ICD-10:DIAGNOSTIC CODINGIN DENTALOctober 31, 2019

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Learning Objectives

By the end of this webinar, participants will be able to:

1. Understand the purpose of ICD-10 coding and how it applies to dentistry

2. Identify how ICD-10 codes can be implemented in a dental practice

3. Recognize how ICD-10 codes can aid with the measurement of oral health

outcomes

4. Acknowledge potential challenges and benefits associated with ICD-10

implementation in dental

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Housekeeping

• All lines will remain muted to avoid background noise.

• A copy of the slides and a link to the recording will be shared after the webinar

concludes.

• In order to receive CE credit you must fill out the webinar evaluation, which

will be shared at the end of the presentation. The evaluation must be

completed by EOD Wednesday, November 6 to receive CE credit. CE

certificates will be distributed by November 15.

The DentaQuest Partnership is an ADA CERP Recognized Provider. This presentation

has been planned and implemented in accordance with the standards of the ADA CERP.

*Full disclosures available upon request

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Q&A Logistics

After the presentations we hope to have some

time for Q&A

Two ways to engage:

• Use the raise hand feature and we will

unmute you

• Type your question in the chat box

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Presenters:

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POLL QUESTION #1Q1. Are you currently using ICD-10 codes in your dental

program? (Possible answers: yes, no- but implementing

soon, no- and no plans to start, no-use other diagnostic

code set)

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ICD-10-CM

International Classification of Disease, 10th Edition

• Licensed by the World Health Organization

• ICD-10- Clinical Modification (CM) developed by Center for Medicare and

Medicaid, Center for Disease Control, National Center for Health Statistics

• Design specific to ambulatory and managed care encounters

• Expanded injury codes; combination diagnosis/symptom codes

• Addition of sixth and seventh characters

• Greater specificity

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ICD-10-CM Diagnostic Coding - The Why

Diagnostic codes equate to Medical Necessity

• To other health providers (Pharmacists, Behavioral Health, Primary Care)

• For community and patient-level resource allocation

• For prior authorization and payment (Medical and Dental)

• To build care pathways, periodicity based on disease status

• To other dentists, dental specialists

• To justify additional/adjunctive services due to elevated risk, co-mortalities

• For EHR or Hosted-Network compliance

• For population health management

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• Patient and Family-Centered Care

• Community-engaged support

• SDOH at the patient level

• Expanding workforce

• Innovative, integrated approaches

• Delivery site expansion

• Population health

Diagnostic Codes as our Common Language

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Evolving Interprofessional Practice in Oral Health

Adapted from Oralhealthworkforce.org

• Case Manager, Case Workers, LCSWs

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ICD-10-CM: Crosswalk to Social Determinants of Health

Olson DP, Oldfield BJ, Navarro SM. ”Standardizing Social Determinants of Health Assessments. Health Affairs Blog. March 18, 2019

ICD-10_CM Official Guidelines for Coding and Reporting FY2019 www.cms.gov/Medicare/coding/downloads/2019-ICD10_Coding-Guidelines-.pdf

FY2019 ICD-10

C&M Guidelines

now extrapolated

from medical

records, not as a

just by treating

clinician, as

secondary

diagnoses

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Dental Procedure Codes

CDT Codes

Updated CY (Jan 1)

ADA

Procedures, services, risk

D+ 4 numbers

Static

Ex: D0340

ICD Diagnostic Codes

ICD-10-CM Codes

Updated FY (Oct 1)

ICD-10 C&M Cmte

Disease, state, condition,

other

3-7 alphanumeric

Agile*

M26.4

Medical Procedure Codes

CPT Codes

Updated CY (Jan 1)

AMA

Location, severity, order of

visit, length of time

5 numbers

Agile*

70350

* Agile= code changes based on descriptors

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Dewey Decimal System…..

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ZEncounterHealth Status

K

Oral Cavity

MJaw, Facial

OPregnancy

SInjury

E

Diabetes

CNeoplasms

GSleep Apnea

ICD-10 “Chapters” for Dentistry

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Common Dental ICD-10-CM Categories

C00-D49 Neoplasms

E08-E13 Diabetes

G47 Sleep Apnea

K00- K14 Diseases of GI/Oral Cavity

M26-27 Dentofacial Anomalies, jaw disorders

O00-O9A Pregnancy, Childbirth and post-partum

S00- S09 Injuries to the head

V01-Y99 External Causes

Z00-Z99 Reasons for healthcare encounter other except for disease, injury

Z11-Z13 Screenings, diagnostic tests, after care, follow up care, routine exams

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• Alphanumeric “characters”

• First character is ALWAYS a letter

• 2nd, 3rd characters are ALWAYS

numbers

• Vary in length from 3 to 7

characters

• Decimal point after 3rd character

• Codes requiring more than 3

characters MUST have the

additional characters added or they

are not valid

• Code 1st for underlying disease

• Code any causal condition first

• Discretionary instruction

• Follow instructions if information

is available

• “Use additional code”

• 1 or + codes to fully identify

• Implies cause and effect

ICD-10-CM Coding Methodology

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ICD-10-CM Classification System

Alpha

#

#

EpisodeofCare

K 0 4 . 6 Category

Etiology,Site,Severity

Dx: Periapical Abscess with sinus

Alpha

#

#

EpisodeofCare

K 0 8 . 4 2 2 Category

Etiology,Site,Severity

Dx: Partial Loss of teeth due to

Periodontitis Class II

Alpha

#

#

EpisodeofCare

K 0 5 . 0 0 Category

Etiology,Site,Severity

Dx: Acute Gingivitis, plaque-

induced

Alpha

#

#

EpisodeofCare

K 0 1 . 2 0 Category

Etiology,Site,Severity

Dx: Dental exam + cleaning

without abnormal findings

Episode of Care- A= initial encounter, D-subsequent encounter, S= sequel

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K02 Dental Caries

K02.3 Arrested dental caries

K02.5 Dental caries on pit and fissure surface

K02.52 …limited to enamel

K02.52 …penetrating into dentin

K02.53 …penetrating into pulp

K02.6 Dental Caries on smooth surface

K02.61 …limited to enamel

K02.62 …penetrating into dentin

K02.63 …penetrating into pulp

K02.7 Dental root caries

K02.9 Dental Caries, unspecified

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ICD-10-CM Z codes

Encounters not dealing with disease or injury

Status and history codes (personal and family) such as tobacco, substance use

Social determinants of health

Z01.2- Dental Exam and cleaning (2 options)

Z01.20 without abnormal findings

Z01.21 with abnormal findings, requires secondary code

Recall exam and new caries noted:

Z01.21 Dental exam with abnormal findings

Z02.51 Dental caries, pit, limited to enamel

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S Specificity

A Acuity

C Chronic Diseases

S Severity

ICD-10 Diagnostic Coding Principles

S K04.1 (pulpitis) vs. k04.9 (unspecified pulp)

A K05.00 (acute gingivitis, plaque-induced)

C E11.630 DM Type 2 with perio disease*

S K02.63 (Smooth surface caries into pulp) vs

K02.9 (Unspecified caries)

*Code for Not Elsewhere Classifiable (NEC) or Not Otherwise

Specified (NOS)

Ex: O99.619 (Pregnancy complicated by dental problem, unspecified

trimester)

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POLL QUESTION #2Q2. If you are using ICD-10 codes, what is your rationale for

using them? (Possible answers: State or payer mandate,

EHR compliance, Best Practice, Interprofessional Practice

and Community Interface, Combination of the above)

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Benefits of ICD-10

Allows for specificity, diagnoses acute and chronic, definitive disease or

symptoms, expandable, same platform as WHO

For dental programs, it should lead to many positives:

• Increase quality tracking

• Increase data for grants, special populations

• Increase medical-dental integration at FQHCs and Partner programs

• Decrease denied claims

• Useful in clinical decision support tools, EBD

• Supports public health activities

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Finding the codes, requirements

https://www.cms.gov/Medicare/Coding/ICD10

American Dental Association Publication bundles and companion applications- CDT + ICD-10

Using ICD-10 Codes in a Shared EHR (Epic):

Virginia Garcia Memorial Health Center’s Story

Presented by:Lisa Bozzetti DDS Dental Director

October 31, 2019

Virginia Garcia Memorial Health Center

Virginia Garcia1969 - 1975

FQHC in Oregon serving Washington and Yamhill

Counties

We serve more than 45,000 patients

• Services at 5 primary care clinics, 6 dental clinics, 6 SBHC• A Women’s Clinic and a mobile outreach clinic• 42% are 18 years old or younger• 98% live in low-income household, 20% farmworkers• 63% Medicaid insured 24% uninsured• Over half best served in a language other than English

We serve 1 in every 15 residents of Washington and Yamhill counties

Leading up to ICD-10 code use

Paper Charts until December 2016

• Paper Encounter – codes entered into Epic at reception

• Used a generic ICD-9 code for all procedures at that time

Given a directive (2015) to use ICD-10 Codes within a week

• Due to a billing change

• Created a guide for our providers and teams, using our paper encounter

• This guide has evolved over the years to also include insurance limitations in our state

Our Process

Entry of ICD-10 Code(s) for visit

Associate ICD-10 Code(s) with CDT Code

Code is then “Dropped” or Completed

ICD-10 Code(s) Selected

© 2019 Epic Systems Corporation. All rights reserved.

CDT Code must be linked to an ICD-10 Code

© 2019 Epic Systems Corporation. All rights reserved.

Elements of our CDT/ICD-10 Coding Guide

• 1 page double-sided

• Frequently used CDT codes in one column

• Frequently used ICD-10 codes in an adjacent column

• Our State’s Medicaid coverage and limitations are incorporated with color-coding

Resources that helped shape the guide?

ADA (Amer. Dental Assoc.) CDT Coding Companion Guides

Epic’s list of ICD-10 codes

Where are they?

Laminated and available in every dental operatory

Our CDT/ICD-10 Coding Guide

Our CDT/ICD-10 Coding Guide

The Future

Facilitate the measure of outcomes in our health center dental program.

Know and better document the populations we serve - be able to describe the oral health conditions that our health center is addressing.

Knowing our population better, we can serve them better and tailor programs and expansion of programs to better serve our patients.

Thank you! Lisa Bozzetti, DDS – Dental Director - lbozzetti@vgmhc.org

@VGMHC

@VirginiaGarcia

@VGMHC

Virginia Garcia Memorial Health Center and Foundation

Virginia Garcia Memorial Health Center

@VGMHCComunidad (Spanish-only page)

ICD-10 and

ImplementationYogita Butani Thakur DDS, MS

Chief Dental Officer

Ravenswood Family Health Center, CA

Ravenswood Family Health Center

Federally Qualified Health Center located in East Palo Alto, CA (a majority-minority community)

Serving patients from South San Mateo County & beyond for 16+ years

Primary, dental, behavioral health, vision care with in-house pharmacy

>90% of our patients have incomes under 200% FPL

Dental Services and Patient

Demographics

Comprehensive dental services including Virtual Dental

Home Services, Oral Conscious Sedation and General

Anesthesia

Specialty care: Pediatric Dentistry and Oral Surgery

ICD-10 and the Dental Practice

Diagnostic tools used to code and classify diseases and

health conditions

Why do we use them?

Required in CA to bill dental claims to Medicaid

Required to book cases in the operating room at the

hospital

Diagnostic Coding

ICD-10 gives description of your patient population

D codes alone don’t tell the full story, they are a list

of procedures performed

ICD-10 give you the reason for performing the

various procedures

Every CDT code can be mapped to one or more

ICD-10 codes

ICD-10 Codes

Revised every year, new codes are added

Codes are further defined for greater specificity

Some EHRs don’t allow you to complete encounters

Correlating CDT and ICD-10 Codes

Supernumerary tooth K00.1= extraction

Malocclusion

M26.4: possible

Ortho Rx

Caries

K02.9

series:

restorative

Abscess K04.6= extraction

and space maintenance

Practical Uses of ICD-10 Codes

For a Health Center or Private Practice:

Can help with assessing what your patient population

looks like: study prevalence and incidence of dental

conditions

Make a case to hire a specialist

Make a case for what cases to refer to a specialist

Fund grants and year-end program reporting

Practical Uses of ICD-10 Codes

Used for patient empanelment:

If I know that a provider has a large proportion of

patients who need dentures and partials, their patient

expectations may be lower than the national average

Used to study population caries risk and how we are

affecting behavior change

Aids with grant applications

Practical Uses of ICD-10 CodesResearch

Data analyses to establish association or linkages between conditions

“Pneumonia prevention strategies for children with neurologic impairment” Lin J et al, 2019 Pediatrics*

Utilizing available ICD-10 codes it was determined that dental care was associated with decreased risk of subsequent severe pneumonia in children who are neurologically impaired.

Practical Uses of ICD-10 Codes

Health Plans

Require ICD-10 to approve or deny dental treatment

under general anesthesia

Correlating Medical and Dental ICD-10 codes are

needed to get patients approved for general anesthesia

at the hospital

Case Study: George

3 year old George came in to our practice referred by

another DDS for possible caries and treatment

Patient needed dental treatment for caries (K02.52 and

K02.62)

George was uncooperative in clinic and parents wanted

treatment under general anesthesia

Health Plan denied the pre-authorization for GA which

was overturned when all medical and dental ICD-10

codes were reviewed

CDT to ICD-9 to 1CD-10 Crosswalk

Implementation

Create guides

Reviewing in meetings

Create multiple check points

Create bundle codes in EDR to increase compliance

Include a section on quarterly peer review

Yogita Thakur DDS, MS

Chief Dental Officer

Ravenswood Family Health Center

www.ravenswoodfhc.org

ythakur@ravenswoodfhc.org

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ICD-10 CLOSINGDiagnostic Coding in Oral Health

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E-cigarettes and Vaping

https://www.cdc.gov/nchs/data/icd/Vapingcodingguidance2019_10_17_2019.pdf

F17.29: Nicotine dependence, other tobacco products.

Electronic nicotine delivery systems (ENDS) are non-combustible tobacco products.

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Next Webinar

E-cigarettes

Thursday, November 21 1-2 p.m. ET

Click here to register

QUESTIONS?

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Webinar Evaluation

https://www.surveymonkey.com/r/DQPOct31Webinar

*Must complete by EOD Wednesday, November 6 in order to receive CE credit