NANOS. Diagnosing and Treating Neuro-Ophthalmology Coding Problems AMERICAN ACADEMY OF OPHTHALMIC EXECUTIVES AMERICAN ACADEMY OF OPHTHALMOLOGY

Transcription

1 NANOS Diagnosing and Treating Neuro-Ophthalmology Coding Problems

2 Financial Disclosure Sue Vicchrilli, COT, OCS Academy Coding Executive

3 North American Neuro-Ophthalmology Society 39 th Annual Meeting February 9-14, 213 Snowbird Ski Resort Snowbird, UT FINANCIAL DISCLOSURE I do not have any financial interests or relationships to disclose.

4 Topics PQRS/E-Prescribing Examinations Evaluation and Management Eye Codes Testing Services Unilateral/Bilateral Bundling Edits Multiple Procedure Payment Reduction

5 Financial Disclosure Modifiers Surgical Procedures ICD-1-CM Transition

6 PQRS and E-Prescribing Bonus or Penalty? The Choice is Yours.

7 PQRS Incentives and Penalties VBP PQRS (Successful Participation) (Not Successful)

8 PQRS 213 In order to receive.5% of all your Medicare Part B, Medicare as a secondary payer, and Railroad Medicare allowables (less DME or any injectable drug)...

9 PQRS 213 Reporting Options Option 1: Report 3 measures correctly 5% of the time via claims (office reporting), or Option 2: Report 3 measures correctly 8% of the time via CMS approve registry.

10 PQRS 213 Physicians who fail to participate in 213 will be subject to a 1.5 percent payment adjustment in 215. Participating means attempting to report at least one PQRS measure between Jan. 1 Dec. 31, 213.

11 PQRS 213 Minor changes to current measure specifications. Glaucoma staging codes removed from measures 12 and 141. Measure 124: Health Information Technology has been eliminated.

12 PQRS 213 Reporting period January 1 through December 31, 213 if reporting three measures via claims or registry.

13 PQRS Measures Measure 12 Measure 14 Measure 18 Measure Ophthalmic Measures Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation Age-Related Macular Degeneration (AMD): Dilated Macular Examination Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy Diabetic Retinopathy: Communication with the Physician Managing On-going Diabetes Care

14 PQRS Measures Measure 117 Measure 13 Measure 137 Measure Ophthalmic Measures Diabetes Mellitus: Dilated Eye Exam in Diabetic Patient Documentation of Current Medications in the Medical Record Melanoma: Continuity of Care Recall System Registry Only Melanoma: Coordination of Care Registry Only

15 PQRS Measures Measure 14 Measure Ophthalmic Measures Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement Primary Open-Angle Glaucoma (POAG); Reduction of Intraocular Pressure (IOP) by 15 percent or Documentation of a Plan of Care

16 PQRS Measures Measure 191 Measure Ophthalmic Measures Cataracts: 2/4 or Better Visual Acuity within 9 Days following Cataract Surgery Registry reporting only Cataracts: Complications within 3 Days Following Cataract Surgery Requiring additional Surgical Procedures Registry reporting only

17 PQRS Measures Measure 224 Measure 226 Measure 265 Note: 15 Ophthalmic Measures Melanoma: Overutilization of Imaging Studies in Melanoma Registry reporting only Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Biopsy Follow-Up Registry reporting only All individual measures other than 137, 138, 191, 192, 224, and 265 can be reported via claims or registry.

18 PQRS: Getting Started Note: If a patient encounter qualifies for more than one of the measures you have selected, report on all that qualify.

19 PQRS 213 Reminder: Not everyone in the practice has to select the same measures. Nor does everyone in the practice need to participate.

20 PQRS 213 Reminder: Reporting is based on the individual NPI. Only those patients treated by that physician will count towards the bonus incentive.

21 PQRS 213 Reminder: The more participating physicians in the practice The greater the total bonus; and The greater your ability to avoid the 1.5% payment adjustment.

22 PQRS 213 Important! Make sure your RA has C96 or N365 to verify that the measures have been reported. If the claim is denied, the measure is denied also and will have to be resubmitted.

23 PQRS Visit for all details Questions?

24 E-Prescribing Incentives and Penalties VBP E RX (Successful Participation) (Not Successful)

25 213 Automatic Exemptions to E-Prescribing Penalties New: Achieved meaningful use sometime between Jan. 1, 211 and June 3, 212. New: Registered for the EHR Incentive program and adopted EHR between Jan. 2, 212 and Jan. 31, 213.

26 E-Prescribing Penalties/Payments Otherwise Report G8553 a minimum of 1 times from your office associated with any billable service (exam, test, surgery) with dates of service between now and June 3, 213, to avoid the payment adjustment, or

27 E-Prescribing Penalties/Payments Report G8553 a minimum of 25 times from your office associated with an exam with dates of service between now and June 3, 213, to receive the payment incentive.

28 PQRS 213 Important! Make sure your RA has C96 or N365 to verify that the e-prescription has been reported. If the claim is denied, G8553 is denied also and will have to be resubmitted.

29 PQRS 213 Remember: Anything the pharmacy caries can be e-prescribed.

30 213/214 E-Prescribing January 1, 213 June 3, 213 January 1, 213 December 31, times to avoid the 214 penalty LAST CHANCE! 25 times to earn the 213 incentive. Prescription can be associated with any Part B service; report by claims only CPT code 9924 is not a reportable service Prescription must be associated with an office visit; report by claims or registry

31 E-Prescribing Resources Visit for all details Questions?

32 Questions?

33 E&M vs. Eye Codes

34 Evaluation and Management Documentation requirements are nationally recognized by all payers. No limitation on frequency for any payer. All diagnosis codes are covered. Eye Codes Documentation requirements may vary by state and by payer. No limitation on frequency for Medicare payers. Non-Medicare payers typically have frequency edits for comprehensive exams. Limited diagnosis coverage list. Those typically covered can be found at Many systemic disease diagnoses are not covered.

35 E&M: History Component Chief complaint History of the present illness (HPI) Review of systems (ROS) Past, family, and social history (PFSH)

36 E&M: History Component Chief complaint Does not have to be in the patient s own words Indicates what elements of the exam should be performed Comprehensive = at least four elements

37 HPI Location: Right eye, left eye, both eyes? Quality: Is the nature of the problem constant, acute, chronic, improved or worsening? Severity: On a scale of 1-1 Mild, moderate, severe Timing: Worse in am or pm? Onset? Duration: How long has the issue been a problem? Context: Associated with any activity? Modifying factors: What efforts have been made to improve the problem? Associated signs and symptoms: Is the problem causing blurred vision, twitching, headache? Brief HPI 1-3 elements Extended HPI 4-8 elements

38 E&M: History Component CC: 18-year-old female presents with progressive field loss OD over six weeks. Denies eye pain.

39 ROS Constitution Fever, weight loss, cancer Eyes Ears, nose, mouth, throat Cardiovascular Respiratory Sudden loss or change, distortion, double vision, itching, redness, discharge, swelling of lids Sinus infection, dry mouth, deafness High blood pressure, circulation problems, cholesterol treatment, heart attack Asthma, emphysema, TB

40 ROS Gastrointestinal Acid Gerd, hepatitis Musculoskeletal Neurological Endocrine Hematologic/lymphatic Allergic/immunologic Arthritis Stroke, MS, HOH Diabetes, thyroid Infection Seasonal allergies, hay fever

41 ROS Problem pertinent ROS Only the system in the HPI is reviewed Extended ROS Complete ROS Two to nine systems are reviewed Ten or more systems are reviewed

42 PFSH Past history documentation may include information regarding: - Prior illnesses and injuries - Prior operations - Current medications - Allergies

43 PFSH Family history documentation may include information regarding: Disease of family member that may be hereditary or place the patient at risk, such as diabetes, amblyopia, retinal detachment, AMD, and glaucoma Specific diseases related to problems identified in the CC or HPI

44 PFSH Social history documentation should include information regarding: - Use of drugs, alcohol, and tobacco

45 PFSH Pertinent history Complete Only one of the three histories is documented All three of the histories are documented

46 PFSH All three of the histories must be present for a new patient or a consultation for those payers that still recognize those codes. Two of three histories must be present for an established patient.

47 PFSH Information should be referenced and updated at each visit. PFSH no change since (date). PFSH no change except since (date).

48 The following elements are components of the eye examination. Exam Visual acuity Gross visual field testing Ocular motility Conjunctiva Does not include determination of refractive error. By confrontation Including primary gaze alignment Bulbar and palpebral

49 Exam Ocular adnexa Pupil and iris Cornea (slit-lamp) Anterior chamber (slit-lamp) Lens (slit-lamp) Lids, lacrimal gland, lacrimal drainage, orbits, preauricular nodes Shape, direct and consensual reaction (afferent pupil), size, shape, morphology Epithelium, stroma, endothelium, and tear film Depth, cells, flare Clarity, anterior & posterior capsule, cortex, nucleus

50 Exam Intraocular pressure Credit for performance of this element can be counted even when documentation states that IOP measurement has been deferred due to trauma, infection, or poor concentration, or contraindicated Optic nerve discs Posterior segment including retina and vessels Through dilated pupils, unless contraindicated, of size, C/D ratio, appearance such as atrophy, cupping, tumor elevation and nerve fiber layer Through dilated pupils, unless contraindicated, exudates and hemorrhages, atrophy, detachments

51 Exam Brief assessment of mental status including: Orientation to time, place and person Mood and affect (eg, depression, anxiety, agitation)

52 Exam Which levels require dilated pupils? New patient and 9925 Established patient unless contraindicated.

53 Number of Diagnosis and Management Options Problem Categories Number Points Score A B C D Self limited or minor: stable, improved or 1 worsening (Maximum of 2) Established problem: stable or improved 1 Established problem; worsening 2 New problem: no additional work-up 3 planned (Maximum of 1) New problem: additional work-up planned 4 Total

54 Number of Diagnosis and Management Options If the score is 1, the number of diagnostic/management options is minimal If the score is 2, the number of diagnostic/management options is limited If the score is 3, the number of diagnostic/management options is multiple If the score is 4 or more, the number of diagnostic/management options is extensive

55 Amount and/or Complexity of Data A Points B Review and/or order of clinical lab tests 1 Review and/or order of radiology/ultrasound (CPT 7 series or 92136) 1 Review and/or order of medical tests (CPT 9 series) 1 Discussion of tests with performing physician 1 Independent review of image, tracing, and specimen 2 Decision to obtain old records and/or additional history from other than patient Review of old records and/or additional history from other than patient Total 1 2

56 Amount and/or Complexity of Data If the score is 1, the amount and/or complexity of data is minimal or low. If the score is 2, the amount and/or complexity of data is limited. If the score is 3, the amount and/or complexity of data is moderate. If the score is 4 or more, the amount and/or complexity of data is extensive.

57 Table of Risk Using the Table of Risk determine the level of risk for each: - Presenting problem - Diagnostic procedure - Management options

58 Level of Risk Presenting Problem(s) Diagnostic Procedure(s) Ordered Management Options Selected Minimal One self limited or minor problem cold, insect bite Lab tests X-rays EKG Rest, Superficial dressings Low Two or more self limited or minor problems One stable chronic illness (cataract, diabetes) Skin biopsies Over the counter drugs Minor surgery with no identified risk factors

59 Level of Risk Presenting Problem(s) Diagnostic Procedure(s) Ordered Management Options Selected Moderate One or more chronic illnesses with mild progression Two or more stable chronic illnesses Endoscopies Obtain fluid from body cavity Minor surgery with identified risk factors Elective major surgery with no identified risk factors Undiagnosed new problem Acute illness or complicated injury Prescription drug management. High One or more chronic illnesses with severe progression or side effects of treatment. Acute or chronic illnesses or injuries that post threat to life or bodily function. Diagnostic endoscopies with identified risk factors Elective major surgery with risk factors Emergency major surgery

60 Final Determination New Patient 3/3 components Comprehensive History Comprehensive Exam Moderate Medical Decision Making = 9924

61 Final Determination New Patient: 3/3 components Comprehensive History Comprehensive Exam High Medical Decision Making = 9925

62 Final Determination Established Patient: 2/3 components: Detailed History Detailed Exam Moderate Medical Decision Making = 99214

63 Final Determination Established Patient: 2/3 components: Comprehensive History Comprehensive Exam High Medical Decision Making = 99215

64 CPT Published Examples Initial visit for 55-year-old diabetic patient with progressive visual field loss, advanced optic disc cupping and neovascularization of retina. 9925

65 CPT Published Examples Initial visit for 29-year-old female with acute orbital congestion, eyelid retraction, and bilateral visual loss from optic neuropathy. 9925

66 Levels of Service Defined New Patient 9921 Usually the presenting problem(s) are self limited or minor and the physician typically spends 1 minutes face-to-face with the patient and/or family. Problem focused history Problem focused examination Straightforward MDM 9922 Usually the presenting problem(s) are low to moderate severity and the physician typically spends 2 minutes face-to-face with the patient and/or family. Expanded problem focused history Expanded problem focused examination Straightforward MDM

67 New Patient Levels of Service Defined 9923 Usually the presenting problem(s) are of moderate severity and the physician typically spends 3 minutes face-to-face with the patient and/or family. Detailed history Detailed examination Low complexity MDM 9924 Usually the presenting problem(s) are of moderate to high severity and the physician typically spends 45 minutes face-to-face with the patient and/or family. Comprehensive history Comprehensive examination Moderate complexity MDM

68 Levels of Service Defined New Patient 9925 Usually the presenting problem(s) are of moderate to high severity and the physician typically spends 6 minutes face-to-face with the patient and/or family. Comprehensive history Comprehensive examination Established Patient Commonly referred to as tech code. Usually the presenting problem(s) are minimal. Typically 5 minutes are spent performing or supervising these services. High complexity MDM

69 Levels of Service Defined Established Patient Usually the presenting problem(s) are self limited or minor. Typically 1 minutes of physician face-toface time with the patient and/or family. Two of these three key components must be documented: Problem focused history Problem focused examination Straightforward MDM Established Patient Usually the presenting problem(s) are of low to moderate severity. Typically 15 minutes of physician face-to-face time with the patient and/or family. Two of these three key components must be documented: Expanded problem focused history Expanded problem focused examination Low complexity MDM

70 Levels of Service Defined Established Patient Usually the presenting problem(s) are moderate or high severity. Typically 25 minutes of physician face-to-face time with the patient and/or family. Established Patient Usually the presenting problem(s) are of moderate to high severity. Typically 4 minutes of physician face-to-face time with the patient and/or family. Two of these three key components must be documented: Two of these three key components must be documented: Detailed history Detailed examination Moderate MDM Comprehensive history Comprehensive examination High complexity MDM

71 Time When counseling and/or coordination of care constitutes more than 5% of the physician/patient and or family encounter, then time may be considered the key or controlling factor to qualify for a particular E&M service. Documentation of time must be recorded in the medical record.

72 Time Chart notation might read: - I spent minutes with the patient. I spent more than half of that time providing counseling and coordination of care.

73 Time - I spent minutes with the patient. I spent more than half of that time discussing the time diagnosis and treatment. - I spent minutes with the patient. I spent half of that time counseling about the diagnosis and the importance of taking the prescribed medication.

74 Residents and Teaching Physicians Both residents and teaching physicians may document services in the medical record. The attending physician who bills Medicare for E&M services, must at a minimum, personally document:

75 Residents and Teaching Physicians - His/her participation in the management of the patient; and - He/she performed the service or was physically present during the critical or key portions of the service performed by the resident.

76 What About Consultations? Even though CMS eliminated consultation codes some commercial payers recognize them.

77 What About Consultations? Two points to remember: 1. Is it really a request for an opinion (consult) or a transfer of care? 2. If Medicare is secondary payer, they will not pay the 2%.

78 Questions

79 Eye Code CPT Description Intermediate Examination 922 and 9212 Intermediate ophthalmological services describes an evaluation of a new or existing condition complicated with a new diagnostic or management problem not necessarily relating to the primary diagnosis, including history, general medical observation, external ocular and adnexal examination, and other diagnostic procedures as indicated; may include the use of mydriasis or ophthalmoscopy.

80 CPT Description Intermediate Examination 922 and 9212 Chief complaint History General medical observation Visual acuity External ocular exam Adnexal exam - May include use of mydriasis or ophthalmoscopy

81 CPT Description Comprehensive Examination 924 and 9214 Comprehensive ophthalmological services describe a general evaluation of the complete visual system. The comprehensive services constitute a single service entity but need not be performed in one session.

82 CPT Description Comprehensive Examination 924 and 9214 The service includes history, general medical observation, external and ophthalmoscopic examination, gross visual fields, and basic sensorimotor examination.

83 CPT Description Comprehensive Examination 924 and 9214 It often includes as indicated: biomicroscopy examination with cycloplegia or mydriasis and tonometry. It always includes initiation of diagnostic and treatment programs.

84 CPT Description Comprehensive Examination 924 and 9214 Chief complaint History General medical observation Visual acuity

85 CPT Description Comprehensive Examination 924 and 9214 External ocular exam Gross visual fields Basic sensorimotor exam Tonometry Fundus exam (dilation as medically indicated)

86 CPT Description Comprehensive Examination 924 and 9214 Initiation of diagnostic and treatment program, which includes: - Prescription of medication - Arranging for special diagnostic or treatment services - Consultations - Lab - Radiological services

87 Questions

88 E&M vs. Eye Codes Bottom line: Determine the appropriate level of E&M code Determine the appropriate level of Eye code

89 E&M vs. Eye Codes Bottom line: Bill the exam that has the highest allowable for that payer.

90 E&M vs. Eye Codes Bottom line: This means you need to obtain the fee schedules for at least your top five payers.

91 E&M vs. Eye Codes CPT code Commercial #1 Commercial #2 Medicare 9921 $8.46 $7 $ $ $123.9 $ $21.9 $177.8 $ $ $273.7 $ $ $345.1 $ $16.82 $129.5 $ $2.2 $24.1 $135.74

92 E&M vs. Eye Codes CPT code Commercial #1 Commercial #2 Medicare $39.49 $37.8 $ $8.46 $72.1 $ $ $119.7 $ $22.2 $179.9 $ $ $24.1 $ $ $136.5 $ $ $197.4 $112.25

93 Signature Log Typed Name Legible signature Legible initials Title John Q. Smith, MD John Q. Smith, MD JQS, MD Physician/MD Sue J. Vicchrilli, COT Elizabeth Cottle, CPC, OCS Sue J. Vicchrilli, COT SJV, COT Certified Technician Elizabeth Cottle E.C. Administrator Barbara Jones Barbara Jones BJ Receptionist

94 Testing Services

95 It s All in the Details 1. CPT description 2. Linked diagnosis codes 3. Unilateral/bilateral distinction/modifiers 4. Delegation of tests 5. Interpretation and report

96 It s All in the Details 6. Technical and professional component 7. Which tests are bundled with other tests? Is unbundling appropriate? 8. Advance Beneficiary Notice (ABN)

97 It s All in the Details What about frequency edits for performance? Unfortunately, rarely published.

98 Frequency If in doubt, obtain Advance Beneficiary Notice (ABN) from Medicare patients Coding Resources (English and Spanish)

99 Audits Every auditor knows any test that is delegated (not performed by the physician) requires a written order which should state:

100 Audits Which test Which eye(s) And the chart note should reflect medical necessity.

101 Audits This must be documented in the medical record (not on the superbill or charge sheet). Technicians may write the order as dictated by the physician. Physician signature required.

102 Global Periods When medically necessary, tests may be billed (and paid), when submitted within the global period of a major or minor surgery.

103 Testing Services Skilled nursing facility Difference between nursing home and SNF SNFs receive payment to rehabilitate the patient. The technical component of all special testing services should be submitted to the SNF and the professional component to Part B Medicare.

104 Physician Health Shortage Area Identified by physician office zip code. Additional payment for the technical (-TC) paid on a quarterly basis. No modifiers necessary.

105 9281/9282/9283 Visual Fields Documentation Note of performance and findings Unilateral Bilateral Bill once when testing one or both eyes TC 26 CCI Version 19. Yes 9281: 99211, 9282, : 99211, : 99211

106 92133 SCODI - Glaucoma Documentation Unilateral Bilateral TC 26 CCI Version 19. Note of performance and findings Bill once when testing one or both eyes Yes 92132, 99211, 92134, 92227, 9225

107 92134 SCODI - Retina Documentation Unilateral Bilateral TC 26 CCI Version 19. Note of performance and findings Bill once when testing one or both eyes Yes 92132, 99211, 92227, 9225

108 9225 Fundus Photography Documentation Note of performance and findings Unilateral Bilateral Bill once when testing one or both eyes TC 26 CCI Version 19. Yes 99211, 92227

109 92275 Electroretinography Documentation Note of performance and findings Unilateral Bilateral Bill once when testing one or both eyes TC 26 CCI Version 19. Yes 99211

110 Testing Services - MPPR Fortunately, ophthalmology is late to the reduction-of-payment-for-testingservices game. CMS initially applied this concept in 1995 to other specialties.

111 Testing Services - MPPR CMS analysis of code pairs frequently performed together revealed evidence of duplicate payment for many activities. For example, greeting the patient, taking his or her history, and collating data were not performed separately for each test, but physicians were being paid as though they were.

112 Testing Services - MPPR When any of the following 27 testing services are performed on the same day, a 2 percent reduction will be applied to the technical (-TC) component of the lowest allowed amount.

113 Testing Services - MPPR

114 Financial Impact - MPPR CPT Code 9225 Fundus Photo OCT 9283 Visual Field Total $ 213 Professional $ 213 Technical $ 213 $65.81 $22.6 $43.21 $43.26 $27.72 $15.53 $61.51 $27.11 $34.39

115 Questions?

116 Modifiers

117 Modifiers When in a group practice with surgical ophthalmologists, global surgery rules impact your coding.

118 Modifier -24 Unrelated E&M by same surgeon during postop period

119 Modifier -24 Append the modifier to the unrelated office visit. Management of a problem unrelated to the surgery or in the unoperated eye. Requires a different diagnosis from the surgical diagnosis code.

120 Modifier -25 Significant, separately identifiable E&M (Eye code too) service by same physician the same day as a minor procedure

121 Modifier -25 Append to the office visit. To be used when a separately identifiable office visit and a minor surgical procedure are performed on the same day.

122 26 Professional component To be used when the physician completes only the professional component of a testing service. Append the modifier to the testing service..

123 Modifier -79 Unrelated procedure or service by the same physician during the postoperative period

124 HCPCS modifiers RT LT E1 E2 E3 E4 Right side Left side Left upper lid Left lower lid Right upper lid Right lower lid

125 HCPCS modifiers GA GY GW TC ABN on file Deny the claim Patient enrolled in hospice Technical component

126 Questions?

127 Code This Case

128 Surgery CPT Code Description 3769 Ligation or biopsy temporal artery Global Period Zero-days Physician Allowable $319 office $212 facility 6227 Lumbar puncture Zero-days $137 office $68 facility Chemodenervation of muscle for blepharospasm Zero-days $121 office $18 facility Myasthenia gravis Zero-days $51 office $28 facility

129 Modifier When performed the same day as an exam is it appropriate to append modifier -25 to the exam? Is the exam significantly, separately identifiable from the minor surgical procedure performed on the same day?

130 Questions?

131 ICD-1-CM ICD-9 ICD-1

132 ICD-1-CM

133 ICD-1-CM Everyone who is covered by the Health Insurance Portability and Accountability Act (HIPAA) must make the transition. Not just those who submit Medicare or Medicaid claims.

134 ICD-1-CM ICD ICD-1 M31.5 Arteritis: Temporal, giant cell Giant cell arteritis with polymyalgia rheumatica M31.6 Other giant cell arteritis

135 ICD-1-CM ICD Blepharospasm ICD-1 G24.5 No other code

136 ICD-1-CM ICD Benign intracranial hypertension ICD-1 G93.2 No other code

137 ICD-1-CM Visual field defect options: H53.41 Scotoma involving central area Central scotoma (not billable) H Scotoma involving central area, right eye H Scotoma involving central area, left eye H Scotoma involving central area, bilateral

138 ICD-1-CM Visual field defect options, cont. H53.42 Scotoma of blind spot area Enlarged blind spot (not a billable code) H Scotoma of blind spot area, right eye H Scotoma of blind spot area, left eye H Scotoma of blind spot area, bilateral - There are many more options.

139 ICD-1-CM What do you code? Retrobulbar optic neuritis Sudden visual loss Headache, tension, episodic, non intractable H53.132, G44.29, H53.8

140 How to Get Started Coders/Billers Run a diagnosis productivity report. Look up the most frequently diagnosis codes you use now and convert them to ICD-1.

141 Headache R51 chronic daily R51 cluster G44.9 intractable G44.1 not intractable G44.9 daily chronic R51

142 Headache R51 histamine G44.9 intractable G44.1 not intractable G44.9 migraine (type) (see also Migraine) G43.99 nasal septum R51 neuralgiform, short lasting

143 Headache R51 unilateral, with conjunctival injection and tearing (SUNCT) G44.59 intractable G44.51 not intractable G44.59

144 Headache R51 short lasting unilateral neuralgiform, with conjunctival injection and tearing (SUNCT) G44.59 intractable G44.51 not intractable G44.59

145 Headache R51 tension(-type) G44.29 chronic G intractable G not intractable G episodic G44.219

146 Headache R51 intractable G not intractable G intractable G44.21 not intractable G44.29

147 How to Get Started Coders/Billers Three to six months prior to ICD-1 implementation Code every chart with ICD-1. Of course only actually submit ICD-9 code.

148 How to Get Started Do not waste time learning the tricks of the trade Instead - learn the trade

149 Conquering ICD-1 Resources Website: Questions may be ed to From those questions a library of Q&A will be developed.

150 Questions?

151