from EHR vendor, specialty training from medical society.
Should be supported by training for practice staff, especially coders/billers.
PAGE 33 PAGE KAREO | CONFIDENTIAL
Why Engage Patients?
PAGE 34
4-Step Plan: Financial Planning
PAGE 35
What We’ll Cover Today
1. ICD-10: What Is It & How Is It Different?
2. 4-Step Plan for Success
3. The Role of Technology
4. Questions
PAGE 36
Role of Technology
Eliminates need to update most forms
Simplifies documentation
Enables code mapping
Supports more accurate, complete coding
Improves billing with electronic superbill
PAGE 37
Role of Technology
Can provide more options for billing and coding like outsourcing
Can make all collection effort more streamlined and effective to strengthen revenue
PAGE 38
Documentation
PAGE 39
Superbill
PAGE 40
Our Schedule for Today…
1 Introduction & Welcome
2 ICD-10: What Physicians Need to Know
3 Discover ICD-10 Resources
4 Answer Questions
PAGE 41
Discover ICD-10 Resources
PAGE 42
Let’s Answer Your Questions
Dr. Tom Giannulli:
Dr. Abhinav Gautam:
888-775-2736
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Twitter.com/GoKareo
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