ICD10 Increased Specificity Paves the Way for Increased

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

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

Learning Objectives • Distinguish the innate differences between unspecified, not elsewhere classified, etc. ,

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

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

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

CMS HCC Roadmaps

CMS HCC Roadmaps

Hot off the Presses!

Hot off the Presses!

Defining: NOS: Not otherwise specified

Defining: NOS: Not otherwise specified

Defining: NEC: Not elsewhere classifiable

Defining: NEC: Not elsewhere classifiable

Conjunction Junction!

Conjunction Junction!

Applying concepts • • • Disease due to… Timing (recurrent) When did it happen,

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

Applying concepts • • • Simple, Mixed Mild, Moderate, Severe Uncomplicated vs Exacerbated Native

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

Clinical concepts • • • Type Temporal factors Caused by/Contributing factors Symptoms/Findings/ Manifestations Localization/Laterality

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

Does it have MEAT? Monitored: Signs, Symptoms, Disease progression or regression Evaluated: Test results,

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

Let’s sink our teeth into it

Let’s sink our teeth into it

You code it 43 -year old female presents with abscess. She has a history

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.

What did you get? 43 -year old female presents with abscess. She has a

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.

You code it Pt presents with cough. Afebrile. Neg CXR. Ruled out GERD. Rx

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

What did you get? Pt presents with cough. Afebrile. Neg CXR. Ruled out GERD.

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

You code it Patient presents today with complaints of trouble sleeping and feeling tired

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.

What did you get? Patient presents today with complaints of trouble sleeping and feeling

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.

You code it Pt presents with depression. Never suicidal. Taking medication as prescribed (Celexa

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.

You code it Pt presents with depression. Never suicidal. Taking medication as prescribed (Celexa

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.

What did you get? Pt presents with depression. Present for 8 years. Never suicidal.

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.

Wrapping it up • MACRA-MIPS and APMs are still grey about how they will

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?

Communication is Key Use your ICD-10 and CPT codes to communicate what you did

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

Questions

Questions

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

Contact information Barbie Hays, CPCO, CPMA, CPC-I, CEMC, CFPC Coding and Compliance Strategist bhays@aafp. org 913 -906 -6000