ICD-10 Codes for the Chiropractic Practice

Read the transcript:

Jason: Welcome, everyone. It’s really good to have you here this afternoon. It’s Jason Barnes and joining me, as always, is my illustrious co-host to these webinars, Jessica Pancoast, the head of the training and help desk teams here at Vericle. We’re really excited to have everyone and this has been a hot topic. And so we are excited to talk about ICD-10 one more time. And so this will be a recap of a lot of the other webinars that you’ve seen including some of the system updates and what we’ve learned so far.

It will not include all of the content because we won’t be doing things like macros today. We are just gonna include the actual system functionality for finding codes, choosing your ICD-10 codes based on your ICD-10s, how to search ICD-10 codes when you’re not cross walking over from an ICD-9 code and making sure that you know how to save those codes, save the searches and group them however you’d like to. So we’ve had some updates there and we’re really excited to share those today.

Not only that, if you have not yet actually created those hierarchies in your system, we’re gonna show you how you can go about doing that with a test patient, and to kick it all off we’re actually gonna show you how to find your most popularly used or frequently used ICD-9 codes so you know which ones need to be mapped over. Jess, anything to add?

Jessica: No, I think that covers everything that we need to go over.

Jason: That’s what we’re planning on doing today. So, thank you for joining us and we’re just gonna dive right into it. Today everyone watching should be familiar with the screen that’s up. This is a fake patient where we are looking at the travel card. You can see there’s x-rays, there’s no ICD-10 or ICD-9 information, and we’re gonna go over that functionality. But before we get into that we actually want everyone to take a break and think about this process as a whole.

In order to figure out which codes you’re gonna need to select so that you’re ready to more readily choose your ICD-10 codes, I wanna to take you into another system. This is actually a real practice in our system that we’re showing you right now. All the names have been changed so that we’re not using anybody’s real practice information, but this is the last year worth of billing information by diagnosis code. Our recommendation is that you run a billing status report to find out which ICD-9 codes you most frequently use because what we found is, although there are a number, 10,977 visits with 11,150 code selections used, there were only 40 total diagnosis codes used last year by this practice.

And if you look at them by percentage, a vast majority of those visits were covered by 10 codes, 8 codes. So what we want you to do is know how to find out what those codes are for your office. To do that, you head to reports, go down to Billing Analytics, choose your billing stats report that’s how we got here. In the bottom of this report, I recommend going back one year, but six months should be adequate, you change the date range and most importantly you have to choose Diagnosis 1.

Now, this might not exist in your drop-down or pop-up, in this case of selections. If it does not that is not a problem, you go back to reports…back to Billing Analytics and then choose your billing stats configuration report. This billing stats config right here will allow you to actually choose Diagnosis 1, make a name for it, save that name and then you’ll have to go back refresh your billing status report and that way you’ll be able to access that new code that you’ve just created for your billing status report.

In this case, let’s make a note that 739.1 is the most commonly used code by this particular office. A high-volume office who sent out over 2345 claims in the last year with this diagnosis code on. Jessica, do you have anything else on the billing stats.

Jessica: No, that explains all. The only thing I can think of is you wanna make sure that Insurance Only and Pip Only is unchecked down the bottom.

Jason: Unchecked, great clarification, thanks. Okay, so getting back to it we want you to be able to create a hierarchy, create favorite codes that will allow you not have to search each time you have a new patient or an existing patient that walks through your door to know what your 739.1 equivalent or equivalents will be in ICD-10. So we’re actually gonna walk you through that process, but the first thing we need to let you know about the three areas where ICD-10 codes are going to be relevant to you.

The first you’re gonna see is the ICD-10 traffic light which I am highlighting right now with my mouse. We’re not gonna click on that just yet but most things in our systems that have a color associated with it are drillable or clickable, you can click on those things. The second are the two lines right here where you used to see just your ICD-9 codes, but now you’ll see both ICD-9s and ICD-10s. And then, in two other places, you’re gonna get the same exact interface, both the Diagnoses tab as well as your EMR Assessment tab. And everyone should know the big reason why we put an ICD-10 button right in your documentation tab is two big reasons.

One is speed and convenience, but that actually fails in comparison for us trying to help you make sure that your documentation matches your billing. When you choose this through the ICD-10 tab in your EMR tab, you’re always going to be putting this in your documentation and you can do it for your billing at the same time, therefore, you will never have incongruent billing and documentation. You wanted to add something there, Jess?

Jessica: No, I just think you misspoke. They want to be on the assessment tab, not the diagnosis tab.

Jason: Oh, the assessment tab. Sorry about that. I’m from New Jersey, I get to speaking too quickly sometimes. But thank you for the correction. So we’re gonna get to that interface in just one moment. Remember this is for practices that perhaps haven’t gone through the motions yet of actually choosing these. So, if you have not chosen an ICD-10 payer for your particular patient yet you’re not gonna be able to do this. So, Jess, do you mind just walking them through how they can set up a fake patient so that they can actually start using this?

Jessica: Sure, no problem. So, for your dummy patients, you’re going to want to set up a fake pair that won’t go out anywhere. So it’s okay if you accidentally hit submit. So what you’re gonna do is you’re going to go into the patient’s account and onto the primary tab. But then, in the insurance planning field, you’re going to type in the word “fake” and then hit the Insurance Plan Name Search. You’ll get three options and you wanna select the one that says, “Fake Payer ICD-10 Only.” Go ahead and select that one and then save the patient account. And that will be a fake payer that won’t go out anywhere, but it is set as accepting ICD-10 codes. So you’ll be able to use that patient to set up all your favorites and all your groupings for all of the rest of your patients.

Jason: Yeah. And so, we recommend doing this with a fake patient and there’s some real reasons for that: number one is you don’t want to send anything out in this fake payer, we’ll keep you totally safe if anyone ever does check this one in and you’ll never build out a visit to Blue Cross Blue Shield’s inadvertently and that’s something we definitely want to avoid. But now we’re going to actually start taking you through some of those mappings. So, let’s start with actually mapping that 739.1 and, Jess, can you help us with that?

Jessica: Sure, not a problem. So for most of you, you’re used to picking your diagnosis from the assessment tab, so that’s exactly what I’m going to do. I’m going to go ahead into my assessment tab and click on a diagnosis. I actually don’t know where 739.1 is on these tabs, so I’m just going to type it in. You guys, of course, can just select that code from any page it happens to be on. Actually, we got a little asterisk letting me know it’s on this page. So you can just go ahead and click it there and then hit Close. It will bring you into the diagnosis tab and yes, you can select and map this to the 10 code from here.

But to keep everything in your notes tab…in your notes…your documentation for the patient, I’m going to go back to the EMR and back to the assessment and select that ICD-10 diagnosis button. This will pop up the same type of ICD-10 widget from that other page. However, this won’t only pull the ICD-9 codes from what I selected in the assessment. And when I map to an ICD-10 code in this version of the widget, it will be in my notes for this patient. So I went ahead and clicked on that ICD-10 diagnosis button. Up at the top, you’ll see this orange box that lists my ICD-9, it’s also got that exclamation point at the top left. This is letting me know that this code has not yet been mapped to an ICD-10 code for this patient.

So I’m going to go ahead and click on that code and it will give me this pop-up. Now, what we do here is we list out the available mappings to ICD-10. These mappings are based off of or actually they’re not based off they are CMSs GEM matching. GEM stands for General Equivalence Mappings. Basically, if you had been using this code in 9, it’s likely that you would wanna use this code in 10. You should still make sure to read it, make sure it makes sense. But the codes that CMS mapped will be highlighted in blue. That’s our indication to you that this is a suggested mapping.

You can, of course, select any of the other ones if you choose that you don’t believe that that is the correct code in this circumstance, the gray ones they’re valid codes. They’re just not the ones that CMS suggested. That’s why they’re grayed out. But I’m going to go ahead and select the blue ones. I get another pop-up that will allow me to add this code by hitting the green plus sign. I can favorite this code by hitting the star or I could favorite this code and add it to a specific group that I have set up. The regular favorites we’ll group them by their definitions, the terms in their definitions.

But the grouping I can say I can put it in the specific group I want regardless of what the definition is. So, those are my available choices up there and then, of course, the X to exit out of it. So I’m gonna go ahead and hit the green plus sign, it has selected that code for me, and my ICD-9 up the top is now in this light blue color with a green checkmark letting me know I have mapped it. If I hit the Save button, you’ll see that the M99.01 is in my ICD-10 diagnosis box down here and it is up in my billing section up at the top. So, at this point, my note and my codes that are going to go on the claim will match.

Jason: Just perfect.

Jessica: Yes, you want them to match. And if for whatever reason if you guys are using note macros or anything like that, if your codes in this section are not up at the top, you can always hit this up arrow, it’ll say it’s going to copy the diagnosis and procedures from the assessment and plans tab and I say yes and any of the codes that are in my notes that are not yet up at the top will be moved up there for me.

Jason: All right. So let’s go into the traffic light just kind of mouse over it to view it so people can see it. That went from red to green. Now, just like any other traffic light, everybody knows how they function, green is now fine. It will turn green as soon as there is one valid ICD-10 code there. And this traffic light is meant to indicate to you guys that, you know, at least there for this payer you’ve selected a valid code to go out. It will not tell you that, “You’ve mapped all of your ICD-9 to your ICD-10. As soon as it has one valid ICD-10 on there, it’s going to be fine.” When you get a patient that shows up with a yellow indicator on there, just what does that mean? What does yellow mean?
Jessica: All right. So, some payers are still set that they are only accepting nines right now or mostly they are workers comp and CIE payers, but any payer that is set up where they are not yet accepting ICD-10 codes you won’t actually have, in most cases, a yellow indicator up there. That means that you have not yet selected ICD-10 codes for that patient, but the payer is not yet requiring 10s. So, there’s nothing wrong.

It’s just letting you know that you can actually set up 10s right now, we will save those 10s. We, of course, will not send them out until the payer lets us know that they are accepting ICD-10s. But having both 9s and 10s on the claim means that we have both sets. So, if the payer decided to switch today and we find out tomorrow, we can easily go back change update that payer and resubmit your claim without having to ask you to add the other set of codes.

Jason: So best practice, and we’re recommending it is to include both sets of codes on any time that you encounter a yellow traffic light. And there is also, unfortunately, Jess, the opposite situation is true because as of October 1, 2015, for any payer that we don’t know if they are making a switch to ICD-10, we’re still defaulting to submitting ICD-10. And we’ve already learned on a couple of different payers such as a state firm, let’s just say, that one region in Maryland is accepting ICD-10s and another region in Maryland is not accepting ICD-10s.

So, we have to make sure that that claim has 9s, ICD-9s ready to go on it. So, I don’t wanna clutter up anyone’s workbench by sending it back to them saying, “Hey, this payer is a little behind the times. They haven’t moved over to their 10 codes yet, please give us 9s.” If you include both of them, just like Jess said, we won’t bother you. We’ll just submit, on the backend we’ll know we’ll make that switch from an ICD-10 to an ICD-9 payer and we will get that claim out without any input from you or your office, which is ideal.

So those are the best practices that’s the traffic light there… I’d like to walk them through one more selection of a search where we don’t go through the assessment tab down to choose it, where we just…we don’t know which ICD-9 to ICD-10 mapping or we just have to search some things, Jess, can you help us with that?

Jessica: Sure, not a problem. Okay. So I have just opened up the widget at the top. All right, so instead of having a ICD-9 up the top that I can just click on, I’m going to use the search right here. Now I can type in a term in this field and I can get results just by that term. So, I’m gonna type in the word neck and hit the Search button and then you can see over on the right-hand side there is 1104 diagnosis that have the word “neck” in the definition.

Jason: Not too terribly helpful.

Jessica: Not too terribly helpful, but you can see I actually have a saved search firm and you can favorite those search terms and save them just by typing them in and then hitting this star on the right-hand side. But I’m going to select one of the ones I’ve previously saved and favorited and you’ll see that this one only has nine. So, we do allow two search terms.

They do not have to be one right after the other as you can see in those definitions for these, none of the definitions say “neck sprain.” It’s sprain at the beginning of the definition and neck at the end. So, it doesn’t have to be terms right back to back in the definition, but you can search by two different terms. So, I’ve searched for next frame. I have my options over on the right-hand side.

Jason: But, Jess, I know what the answer is, but an observation, I see that two of the codes on the right-hand side search section have stars next to them, what does that mean?

Jessica: All right, so these codes that have the stars next to them are codes that this particular doctor has favorited, has saved for easy use later on. And he did so just by clicking on one of those codes and hitting the star icon. So, it was unfilled in, he clicked it and it filled it in to favorite it. Whenever you are in the ICD-10 widget, you have a list of favorites down at the bottom and I’m actually going to undo my search real quick because I wanna show you what happens when you first come in here.

When you first come in here, we are going to list all the favorites that you have made. So you’ll see all of them right here. So if you have really quick codes that you can just select, you can just go straight down there and select the codes if you know what they are. But you can also use these search terms to filter that favorite list. So if I go back to the next screen, you’ll see that there’s only two codes that I have favorited that have the word “neck” and “sprain” in their definition. So selecting next sprain in the search term filtered my favorites and I can just go ahead and click them right from here to add them to my codes, my selected codes.

That way… It’s just that it makes it a lot faster to find those codes going forward. Some of you will have questions about these red symbols and these green dollar sign symbols. We do try to give you information about whether or not the codes are billable. So you’ll see that some of them are listed as non-billable codes. They are not specific enough according to Medicare. So, be on the lookout for those and you will see that happenstance, that the one for next frame actually has these initial subsequent and sequela options.

So what initial subsequent and sequela means, initial is for the initial set of visits for a specific issue. It’s not just the first visit. It’s the first time a patient is being treated for a particular issue and it’s for that entire length of care for that. Once that care has been completed, if the patient comes back a year later maybe and goes to a different doctor and is seen again for the same issue, then you would be selecting that subsequent option.

And sequela is actually like burns and…complications, that’s the word I was looking for. It’s complications from the treatment of the original issue. So, scars and burns are two of the examples that I’ve seen. So, those are what those initial subsequent and sequela options for each of these codes means.

Jason: Perfect. What about laterality?

Jessica: All right. So some codes will have laterality, you know, obviously, knees and shoulders or arms. You’re going to see options for right, left and unspecified. Just in the beginning, Medicare and the payers are being very lenient. They are accepting those unspecified codes for right now, but at some unnamed time in the future, they are going to stop paying for those unspecified codes. They do want you to tell them whether it is the left or right knee, you should be able to tell them that information. So, of course, they want you to be as specific as possible. In the beginning, though will have to accept this unspecified, but going down the line you are going to have to tell them whether it’s the left or the right.

Jason: Let me leave the witness here, Jess, what if I was searching for a shoulder and the left in the right shoulder were not to actually to do quick on shoulder in search terms, the left and the right shoulder were grayed out and the unspecified shoulder was blue. What does that mean and for all those doctors out there, you are going to run into this in laterality? Sometimes the left or the right versions or…I’ll call them versions of the ICD-10 code are grayed out and the unspecified one is recommended. That is official CMS recommendation for that specific code set that the unspecified code be billed at first.

So, keep that in mind. You can choose the more specific options, bill it out, you will see that their bill will code but they’re not a recommended code. You will get paid for that code until Medicare gets enough data and again, they said it’s going to be an unspecified period of time. They didn’t say a year, they didn’t say 10 months there’s gonna be an unspecified amount of time then they’re going to stop accepting certain codes and that’s where we’ll start talking a little bit more about the network effect and tower plans.

I know right now if you were to mouse over a code nothing’s going to pop up. Our radar chart here or our radar for what’s going to happen in the future involves a few different things. We have hired an organization to help us analyze the data, the code sets that are being used, and makes recommendations in the future. So, we’re going to have pop-ups when you mouse over codes that will tell you more specific information on whether or not it is or is not billable. So that should be something that you look forward to in the future.

If you do choose a specific code and there’s a problem, we will start adding real-time notifications right here, number one and number two, back in notifications that will send claims to work ventures should there be other selections that we would recommend that you consider.

Jessica: All right. And just to give everyone a way to find those, if you do find that you have a unspecified option selected and you don’t see those left and right options and you want to choose one of those left and right options, the next level up which should be the same code minus the last digit will actually have a plus sign, and I’ll show you. It looks like this right up here. This is the next level up and if you hit the plus sign it will open up and let you see all the other options that are under that level. So those left and right ones will be under there, if that particular code has a left and right option.

Jason: So the Search Options we found were adequate for a lot of our providers, Jess, but over the last few weeks we’ve actually received a great deal of inquiry and requests regarding another way to do this. So, do you mind clicking out of this and just going back to the ICD-9 hierarchy in the super bill place, yep, right there. So, a lot of our doctors in the past would set up this super bill to be organized a certain way, cervical spine, thoracic spine etc. The region has been the most popular way of actually organizing those. And so in response to these requests and inquiries, our tech team has designed another way to groove ICD-10 codes and so, Jessica, you’re gonna show them that?

Jessica: Sure, right down at the bottom or if you have a wider screen to the right you will have Favorites and you’ll have Groups. So if you click on the group’s tab, you’ll actually be able to not only create new groups, but be able to see any of the groups that you have already created. And these, you know, if you hit Create Group you’ll see the pop-up you can name it whatever you want. So you can name it based on what your ICD-9s were set up under.

So you can…if you don’t want to remember where they are now, they’re same place they were before. You create those groups and then when you do your searches and you click on the codes, you can select the star with the folder icon and then tell it to go into a particular group. That way when you go into that group you will see all the codes that you yourself have put there regardless of what the definition of that term is.

Jason: And this is about speed. This is about you spending some time choosing most, if not all, of the codes that you’re going to use based on your ICD-9 history so that you can favorite and organize these the way that you need to, so that then, you know, the next time you’re going to treat a patient that you know is going to need an ICD-10 code, you can find them as quickly as possible, select them. And again, I’ll keep reiterating this making sure that your documentation matches your billing, so that you can get on to the next patient or on to families, whatever your goals are.

We want to stretch quite a bit that the ICDs codes are more specific and that Medicare said they’re going to pay them, but ICD-10 is not just about choosing codes. The added level of specificity also adds a larger burden or a requirement on the provider to make sure they’re documenting like they were before to support the diagnosis and the treatment. So, if you find this webinar helpful, I think you’ll enjoy seeing some of the other webinars that we’ve put on. One primarily that I’ll recommend is one by Dr. Davila where he talks quite a bit about that topic. So, look for that, as well, it’s been well published on a number of websites, so.

Jessica: Yeah, just one more thing about the groups, you do have an easy way to select all the codes in a group by the Select All button down at the bottom in a particular group. So rather than clicking on each one using the plus sign, you can just hit the Select All button. And one thing that I happen to really like, in order to rearrange your codes for ICD-10, you still have the option up here where you can say, you know, “Move to this position,” and they will move around, but you also in the selected code area…you can actually move those around in the order you need them to be. So, I actually kind of like that.

Jason: Yeah, it’s helpful. Okay, Jess, one other staged question for you. What if I went in there and I saved all of my codes, they’re perfect for all the chiropractors in my office and I can save them a lot of time, so they don’t have to go in and choose these, is there a way for us to share these?

Jessica: Yes, there are. All right. So, in the ICD-10 widget, regardless of wherever you go into it, whether it’s the diagnosis tab or the EMR assessment tab, under the search section you will have two icons. They look like clouds with arrows in them. To export all of your saved code, searches, and groups, you can hit the one on the left, the one with the down arrow. You will get a pop-up that asks, “Which favorites you want to include?” We did default to include all of them, but you can uncheck any of the ones you don’t wanna export out.

You then have two options, Export into a File. If you choose this option, it will download this file onto your computer and then you can do whatever you want with the file. If you have a friend at another office who you wish to share your favorites with, you can take that file and stick it in an email or attach it to an email and shoot it out to them. And if they use our system as well, they can go ahead and upload it and I’ll show you how to upload those files.

Jason: I’m going to bring that up because I actually got some feedback from a previous webinar that we have coaching groups that use this. And the main, you know, coaching practices put their favorites together just yesterday and then emailed it out to all of their subsequent practices saving them a lot of time, energy and effort. So, there was a great deal of gratitude relayed to us for creating this feature, which I had nothing to do with.

Jessica: All right, so that is the first option. The second option is to Share With the Practice. If you choose this option, we do actually save that grouping that those favorites on our side rather than downloading them to your computer. We do default the name down at the bottom, but you can overwrite that and have it named whatever you would like. I do know some practices…multi special practices want to share codes based on specialty. So you can name it as a particular specialty. I do recommend keeping the date in there, however, just so if there are multiple shares you are able to tell which one is the most recent.

But you can choose whichever item you’d like and hit the Export button up at the bottom. That will either save it to our side if you’re doing share with practice or download it onto your computer if you’re doing export to a file. So now that you’ve exported all your favorites, now it’s for the next person, the one you’re trying to share it to import it. So they log in, they go here and they click on the icon on the right, the cloud with the up arrow. They, again, can say which type of favorites they wish to import.

Obviously, they can only import what the file has saved. So if you did not export your groups, they cannot import your groups, but they can choose to restrict what is important just by unchecking those boxes. We do default to pulling everything. And then it’s just choosing where that file is coming from. If it was emailed to them and they download it on their computer, they can select from a file and hit Choose File, it’s just going to bring up a browser option where they can browse their computer for wherever they saved that file.

Or the next option from a practice share, all these shares that have been done from within your practice will be listed in the drop down, down at the bottom and you can select the one that you want from the list and hit Import. And then all of those favorite, searches, codes and groups will be imported to that new person’s logins.

Jason: Fantastic. So let’s recap, we’ve shown you how to find your ICD-9s so you know which ones you have to crosswalk, we’ve shown you how to crosswalk, we’ve shown you how to search for stand-alone ICD-10 codes should you need to, showed you how to create favorites, how to create favorite searches, how to group those favorites in other ways should you want to create your own hierarchy, an organizational method. And at this point, we’ve talked about the backend, how we’re going to choose the right code and what the traffic light means. We have gone over almost all of this.

The only thing we really haven’t gone over is what happens when you have a problem. If you do have a problem, and we’ve had some one-off situations where something was or was not working. We got to practice just to pick one out of the air who said, “I chose an ICD-99 code and it simply did not show up in the widget.” And what we had learned is that if you choose an expired ICD-9 code, the system is smart enough to not let you choose that and move it over. We just didn’t notify you.

So we have a fix in to make sure that you get the notification for that. We need your input. So, if you do run into an issue which we hope you don’t, but we know you know there’s a lot of different scenarios that can happen, please bring it to our attention. Don’t suffer in silence. We’re here to help. We very much want to make sure you get all the information you need to have your practice implement ICD-10 with no incidents.

Jessica: Yeah. So, if you guys are having any issues of ICD-10, please go up to the help menu, Open Help Request Tasks, put in what you’re… but problem you’re having in the first field, type in the patient’s name in the second, hit Send and send it to the help desk. We will get the information if it’s complete, and if we can replicate it on end and we can get that over to our support and dev teams so we get it fixed.

Jason: Well, Jess, thank you so much for participating today. I know that your team has filled it all a lot of questions regarding ICD-10 and we’re getting great feedback. We really appreciate it. And we thank everyone for watching, please let us know what you think of this, you know, give us ratings, give us a feedback, we’re always starving for how it is that our users are utilizing system and making their practices run, thanks to you.

Learn all about ICD-10 on our ICD-10 page.