Your Top Questions about the ICD-10 7th Character Answered!

Lea Chatham March 31st, 2015

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Kareo ICD-10 ResourcesIn the recent webinar, ICD-10: 4 Steps to Success, participants got a great overview of ICD-10, the impact on practices, and the 4 steps to help ensure success. Speaker Michelle Cavanaugh also spent nearly 20 minutes answering a wide range of questions from attendees, including many about the 7th character and how the coding works for initial, subsequent and sequela visits. In this blog post, we’re sharing those answers.

Prior to the questions, here is a quick overview of the initial, subsequent , a sequela coding:

A=Initial Encounter: Used while the patient is receiving active treatment for the condition being diagnosed. Examples could be surgery encounter, ER, evaluation and treatment by a new physician.

B=Subsequent Encounter: Used for care after the patient has received active treatment for the condition and is now receiving routine care during the healing or recovery phase. For example, cast change or removal, medication modification, follow up care for that injury or condition.

S=Sequela: Used for complications or conditions that the patient might develop as a result of the initial condition or injury. We used to call these late affects. Examples might be a joint contracture, a scar, painful hardware after an arthrodesis was done.

Q: Does every visit require the initial, subsequent, or sequela coding? Tweet this Kareo story
A: No. Refer to the ICD-10 code book to guide you on which diagnosis codes use this coding convention.

Q: Is the 7th character required or used in all specialties?
A: No, it is not.  Refer to the ICD-10 code book to guide you on which diagnosis codes use this coding convention.

Q: Is 7th character “A” only for new patients, or can it be an established patient with this new diagnosis? Tweet this Kareo story
A: The seventh character “A” is used only on selected codes. Refer to the ICD-10 code book to guide you on which diagnosis codes use this coding convention. It would be appropriate to use it on a patient receiving initial treatment for that diagnosis.

Q: Is the sequela encounter the final encounter of treatment? So if the patient had 4 visits there would be 1 initial visit, 2 subsequent visits, and then the sequela visit would be billed once the issue is determined to be resolved?
A: No. The sequela would only be applicable to any long-term or residual effect from the initial injury. If none existed then it would be appropriate to only have diagnosis coding for initial and subsequent visits.

Q: Do the “A” and “D” suffix for initial and subsequent visits go with 99213 vs 99203 if they are new to our practice but following up from ER?
A: Since 99213 and 99203 are CPT codes, you would select the proper one based on whether the patient is new to your practice or already established.

Q: Is it accurate to use the initial encounter 7th character multiple times before using the subsequent encounter 7th character.
A: This would be an unusual situation. It would be most commonly seen in the instance of an ER patient who is being treated by multiple providers for an initial injury. For example, the patient with a fracture is seen by the ER doctor and the radiologist to diagnosis and initiate treatment so they would both code with a diagnosis for initial encounter.

Q: How do we know that the patient has been seen for an issue already? Most of our patients are geriatric with dementia and Alzheimer’s.
A: If the patient was seen in your practice, this information will be in the patient’s record. If the patient was referred to you then you should have a referral from the other provider. If neither of these are the case, you may be able to figure this out when taking the history or through a caregiver. Also, remember not all ICD-10 codes require the use of the 7th character to delineate the visit is a new or subsequent care visit. See the ICD-10CM code book to become familiar with the applicable diagnosis codes.

For more of Michelle’s insights watch the recording of ICD-10: 4 Steps to Success. You can also get more tools and resources at the Kareo ICD-10 Resource Center.

About the Author

Michelle Cavanaugh, RN, CPC, CANPC, CGIC, CPB, CMRS, is an AHIMA approved ICD-10 trainer, certified coder, certified professional biller, and certified medical reimbursement specialist. She owned her own successful medical billing company with over 60 customers for 16 years. Prior to that she worked as an ICU RN and Nursing Director for two home health agencies. Michelle is a member of AAPC, AHIMA, and AMBA. She graduated with her BSN from the University of Maryland.

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ICD-10 Changes for Rheumatology: Important Diagnoses to Consider

Lea Chatham March 25th, 2015

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Kareo ICD-10 Resource CenterBy Lisa A. Eramo

Like most specialties, rheumatology will see changes and expansions in ICD-10. Tweet this Kareo story


It’s important to review these changes and ensure that any templates in the electronic record (or paper encounter forms) are updated accordingly. Betty Hovey, CPC, COC, CPB, CPMA, CPC-I, CPCD, director of ICD-10 development and training at the American Academy of Professional Coders (AAPC) provides an overview of some of ICD-10 changes for several conditions relevant in this specialty.

1. Systemic lupus erythematosus. In ICD-10, there are 10 different codes that denote this condition. These codes distinguish between drug-induced lupus (specify the drug) vs. lupus with organ or system involvement (i.e., endocarditis, pericarditis, lung involvement, glomerular disease, tubular-interstitial nephropathy, or other organ involvement).

2. Gout. Codes for gout have greatly expanded in ICD-10. Document the type of gout (i.e., idiopathic, lead-induced, drug-induced, due to renal impairment, or secondary), then specific anatomical location, and laterality. For lead-induced gout, specify the toxic effect of lead and its compounds. For drug-induced gout, specify the drug that caused the gout. For gout due to renal impairment, document the associated renal disease. For secondary gout, specify the associated condition. If the gout is chronic, document whether it is with or without tophus.

3. Rheumatoid arthritis. Many of the ICD-10 codes for rheumatoid arthritis are combination codes, meaning they include an associated diagnosis. These codes also include a specific anatomical location as well as laterality. For example, ICD-10 code M05.111 denotes rheumatoid lung disease with rheumatoid arthritis of the right shoulder.

4. Psoriatic arthropathy. In ICD-9, one code (696.0) denoted this condition. However, in ICD-10, there are six codes in category L40.5-. Physicians must document whether the condition is distal interphalangeal psoriatic arthropathy, psoriatic arthritis mutilans, psoriatic spondylitis, psoriatic juvenile arthropathy, or other psoriatic arthropathy.

4. Ankylosing spondylitis. In ICD-9, one code (720.0) denotes this condition. However, in ICD-10, codes are greatly expanded to include details about the specific anatomical site (i.e., region of the spine). For example, ICD-10 code M45.3 denotes ankylosing spondylitis of the cervicothoracic region.

Preparing for ICD-10
Many of the diagnoses relevant to rheumatology include laterality, anatomical specificity, and causation. When possible, rheumatologists should document the relationship between two conditions using language such as ‘due to,’ ‘exacerbated by,’ ‘with,’ or ‘in.’ This helps demonstrate patient severity, and it also allows coders to assign the most specific code. Payers may automatically deny codes that are unspecified.

As with all specialties, rheumatology practices should ensure that any encounter forms are updated to include details necessary for ICD-10. With rheumatology, it’s not possible to include all code options on an encounter form. For instance, there are five pages of codes for gout alone. Instead, consider including the conditions with which patients are most frequently diagnosed. If the practice diagnoses gout frequently, is there a specific type or anatomical location that is diagnosed more often than another? Can you omit unspecified codes from the encounter form to leave more space for additional diagnoses? Can you include documentation prompts to encourage physicians to document laterality rather than include separate codes for this information? The potential complexity of doing this all on paper is a good reason to consider upgrading to an EHR if you have not already, and more specifically an integrated EHR and billing system that enables you to send a complete electronic superbill.

Whether using paper or EHR, you may want to keep a code cheat sheet handy. For example, Janssen Biotech, Inc. provides a quick reference crosswalk for rheumatology.  You can use a third party tool like this, or run your own top codes report using your practice management software or EHR and do a code mapping from ICD-9 to ICD-10 the reflect exactly the top codes for your practice. Either way, just be sure to get prepared and have resources handy to help make the transition a little easier.

For more ICD-10 news, updates, and tools, visit the Kareo ICD-10 Resource Center.

About the Author

LisaEramofreelanceLisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She also works as a healthcare content specialist for Agency Ten22. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal and AHIMA Advantage. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.

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5 Medical Practice Front Desk Time Savers

Lea Chatham March 24th, 2015

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Tweet this Kareo StoryBy Adria Schmedthorst

You know the saying, “You only get one chance to make a first impression.”  Your front desk staff is the first to greet your patients, respond to their needs, and show what it will be like to be part of your practice.

A chaotic front desk leads to frustration and poor patient interactions while an efficient one can increase both patient satisfaction and practice revenues.

Here are five medical practice front-desk time savers all offices should consider implementing. Tweet this Kareo story

  1.  Pre-registration:  Whether by email or patient portal, all practices need to have new patients pre-registering and completing paperwork prior to their first visit. The front desk bottle-neck created by new patients filling out a stack of insurance and history forms can derail your day.
  2. Outsourcing appointment calls:  Outsourcing is now quite common. It is simple to set up a phone tree to direct all appointment calls to a line answered by a reputable call center. And, as a bonus, it is far less expensive than employing an extra staff member to field those calls.
  3. Take a hard look at your patient paperwork:  One of the easiest ways to save time at the front desk is to streamline patient paperwork. Does the patient history form make sense? Or, are you going to be asking all those questions again when you do your review of systems? Should they be filling out insurance card information when you will be making a copy of the card? Holding onto old paperwork standards can slow down your office flow, reduce number of patient visits, and decrease patient satisfaction.
  4. Automate your prescription refill system: Calls for prescription refills can be one of the biggest time sucks for your front desk staff. Fielding the call, getting all the information, and forwarding it to nurses is often just the beginning. Pharmacy follow-ups and second and even third calls from patients can be the standard. Instead, streamline the system by having your front desk forward patient calls for refills straight to the nurses’ voicemail, with a recording to inform patients that all requests will be handled by the end of the day. Pharmacy calls can be sent to a separate voicemail with instructions to send an electronic refill request or fax. These requests can be handled in one to two batches during the day to increase efficiency.
  5.  Patient Portals:  With a portal, patients can sign in to request appointments, print copies of records, pay bills, and ask questions…all things that your front desk would normally have to spend time on the phone handling. Not all patients will embrace the portal but the ones who do will drastically reduce the strain on your front desk staff.

More than any other area of your practice, your front desk has an impact on efficiency and patient flow. By implementing these five front desk time savers, you will reduce the burden on your front desk staff and increase both the performance and revenues of your practice.

About the Author

Adria Schmedthorst is a writer focusing on the medical device, technology, software, and healthcare industries. Adria is the founder of AMS Copy and a healthcare professional herself with more than 10 years in practice. She now uses her knowledge of the industry to help companies achieve their goals of writing content that speaks to the hearts and minds of medical professionals. She has been featured in blogs, written articles, and other publications for the industry, and ghostwritten books for doctors in both the United States and Australia.


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Free Assessment: Are You Ready for ICD-10?

Lea Chatham March 19th, 2015

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The ICD-10 deadline is October 1, 2015. If you aren’t prepared, it could mean a huge impact on your bottom line! As a small business you can’t afford to lose revenue because of claim denials due to ICD-10.

Take this simple assessment to see how ready you are and get your free ICD-10 Success Plan Checklist. Tweet this Kareo story

Kareo Free ICD-10 Assessment

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-X {ESPU} New HCPCS modifiers—not an alternate ESPN channel

Lea Chatham March 18th, 2015

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Tweet This Kareo Storyby Betsy Nicoletti

There was already confusion about the correct use of surgical modifier 59. Physicians and coders often appended the modifier to a second procedure, whether it was needed or not, just to be safe. It was like applying a Band-Aid, even when the skin wasn’t broken. The CPT definition of modifier 59 is a distinct procedural service.  (See the full CPT definition below). CMS tells us that it is the modifier of last resort, to be used only when another modifier doesn’t more accurately describe the situation. It should be used when a second procedure is a component code of the primary procedure but the second procedure  meets the requirements of distinct.

To add to the existing confusion, CMS released a transmittal in August 2014 defining four new modifiers called the –X{EPSU} modifiers which will eventually replace modifier 59. CMS made the change because it identified a high error rate in the use of modifier -59. However, CMS did not make the use of these modifiers mandatory. Some Medicare Contractors and private payers will begin phasing in these modifiers. Medical practices will have to check with their contractors to see if they must use the modifiers.

Here is an overview on the four –X{EPSU} modifiers that will replace modifier 59:Tweet this Kareo story

  1. XE Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter
    Use modifier –XE when the second procedure was performed at a different encounter and is not described more accurately by modifier 24, 25, 27, 57, 58, 78, 79 or 91.
  2. XS Separate Structure, A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure
    In an article about modifier 59, CMS states that in order to use modifier 59 for different anatomic site, the procedures must be those that are not usually performed together or when the services are on different anatomic regions. They give three examples of treatment of a single anatomic site: treatment of the nail, nail bed, and adjacent soft tissue, treatment of posterior segment structures in the eye, and arthroscopic treatment of structures in adjoining areas of the same shoulder.  It would not be correct to use modifier –XS in these examples. In order to use modifier –XS for the second procedure, the second procedure must be performed on a separate organ or structure.
  3. XP Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner
    Modifier –XP is used to report service that was performed by a different practitioner on the same calendar day as the first procedure. Because these four –X{ESPU} modifiers are in lieu of reporting modifier 59 they should only be reported when there is no other modifier which can be used. If any of the other surgical modifiers described the situation, use it.
  4. XU Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service
    One example of the correct use of modifier -XU is when a diagnostic procedure precedes a therapeutic procedure and a diagnostic procedure is the basis for performing the therapeutic procedure. The diagnostic procedure must occur before the therapeutic procedure, must clearly provide the information needed to decide whether to proceed with a therapeutic procedure and must does not constitute a service which would otherwise have been required during the therapeutic procedure.  Do not report both if the diagnostic procedure is an inherent component of the surgical procedure.

CMS has not mandated the use of these modifiers. Individual Medicare Contractors may make their own decisions about the pace of adopting them. CMS itself said “CMS will continue to recognize the-59 modifier in many instances but may selectively require a more specific –X{EPSU} modifier for billing certain codes at high risk for incorrect billing.”  Examples of what CMS considers high risk billing are in their modifier 59 article, cited below.  Many surgical practices are continuing to use modifier 59, and are waiting to adopt these modifiers until more specific guidance is provided by their own Contractor. Private payers typically lag in adopting HCPCS codes and modifiers. Surgical practices should refrain from using these modifiers for their private prayers unless instructed to do so.

Additional Resources 

The CPT Manual defines modifier 59 as follows: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.”

MedLearn Matters 8863 “Specific Modifiers for Distinct Procedural Services”  

CMS Transmittal 1422 8/15/14 “Specific Modifiers for Distinct Procedural Services”

Modifier 59 info from Medicare’s CCI Edits

About the Author

Expert Betsy_Nicoletti_advises how to improve your patient collectionsBetsy Nicoletti is the author of The Field Guide to Physician Coding and the 2007 Physician Auditing Workbook, as well as founder of She developed The Accurate Coding System to help doctors get paid for the work they do. She simplifies complex coding rules for practitioners and engages physicians in a positive and respectful way, which encourages attention and accuracy in their coding. Besides doing auditing and compliance work, she is a speaker, writer and consultant in coding education, billing and accounts receivable.

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Free Webinar: 4 Steps to ICD-10 Success

Lea Chatham March 16th, 2015

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Register nowICD-10: 4 Steps to Success
Thursday, March 19. 2015
10:00 AM PT, 1:00 PM ET

Position your practice for ICD-10 success with 4 simple steps. Tweet this Kareo story



ICD-10 is only six months away. Have you put off preparing for ICD-10? If so, you can’t wait any longer. This major change could have an impact on your bottom line. As a small business, you can’t afford not to be prepared. This webinar offers four simple steps to help make the transition easier on your practice.

In this free webinar, ICD-10-CM trainer Michelle Cavanaugh will review:

  1. What ICD-10 is and how it differs from ICD-9
  2. What you should have already done
  3. The 4 steps to help ensure success on October 1

Register Now

About the Speaker

Michelle Cavanaugh, RN, CPC, CANPC, CGIC, CPB, CMRS, is an AHIMA approved ICD-10 trainer, certified coder, certified professional biller, and certified medical reimbursement specialist. She owned her own successful medical billing company with over 60 customers for 16 years. Prior to that she worked as an ICU RN and Nursing Director for two home health agencies. Michelle is a member of AAPC, AHIMA, and AMBA. She graduated with her BSN from the University of Maryland.

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Latest ICD-10 Updates in March Kareo Getting Paid Newsletter

Lea Chatham March 10th, 2015

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The March edition of the Kareo Getting Paid Newsletter has  latest updates on ICD-10 along with news on exciting new developments at Kareo. The newsletter also provides a chance to discover upcoming events, news, and resources from Kareo. Plus, you’ll learn about how to register for our upcoming free educational webinar, ICD-10: 4 Steps to Success, presented by ICD-10 trainer Michelle Cavanaugh. Read all this and more now!



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Group Visits: Improve Access, Patient Satisfaction, and Revenue

Lea Chatham March 9th, 2015

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Tweet This Kareo Storyby Laurie Morgan, Senior Consultant and Partner, Capko & Morgan

Wouldn’t it be great if chronically ill patients could leave your practice feeling like they’d spent two hours with their physician – without the physician spending any more time than a standard office visit? And what if those same patients also left feeling more empowered and supported, more committed to compliance, and less alone in dealing with their illness?

It’s not a time-travel fantasy or a pipe dream. There is a way patients can leave your practice feeling like they got extra attention without your providers spending any more time with them. It’s possible through the magic of a group visit program.Tweet this Kareo story

Here’s how it typically works. A physician identifies a group of patients who have a similar, chronic condition that requires frequent visits (a great use of the lists feature in your EHR). Then the practice confirms each patient’s willingness to participate in a group – acknowledging that they’ll be sharing health information with other group members, while also agreeing to keep everyone’s information confidential outside the practice walls. As they arrive, participants have an initial visit in the exam room – depending on their problems, this might involve only vitals and an interview by a nurse, or it might involve a short encounter with the physician. After all of the private visits, all patients complete their visit together in a conference room or the reception area. Each patient hears the feedback their fellow patients are receiving from the physician, and, where appropriate, they can chime in with their insights or support. For example, if a fellow patient is nervous about taking medication for the first time, or switching to a new drug, others in the group who have experience with it can offer feedback.

All patients are with the doctor for nearly the entire 1.5-2 hours of the group session, so they all feel they’ve had a lengthy visit. The longer format gives patients a chance to ask questions that they might otherwise forget in a shorter office visit. The group format also allows your providers to delve deeper into subjects like stress reduction, exercise, and nutrition – perhaps bringing in other experts – and allows patients to share their own experiences towards health improvement goals.

Once a group visit is completed, each patient’s insurance is billed for the appropriate E&M code for their individual situation (even though part of the visit took place in front of all the other patients).

Group visits (also called shared medical appointments) can be a great way for a practice to offer more access, since they’re typically scheduled in an evening to allow for use of common space. Practices may start with a single group, and with meetings quarterly or twice a year (whatever makes sense based on the participants’ follow-up care needs). Once a practice gains momentum with the idea, more groups can be added (or more patients added to the group). And while group visits are typically thought of as a primary care program – diabetes is the classic example of a condition ideal for groups – it can work for any specialty with a large enough population of patients with the same chronic condition. Some examples include HIV, chronic pain, COPD, asthma, cancer, and hypertension. And it can even work for healthy maternity patients who need to come in regularly for pre-natal care as well.

If you’re interested in starting a group visit program, the AAFP is a great place to start – they have many group visit resources on their website. For more on group visits and other ways to use your EHR to help generate revenue, watch the recording of my recent recent webinar, Finding the ROI in Your EHR.

About the Author

Laurie MorganLaurie Morgan is a senior consultant and partner at Capko & Morgan. She managed both start-ups and large-scale operations in the media industry before turning her focus to medical practice management. Her consulting focus is on driving and capturing revenue and operating more efficiently. Laurie has an MBA from Stanford University. 

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ICD-10 Likely to Move Ahead

Lea Chatham March 9th, 2015

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Kareo ICD-10 Resource CenterAs we near both the six months to ICD-10 mark and the congressional vote that will likely seal in that date, various surveys and updates are hitting the wire. The industry is getting a pretty clear picture of where things stand as everyone braces for ICD-10 impact on October 1.

Here are some key highlights from the latest ICD-10 news: Tweet this Kareo story

  1. Further Delays Unlikely: Most people don’t think that there will be another delay. Two-thirds of respondents to one survey said they thought the October deadline would go ahead. A recent article in Healthcare IT News indicates many senators agree.
  2. Preparedness: A recent survey indicated that about 21% of practice are on track with ICD-10 pre while another 23% say they don’t have the resources to begin preparing.
  3. Testing Moving Ahead: According to CMS, 81% of submitted ICD-10 test claims were accepted during the first ICD-10 end-to-end testing from January 26 through February 3, 2015. Testing of nearly 15,000 claims included providers, clearinghouses, and billing agencies. Overall, the results indicate CMS is ready to accept ICD-10 claims. However, most practices and billing companies indicate they have not done testing yet. In a recent study conducted by HBMA, 84% said they have not yet conducted end-to-end testing for ICD-10.
  4. Revenue Impact Is Biggest Concern: Nearly 60% of practices are most concerned about the impact on revenue and cash flow with ICD-10.
  5. But Cost to Implement Is Low: The cost to implement ICD-10 is turning out to be much lower than previously thought. According to the latest survey from PAHCOM, the per provider expenditures for small practices will be around $3,400 for a single provider practice and $1,800 per provider for a practice with six providers.

While it isn’t all wine and roses, the overall picture is pretty positive. Testing is moving ahead, the costs to implement ICD-10 are lower than originally predicted, and the October 1 deadline is likely to stay in place.

If you’ve been waiting to be sure that ICD-10 will move ahead before implementing new software or services, it is time to get going. The sooner new systems are in place the more time the practice will have to implement, train, and test for ICD-10. You don’t want to be down to the wire in September trying to implement a new billing system and prepping for ICD-10.

Find out more about the key steps to ICD-10 success and the role of technology at my upcoming free webinar, ICD-10: 4 Steps to Success, on March 19. Register Now!

About the Author

Michelle Cavanaugh is an AHIMA approved ICD-10-CM trainer, certified coder, certified professional biller, and certified medical reimbursement specialist. She owned her own successful medical billing company with over 60 customers for 16 years. Prior to that she worked as an ICU RN and Nursing Director for two home health agencies. Michelle is a member of AAPC, AHIMA, and AMBA. She graduated with her BSN from the University of Maryland.

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Providers Share Stories about Achieving ROI with EHRs

Lea Chatham March 5th, 2015

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Kareo EHRBy Lisa A. Eramo

Let’s face it: EHR implementation can be a costly venture. Not only do practices incur costs for purchasing and licensing EHR technology, but they also experience costs associated with lower productivity, training, change management, and transitions in workflows. Thus, it’s no surprise that practices want—and need—to ensure that they’ll eventually see a return on investment (ROI) for all of the time, labor, and resources that they invest.

What type of EHR ROI can the average practice expect? Tweet this Kareo story
For Coastal Medical, a physician-owned practice based in Providence, RI, the ROI of its EHR is apparent. Overall, the practice says it received a 200% ROI by improving the quality of care it delivers to patients. The ROI can be attributed to better chronic care management, expansion of services to offer a weekend clinic, and the ability to take advantage of Meaningful Use, PQRI, and eprescribing. shares a variety of stories in which providers have voiced many benefits derived from EHRs and Meaningful Use. Improved patient care is the most common thread among many of these stories. Improvements in patient care contribute to ROI because they enhance outcomes that are so important in an increasingly quality-driven healthcare environment.

Consider Dr. Tobe Fisch, a primary care internist and director of practice innovation at Princeton Health Affiliated Physicians/Princeton Medicine (Princeton Medicine). Princeton Medicine includes the outpatient practices of Princeton HealthCare System in Princeton, New Jersey. Fisch and his colleagues worked to integrate Princeton Medicine’s EHR with Princeton HealthCare System’s health information exchange so providers would have instant access to information such as blood tests, radiology and pathology results, dictations, and discharge summaries. This improved care coordination that targets high-risk patients has increased immediate post-discharge follow-up with patients from 0% to 100% and ensured that most of Princeton Medicine’s patients are seen within 7 to 14 days of hospital discharge. Fisch’s story exemplifies the ways in which EHR technology can address gaps in care, particularly for patients with multiple chronic conditions and/or frequent hospitalizations.

Improving outcomes is an important aspect of the ROI of EHR technology. Consider Chad Jensen, the executive office manager at LaTouche Pediatrics, a three-site pediatric practice in Anchorage, Alaska. Jensen’s practice uses EHR-generated clinical summaries to identify patients who are due for certain immunizations. Here’s how it works: The EHR generates lists of patients who require immunizations. These lists are uploaded into an automated calling system. This system then notifies patients to call a scheduler and set up an appointment. Jensen’s work incorporating an automated immunization reminder system into the practice has been instrumental in improving immunization rates and outcomes.

Dr. John Berneike, a family physician and clinical director at St. Mark’s Family Medicine, an independent practice and residency clinic in Salt Lake City, uses the EHR to improve outcomes for patients with diabetes. After recording baseline clinical measures for patients with diabetes, the clinic uses a data analytics tool to scan the EHR database and generate daily status reports about patients with diabetes. The clinic uses this information to monitor changes in clinical markers and provide patients with preventive care reminders.

Some practices have had success with directly lowering operating costs as a result of EHR implementation. Consider Dr. Michael Salesin, a West Bloomfield, MI gynecologist, who says the EHR has resulted in fewer FTEs, significantly lower paper costs, and a more efficient workflow. In addition, 95% of patients access electronic data—particularly test results—from their records through a patient portal.

Questions remain
Despite these success stories, questions remain. Why do some practices see a clear return while others may not? And does there have to be ROI to justify an EHR when there are so many other benefits? Some of these are addressed in the recent webinar, Finding ROI in Your EHR, which is available to watch anytime.

About the Author

LisaEramofreelanceLisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal and AHIMA Advantage. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.


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