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Learning ObjectivesBy the end of this webinar, participants will be able to:1. Understand the purpose of ICD-10 coding and how it applies to dentistry2. Identify how ICD-10 codes can be implemented in a dental practice3. Recognize how ICD-10 codes can aid with the measurement of oral healthoutcomes4. Acknowledge potential challenges and benefits associated with ICD-10implementation in dental2

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 webinarconcludes. In order to receive CE credit you must fill out the webinar evaluation, whichwill be shared at the end of the presentation. The evaluation must becompleted by EOD Wednesday, November 6 to receive CE credit. CEcertificates will be distributed by November 15.The DentaQuest Partnership is an ADA CERP Recognized Provider. This presentationhas been planned and implemented in accordance with the standards of the ADA CERP.*Full disclosures available upon request3

Q&A LogisticsAfter the presentations we hope to have sometime for Q&ATwo ways to engage: Use the raise hand feature and we willunmute you Type your question in the chat box4


POLL QUESTION #1Q1. Are you currently using ICD-10 codes in your dentalprogram? (Possible answers: yes, no- but implementingsoon, no- and no plans to start, no-use other diagnosticcode set)6

ICD-10-CMInternational Classification of Disease, 10th Edition Licensed by the World Health Organization ICD-10- Clinical Modification (CM) developed by Center for Medicare andMedicaid, 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 specificity7

ICD-10-CM Diagnostic Coding - The WhyDiagnostic 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 management8

Diagnostic Codes as our Common Language Patient and Family-Centered Care Community-engaged support SDOH at the patient level Expanding workforce Innovative, integrated approaches Delivery site expansion Population health9

Evolving Interprofessional Practice in Oral Health Adapted from Oralhealthworkforce.orgCase Manager, Case Workers, LCSWs10

ICD-10-CM: Crosswalk to Social Determinants of HealthFY2019 ICD-10C&M Guidelinesnow extrapolatedfrom medicalrecords, not as ajust by treatingclinician, assecondarydiagnosesOlson DP, Oldfield BJ, Navarro SM. ”Standardizing Social Determinants of Health Assessments. Health Affairs Blog. March 18, 2019ICD-10 CM Official Guidelines for Coding and Reporting FY2019 www.cms.gov/Medicare/coding/downloads/2019-ICD10 Coding-Guidelines-.pdf11

Dental Procedure CodesICD Diagnostic CodesMedical Procedure CodesCDT CodesICD-10-CM CodesCPT CodesUpdated CY (Jan 1)Updated FY (Oct 1)Updated CY (Jan 1)ADAICD-10 C&M CmteAMAProcedures, services, risk Disease, state, condition,otherLocation, severity, order ofvisit, length of timeD 4 numbers3-7 alphanumeric5 numbersStaticAgile*Agile*Ex: D0340M26.470350* Agile code changes based on descriptors12

Dewey Decimal System .13

ICD-10 “Chapters” for DentistryCEGKNeoplasmsDiabetesSleep ApneaOral CavityMOSJaw, FacialPregnancyInjuryZEncounterHealth Status14

Common Dental ICD-10-CM CategoriesC00-D49NeoplasmsE08-E13DiabetesG47Sleep ApneaK00- K14Diseases of GI/Oral CavityM26-27Dentofacial Anomalies, jaw disordersO00-O9APregnancy, Childbirth and post-partumS00- S09Injuries to the headV01-Y99External CausesZ00-Z99Reasons for healthcare encounter other except for disease, injuryZ11-Z13Screenings, diagnostic tests, after care, follow up care, routine exams15

ICD-10-CM Coding Methodology Alphanumeric “characters” First character is ALWAYS a letter 2nd, 3rd characters are ALWAYSnumbers Vary in length from 3 to 7characters Decimal point after3rdcharacter Codes requiring more than 3characters MUST have theadditional characters added or theyare not valid Code 1st for underlying disease Code any causal condition first Discretionary instruction Follow instructions if informationis available “Use additional code” 1 or codes to fully identify Implies cause and effect16

ICD-10-CM Classification SystemDx: Periapical Abscess with sinus.6Etiology, Site, SeverityDx: Partial Loss of teeth due toPeriodontitis Class IIEpisode.4 22Etiology, Site, Severity5.AlphaK 0Category#8of Care0 0Etiology, Site, SeverityDx: Dental exam cleaningwithout abnormal findings#of Care##AlphaK 0CategoryAlphaK 0Category#4#Episodeof Care##AlphaK 0CategoryDx: Acute Gingivitis, plaqueinducedEpisode1.Episodeof Care2 0Etiology, Site, SeverityEpisode of Care- A initial encounter, D-subsequent encounter, S sequel17

K02 Dental CariesK02.3 Arrested dental cariesK02.5 Dental caries on pit and fissure surfaceK02.52 limited to enamelK02.52 penetrating into dentinK02.53 penetrating into pulpK02.6 Dental Caries on smooth surfaceK02.61 limited to enamelK02.62 penetrating into dentinK02.63 penetrating into pulpK02.7 Dental root cariesK02.9 Dental Caries, unspecified18

ICD-10-CM Z codesEncounters not dealing with disease or injuryStatus and history codes (personal and family) such as tobacco, substance useSocial determinants of healthZ01.2- Dental Exam and cleaning (2 options)Z01.20 without abnormal findingsZ01.21 with abnormal findings, requires secondary codeRecall exam and new caries noted:Z01.21 Dental exam with abnormal findingsZ02.51 Dental caries, pit, limited to enamel19

ICD-10 Diagnostic Coding PrinciplesSSpecificitySK04.1 (pulpitis) vs. k04.9 (unspecified pulp)AAcuityAK05.00 (acute gingivitis, plaque-induced)CChronic DiseasesCE11.630 DM Type 2 with perio disease*SSeveritySK02.63 (Smooth surface caries into pulp) vsK02.9 (Unspecified caries)*Code for Not Elsewhere Classifiable (NEC) or Not OtherwiseSpecified (NOS)Ex: O99.619 (Pregnancy complicated by dental problem, unspecifiedtrimester)20

POLL QUESTION #2Q2. If you are using ICD-10 codes, what is your rationale forusing them? (Possible answers: State or payer mandate,EHR compliance, Best Practice, Interprofessional Practiceand Community Interface, Combination of the above)21

Benefits of ICD-10Allows for specificity, diagnoses acute and chronic, definitive disease orsymptoms, expandable, same platform as WHOFor 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 activities22

Finding the codes, D10American Dental Association Publication bundles and companion applications- CDT ICD-1023

Using ICD-10 Codes in a Shared EHR (Epic):Virginia Garcia Memorial Health Center’s StoryPresented by:Lisa Bozzetti DDSDental DirectorOctober 31, 2019

Virginia Garcia Memorial Health CenterVirginia Garcia1969 - 1975FQHC in Oregon servingWashington and YamhillCounties

We serve more than 45,000 patients Services at 5 primary care clinics, 6 dental clinics, 6 SBHCA Women’s Clinic and a mobile outreach clinic42% are 18 years old or younger98% live in low-income household, 20% farmworkers63% Medicaid insured 24% uninsuredOver half best served in a language other than EnglishWe serve 1 in every 15 residents of Washington and Yamhill counties

Leading up to ICD-10 code usePaper Charts until December 2016 Paper Encounter – codes entered into Epic at reception Used a generic ICD-9 code for all procedures at that timeGiven 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 ourstate

Our ProcessEntry of ICD-10 Code(s) for visitAssociate ICD-10 Code(s) with CDT CodeCode 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 inone column Frequently used ICD-10 codesin an adjacent column Our State’s Medicaidcoverage and limitations areincorporated with colorcodingResources that helped shape theguide?ADA (Amer. Dental Assoc.)CDT Coding Companion GuidesEpic’s list of ICD-10 codesWhere are they?Laminated and available in everydental operatory

Our CDT/ICD-10 Coding Guide

Our CDT/ICD-10 Coding Guide

The FutureFacilitate the measure of outcomes in our health center dentalprogram.Know and better document the populations we serve - be able todescribe the oral health conditions that our health center is addressing.Knowing our population better, we can serve them better and tailorprograms and expansion of programs to better serve our patients.

Thank you!Lisa Bozzetti, DDS – Dental Director - lbozzetti@vgmhc.org@VGMHC@VGMHCComunidad (Spanish-only page)@VirginiaGarcia@VGMHCVirginia Garcia Memorial Health Center and FoundationVirginia Garcia Memorial Health Center

ICD-10 andImplementationYogita Butani Thakur DDS, MSChief Dental OfficerRavenswood Family HealthCenter, CA

Ravenswood Family Health Center Federally Qualified Health Centerlocated in East Palo Alto, CA (amajority-minority community)Serving patients from South SanMateo County & beyond for 16 yearsPrimary, dental, behavioral health,vision care with in-house pharmacy 90% of our patients have incomesunder 200% FPL

Dental Services and PatientDemographics Comprehensivedental services including Virtual DentalHome Services, Oral Conscious Sedation and GeneralAnesthesia Specialty care: Pediatric Dentistry and Oral Surgery

ICD-10 and the Dental Practice Diagnostictools used to code and classify diseases andhealth conditions Why do we use them? Required in CA to bill dental claims to Medicaid Required to book cases in the operating room at thehospital

Diagnostic Coding ICD-10gives description of your patient population D codes alone don’t tell the full story, they are a listof procedures performed ICD-10 give you the reason for performing thevarious procedures Every CDT code can be mapped to one or moreICD-10 codes

ICD-10 Codes Revisedevery 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 CodesMalocclusionM26.4: possibleOrtho RxCariesK02.9series:restorativeSupernumerary toothK00.1 extractionAbscess K04.6 extractionand space maintenance

Practical Uses of ICD-10 CodesFor a Health Center or Private Practice: Can help with assessing what your patient populationlooks like: study prevalence and incidence of dentalconditions 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 Usedfor patient empanelment: If I know that a provider has a large proportion ofpatients who need dentures and partials, their patientexpectations may be lower than the national average Used to study population caries risk and how we areaffecting behavior change Aids with grant applications

Practical Uses of ICD-10 CodesResearch Data analyses to establish association or linkages betweenconditions“Pneumonia prevention strategies for children withneurologic impairment” Lin J et al, 2019 Pediatrics*Utilizing available ICD-10 codes it was determined thatdental care was associated with decreased risk ofsubsequent severe pneumonia in children who areneurologically impaired.

Practical Uses of ICD-10 CodesHealth Plans Require ICD-10 to approve or deny dental treatmentunder general anesthesia Correlating Medical and Dental ICD-10 codes areneeded to get patients approved for general anesthesiaat the hospital

Case Study: George 3year old George came in to our practice referred byanother DDS for possible caries and treatment Patient needed dental treatment for caries (K02.52 andK02.62) George was uncooperative in clinic and parents wantedtreatment under general anesthesia Health Plan denied the pre-authorization for GA whichwas overturned when all medical and dental ICD-10codes were reviewed

CDT to ICD-9 to 1CD-10 Crosswalk

Implementation Createguides 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, MSChief Dental OfficerRavenswood Family Health rg

ICD-10 CLOSINGDiagnostic Coding in Oral Health51

E-cigarettes and VapingF17.29: Nicotine dependence, other tobaccoproducts.Electronic nicotine delivery systems (ENDS) arenon-combustible tobacco odingguidance2019 10 17 2019.pdf52

Next WebinarE-cigarettesThursday, November 21 1-2 p.m. ETClick here to register53


Webinar ebinar*Must complete by EOD Wednesday, November 6 in order to receive CE credit55

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