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Disclaimer
The materials utilized in this presentation are intended solely for use in conjunction with today’s seminar.
Although great efforts have been taken in the preparation of today’s material, neither THIMA, the speakers, nor their employers assume responsibility for errors or omissions or for damages resulting from the use of the information contained therein.
Advice is general, thus participants should consult professional counsel for specific legal, ethical, technical and clinical questions prior to claim submission.
This lecture was prepared with information that was publicly available at this time. ICD-10-CM and PCS is constantly evolving. Please consult official guidance prior to code preparation or submission.
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Introduction to THIMA
The Tennessee Health Information Management Association (THIMA) is an organization of health information management professionals that fosters the professional development of its members through education, representation, and lifelong learning.
THIMA is part of the American Health Information Management Association, one of the official ICD-10 Cooperating Parties responsible for maintaining this official HIPAA-compliant transaction set.
These commitments promote quality health information for the benefit of the public, healthcare consumers, providers, and other users of clinical data.
Learn more at: http://www.thima.org
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Special Thanks to the THIMA ICD-10 Team!
Sheretta Anderson Julie Appleton Carmen Bellos LeighAnn Braswell LaRonda Ford Gail Garrett Becky Hancock Dana Hitchcock Tysha Johnson Kim Jones-Huddleston, CCS Tempe Kelly James Kennedy Kim Lee
Joann Miller
Lori Purcell
Shawn Scarbrough
Karen Scott
Jane Shrader
Jessica Steve
Sherry Stiltner
Jalanna Taplin
Gwen Williams
Laura Winger
Trannie Woodson
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• Co-Chairs: Kathy Hallock and Beverly Selby
THANK YOU TO
TENNESSEE MEDICAL ASSOCIATION
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Objectives
Orient physicians and their practice management for the impending transition of ICD-9-CM to ICD-10-CM on October 1, 2014
Develop a framework for ICD-10-CM planning and implementation strategies
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Time Line for Implementation
Start Date
October 1, 2014
Coder & Physician Education
Jan 2012- Dec 2014
Infrastructure Readiness
Jan 2009- Dec 2011
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Code Structure Differences ICD-9-CM Versus ICD-10-CM
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I-9
I-10
Reasons for Physicians To Learn ICD-10-CM
Accurate representation of patient’s condition in their coded database. Trending of their patient
populations Coded data is used for
quality initiatives
Medical necessity compliance Diagnostic tests and
treatments require specific codes to qualify for payment.
Severity of illness must support E&M codes
Physician profiling Medicare Physician Value-
Based Purchasing Private insurance profiling
BCBST United Healthcare
Physician integration
initiatives ACOs Medical Homes Bundled payments Others
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• Increasing Use of Bundled Payments – Hospitals and Physicians paid out of the same
payment for current admissions and all care within 30 days of discharge • Addresses “Preventable” Readmissions
– 18% of Medicare’s inpatient expenditures is for readmissions within 30 days
– $12 billion spent annually on “preventable” readmissions
– Places physicians at risk for efficient hospital resource utilization. • Requires physicians to understand and document
completely consistent with MS-DRG methodologies
Impact on Physicians Direction for Healthcare Reform
Source: Medicare Payment Advisory Commission
Provider Profiling of Quality and Efficiency
CMS has established a website whereby physicians cost efficiency and quality may be accessed. Much like Medicare’s Hospital, Dialysis, or Nursing Home Compare sites
• Absolutely crucial to know how ICD-10-CM diagnoses will affect medical necessity and fee schedules – What codes support medical necessity for the services rendered?
• The mapping of ICD-9-CM to ICD-10-CM is NOT perfect. • Medicare has not yet published NCDs with ICD-10-CM codes yet
– Stay tuned
• Wouldn’t hurt to learn more about provider profiling
– Medicare Value-Based Purchasing https://www.cms.gov/physicianfeedbackprogram/ – Check with BCBST and United Healthcare about their programs – If your IPA or group has a strategy to implement an Accountable Care
Organization, consider how ICD-10-CM will affect the risk-adjustment methodology.
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Contracting – Physician Profiling
Who Is Profiling Hospitals & Physicians?
Federal/state regulatory agencies
The Joint Commission
CMS – Center for Medicare & Medicaid Services
AHRQ – Agency for Health Research & Quality
University HealthSystem Consortium (UHC)
Peer Review Organizations -Q Source in Tennessee
Managed care payers
Third-party payers
Profiling agencies (i.e. US News & World reports)
Hospitals
Physician groups
State Health Departments
Employers – The Leapfrog Group
Consumers/General Public (via Internet)
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Departments Impacted
Coders/Clinical Documentation Specialist
Clinical department managers
Other HIM personnel Ancillary departments
Clinicians Data analysts
Senior management Researchers
Information Technology Epidemiologists
Quality management Performance Improvement
Utilization Management Compliance
Accounting Data quality management
Business Office Data security
Auditors and consultants Clinic Personnel
Patient access and registration Medical Staff/Nurse Practitioners
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Logistical Issues in the transition from ICD-9 to ICD-10
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Available Tool for Converting ICD-9/ ICD-10 Codes
• General Equivalence Mapping (GEMs) assist in converting data from ICD-9-CM to ICD-10-CM
• This is a tool only!
“GEMs will get you to the right theater, but not necessarily the right movie or desired seat”
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Potential Problems with GEMs
• A single ICD-9-CM code may now be represented by multiple ICD-10-CM codes One to many
• Multiple ICD-9-CM codes may map to only one ICD-10-CM code Many to one
• An ICD-10-CM code cannot be arbitrarily chosen from the GEMs A code may not represent the
complexity of the illness (e.g. unspecified code) – this could result in underpayments
A code may overstate the complexity of the illness – this could result in audits and retrospective recovery of payments.
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Not One to One • ICD-9-CM code • 821.32 FX Other/Unspecified Part Of Femur; Lower End, Open;
Epiphysis, Lower (Separation) – The single most appropriate ICD-10-CM code should be selected.
• ICD-10-CM code(s) • S72.443B Displaced fracture of lower epiphysis (separation) of unsp
femur, 7thB • S72.443C Displaced fracture of low epiphysis (separation) of unsp
femur, 7thC • S72.446B Nondisplaced fx of low epiphysis (separation) of unsp
femur, 7thB • S72.446C Nondisplaced fx of low epiphysis (separation) of unsp
femur, 7thC
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Differences between ICD-9 and ICD-10
• 14,000 ICD-9 diagnosis codes – ICD-9-CM diagnosis codes
are primarily numerical, though some alpha characters are used (e.g. V-codes)
• 4,000 ICD-9 procedure codes – ICD-9-PCS are numeric
only.
• Approximately 87,000 ICD-10-CM diagnosis codes – ICD-10 diagnosis codes
have alphanumeric characters
• Approximately 70,000 ICD-10 PCS codes – ICD-10-PCS have
alphanumeric characters
Code Structure Differences ICD-9 Example
Code Structure Differences ICD-10 Example
• Certain conditions have both an underlying etiology and multiple body systems manifestations due to the underlying etiology – For such conditions, the ICD-10-CM has a coding
convention that requires the underlying condition to be sequenced first followed by the manifestation.
– Wherever such a combination exists, there is a “use additional code”: note at the etiology code, and a “code first” note at the manifestation code.
– These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation
“Use Additional Code” “Code First”
Uncertain Diagnoses Outpatient vs. Inpatient
• Outpatients – Do not code diagnoses
documented as “probable”, “suspected”,
“questionable,” “rule out,” or “working diagnosis”
or other similar terms indicating uncertainty
Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit
• Inpatients – If the diagnosis documented at the
time of discharge is qualified as “probable”, “suspected”, “likely”, “questionable”, “possible”, or “still to be ruled out” or other similar terms indicating uncertainty, code the condition as if it existed or was established.
– The bases for these guidelines are the diagnostic workup, arrangements for further workup or observation, and initial therapeutic approach that correspond most closely with the established diagnosis
– This guidance does NOT apply to AIDS, Avian Influenza or H1N1 Influenza
ICD-10 Clarifies “Excludes”
A type 1 excludes note is a pure excludes note. It means “NOT CODED HERE”
S72.13 Apophyseal fracture of femur
• Excludes1: chronic (nontraumatic) slipped upper
femoral epiphysis (M93.0-)
A type 2 excludes note represents “NOT INCLUDED HERE”
• S72.4 Fracture of lower end
of femur – Fracture of distal end of
femur • Excludes2: fracture of shaft of
femur (S72.3-) – physeal fracture of lower
end of femur (S79.1-)
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Coding Fundamentals for Orthopedics
Chapter ICD-9 Codes ICD-10 Codes Total Code Increase
Diseases of the
musculoskeletal system and
connective tissue
992 6339 5347
Ortho changes with ICD-10?
*Analysis includes diagnosis codes only
MUSCULOSKELETAL SYSTEM
Muscular system
• Provides the body with the ability to move in obvious ways – Walking
– Grasping a knife or fork
– Beating of the heart
– Movements of food
– Posture
– Ability to sit or stand
– Stabilize joints
– Produce heat
– protection
Skeletal System
• Performs important functions to include – Support
– Protection
– Leverage
– Storage
– Blood cell production
MAKE UP OF HUMAN SKELETAL 206 BONES
• Cranial bones 8 • Facial bones 14 • Hyoid 1 • Ossicle 6 • Vertebral 26 • Sternum 1 • Ribs 24 • Clavicle 2 • Scapula 2 • Humerus 2 • Ulna 2 • Radius 2
• Carpals 16 • Metacarpals 10 • Phalanges 28 • Pelvic Girdle 2 • Femur 2 • Fibula 2 • Tibia 2 • Patella 2 • Tarsus 2 • Metatarsus 10 • Phalanges 28
Fractures: Coding Guidelines • 19. Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes
(S00-T88)
• c. Coding of Traumatic Fractures
• The principles of multiple coding of injuries should be followed in coding fractures. Fractures of specified sites are coded individually by site in accordance with both the provisions within categories S02, S12, S22, S32, S42, S49, S52, S59, S62, S72, S79, S82, S89, S92 and the level of detail furnished by medical record content.
• A fracture not indicated as open or closed should be coded to closed. A fracture not indicated whether displaced or not displaced should be coded to displaced.
• 2) Multiple fractures sequencing
• Multiple fractures are sequenced in accordance with the severity of the fracture.
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Osteoporosis
• A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone.
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Aftercare Z Codes
• The aftercare Z codes should not be used for aftercare for traumatic fractures. For aftercare of a traumatic fracture, assign the acute fracture code with the appropriate 7th character.
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Other Terms Associated with Fractures
• Spontaneous rupture
– Occurs when normal force is applied to tissues that are inferred to have less than normal strength
• Fragility fracture
– Sustained with trauma no more than a fall from a standing height or less occurring under circumstances that would not cause a fracture in a normal healthy bone
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Seventh Character Guidelines
• 1) Initial vs. Subsequent Encounter for Fractures
• Traumatic fractures are coded using the appropriate 7th character for initial encounter (A, B, C) while the patient is receiving active treatment for the fracture. Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician. The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.
• Fractures are coded using the appropriate 7th character for subsequent care for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase. Examples of fracture aftercare are: cast change or removal, removal of external or internal fixation device, medication adjustment, and follow-up visits following fracture treatment.
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• Initial encounter A
• Subsequent – routine healing D
• Subsequent – delayed healing G
• Subsequent – nonunion K
• Subsequent – malunion P
• Sequela S
Seventh Character Extensions for Fractures
Seventh Character cont.
• Character A is for a patient that is receiving active treatment for the fracture.
• Examples include surgical treatment, ED encounter, and evaluation and treatment by a new physician.
Seventh Character cont.
• Character D is for encounters after the patient has completed active treatment.
• Examples include cast change or removal, removal of external or internal fixation device, medication adjustment, other aftercare and follow-up visits.
• The "S" character replaces the late effect categories (905 - 909) in ICD-9-CM. Data will be much more specific and clinicians will be able to track sequela (late effects) back to each specific type of injury.
Seventh Character cont.
Coding Note:ICD-10-CM has three
different categories for pathologic fractures – due to neoplastic disease, due to osteoporosis, and due to other specified disease.
Pathologic Fractures
ICD-9
ICD-9 has less than 10 pathologic fracture codes (733.13-733.19). In ICD-10 there are over 150
ICD-10 Examples
• M8008xA Age-related
osteoporosis with current pathological fracture, vertebra, initial encounter for fracture.
• M80051A Age-related osteoporosis with current pathological fracture, right humerus, initial encounter for fracture
• M8458xA Pathological fracture in neoplastic disease, vertebra, initial encounter for fracture
When coding pathological fractures in ICD-10, documentation must be present in the medical record to accurately reflect what is going on with the patient
• Exact location of the fracture including site and laterality (right vs. left)
• Etiology of the fracture (osteoporosis, neoplastic disease, etc.)
• Encounter type. Is this the patient’s initial encounter or subsequent encounter. In addition, it must be reflected in the medical record whether the subsequent encounter was with delayed healing.
Pathologic Fracture cont.
• Osteoporosis with Current Pathological Fracture
– Category M80, Osteoporosis with current pathological fracture, is for patients who have a current pathologic fracture at the time of an encounter. The codes under M80 identify the sit of the fracture. A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if that patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone
Coding Guideline I.C.13.d.2.
Teaching Tip: Discuss interpretation of clinical information with the class. The interpretation of Coding Guideline I.C.13.d.2 must be made by the physician. It is not appropriate for the coder to interpret if the patient had a minor fall or trauma that would not usually break a normal, healthy bone. The physician provides a connection between the fall and fracture due to osteoporosis.
EXAMPLE: M84.551A Fracture, pathological (pathologic), due to neoplastic disease, femur
C79.51 Carcinoma (malignant), metastatic, see Neoplasm, secondary. Refer to Neoplasm Table, by site, bone, femur, right side, secondary.
Z85.118 History, personal (of), malignant neoplasm (of), lung
Z92.3 History, personal (of), radiation therapy
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Example:
M80.08xA Fracture, pathological (pathologic), due to osteoporosis, specified cause NEC – see Osteoporosis, specified type NEC, with pathological fracture. Osteoporosis (female) (male), senile – see Osteoporosis, age-related, with current pathologic fracture, vertebra(e)
Rationale: In ICD-10-CM, a combination code is utilized to report osteoporosis with an associated pathological fracture. When identifying senile osteoporosis, the codebook directs the coder to age-related osteoporosis.
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Other Musculoskeletal Codes and Examples
• Arthropathies (M00-M25) • Includes: Disorders affecting predominantly peripheral (limb) joints • Infectious arthropathies (M00-M02) • Note: This block comprises arthropathies due to microbiological agents.
Distinction is made between the following types of etiological relationship:
• a) direct infection of joint, where organisms invade synovial tissue and microbial antigen is present in the joint;
• b) indirect infection, which may be of two types: a reactive arthropathy, where microbial infection of the body is established but neither organisms nor antigens can be identified in the joint, and a postinfective arthropathy, where microbial antigen is present but recovery of an organism is inconstant and evidence of local multiplication is lacking.
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More Examples
• Inflammatory polyarthropathies (M05-M14) • Osteoarthritis (M15-M19) • Other joint disorders (M20-M25) • Dentofacial anomalies [including malocclusion] and other
disorders of jaw (M26-M27) • Systemic connective tissue disorders (M30-M36) • Dorsopathies (M40-M54) • Soft tissue disorders (M60-M79) • Osteopathies and chondropathies (M80-M94) • Other disorders of the musculoskeletal system and
connective tissue (M95)
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Complications
• Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified (M96)
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Coding Guidelines Complications
• Care for complications of surgical treatment for
fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes.
• Care of complications of fractures, such as malunion and nonunion, should be reported with the appropriate 7th character for subsequent care with nonunion (K, M, N,) or subsequent care with malunion (P, Q, R).
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Biomechanical Lesions NEC • Biomechanical lesions, not elsewhere classified (M99) • M99Biomechanical lesions, not elsewhere classified • Note: This category should not be used if the condition can be classified
elsewhere. • M99.0Segmental and somatic dysfunction • M99.00Segmental and somatic dysfunction of head region • M99.01Segmental and somatic dysfunction of cervical region • M99.02Segmental and somatic dysfunction of thoracic region • M99.03Segmental and somatic dysfunction of lumbar region • M99.04Segmental and somatic dysfunction of sacral region • M99.05Segmental and somatic dysfunction of pelvic region • M99.06Segmental and somatic dysfunction of lower extremity • M99.07Segmental and somatic dysfunction of upper extremity • M99.08Segmental and somatic dysfunction of rib cage • M99.09Segmental and somatic dysfunction of abdomen and other regions
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Strategies for ICD-10-CM Planning for Physician Practices
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o Contracting – Physician Profiling o Information Systems o Documentation
o Superbill o Medical record - EMR
o Current provider and staff knowledge gaps and opportunities
Organizational Self-Assessment
AHIMA has a free assessment tool available at the following website http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_046380.xls
• Inventory all forms that use ICD-9 diagnosis codes. – Superbills may become quite lengthy
• May require innovative (or computerized) approaches, especially with laterality and episodes of care.
– Assess whether documentation currently in your medical records will support the level of specificity for ICD-10. • Ascertain that coding is based on provider documentation,
not just what’s on the Superbill • Ascertain congruence between the codes indicated on the
Superbill and what’s documented in the medical record.
Documentation Infrastructure
ICD-9-CM ICD-10-CM
715.16 Primary localized osteoarthrosis, lower leg M17.10 Unilateral primary osteoarthritis, unspecified knee
724.2 Lumbago M54.5 Low back pain
813.41 Closed Colles’ fracture S52.539A Colles' fracture of unspecified radius, initial encounter for closed fracture
824.2 Closed fracture of lateral malleolus S82.63XA Displaced fracture of lateral malleolus of unspecified fibula, initial encounter for closed fracture
715.15 Primary localized osteoarthrosis, pelvic region and thigh
M16.10 Unilateral primary osteoarthritis, unspecified hip
824.0 Closed fracture of medial malleolus S82.53XA Displaced fracture of medial malleolus of unspecified tibia, initial encounter for closed fracture
810.02 Closed fracture of shaft of clavicle S42.023A Displaced fracture of shaft of unspecified clavicle, initial encounter for closed fracture
719.46 Pain in joint, lower leg M25.569 Pain in unspecified knee
847.2 Lumbar sprain and strain S33.5XXA Sprain of ligaments of lumbar spine, initial encounter
820.00 Closed fracture of unspecified intracapsular section of neck of femur
S72.019A Unspecified intracapsular fracture of unspecified femur, initial encounter for closed fracture
Top 10 Diagnosis in Ortho Practice
Documentation Infrastructure
• Download top codes you use now and crosswalk to ICD-10-CM
– Help determine if continuation of paper form is possible (most likely not)
– Give you an idea of key areas impacted by ICD-10 change for your specialty
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Documentation Example
• Displaced transverse fracture of shaft of humerus, right arm initial encounter for closed fracture.
• ICD-9: 812.2
• ICD-10: S42.321A
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Strategies for ICD-10
Communication and Collaboration must include at a minimum the following key people at your physician practices:
1. Finance - Contracting
2. Information Technology (IT)
3. Coding/Billing
4. Providers
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Information Systems
• How are ICD-9 CM codes currently used in information systems?
• Which vendor software applications are being used?
• Can the system handle alphanumeric structure?
• Can the current system house both ICD-9 and ICD-10 codes simultaneously?
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An ICD-10-CM Superbill Example
Finance
Cash flow reserves
– Transition will create coding and claims processing delays
– Enough reserves to keep organization afloat financially during the transition
– Prepare for any unexpected costs
– Potential reduced revenue due to delayed reimbursement
– Evaluate staffing
• Determine if additional staff needed
– < productivity
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Organizational Self-Assessment
• AHIMA has a free assessment tool available on their website http://www.ahima.org/topics/icd10
• CMS has free resources for physician offices available on their website http://www.thima.org/resources/icd-10/icd-10-resources/
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Contracting – Physician Profiling
Absolutely crucial to know how ICD-10-CM diagnoses will affect medical necessity and fee schedules
Would not hurt to learn more about provider profiling
Physician Profile determined by inpatient and outpatient coding
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Information Systems
• Contact System Vendors Confirm that your vendors are on track with ICD-
10. Identify potential vendor costs for example
hardware upgrades, customization, staffing, and OT.
Determine if the upgrades are included in the
current contract or if there will be additional costs to upgrade.
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Educational Needs
Coders and frontline staff Do not know –ICD-10-CM.
Areas of greatest need: Code structure, additions,
revisions, and deletions Primarily anatomy and
terminology pertinent to their practice; however clinical pathophysiology and disease nomenclature is a plus
Medical necessity requirements and changes.
• Physicians Impact of lack of specificity
upon their profiles What terms and/or codes
more aptly or congruently reflect their patient’s conditions. Don’t forget that hospital billing
affects this as well.
How to use the new Superbills or documentation templates
How to work collaboratively with the office and hospital coding and frontline staff to reduce denials
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Invest and use a current ICD-10-CM book/software
Outlines the “do’s” and “don’ts” -- Similar to but not exactly the same as ICD-9 http://www.cdc.gov/nchs/data/icd10/10cmguidelines_2013_final.pdf
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Application of Current Coding Clinic Advice to ICD-10
Coding Clinic is a publication of the American Hospital Association that offers official advice on ICD-9-CM code assignment and sequencing
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Awareness Education
Senior Management, IT staff, Department Managers, and Medical Staff need awareness education regarding: Overview of the differences between ICD-9 and ICD-10
Value of new code sets
How ICD-10 fits with other internal and external initiatives
Budgetary implications
Impact on documentation and need for more specificity
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Impact of Transition
Presents both opportunities and challenges
Scope and complexity are significant
Coded data is more widely used than when the US transitioned to ICD-9-CM
Transition will require substantial changes affecting many systems, processes and people
Definite impact on coding and billing productivity
This is a team effort and will require many players working together for a common goal
Physicians need to be advised of increased query activity
Don’t delay getting started!
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Consequences of Poor Preparation
Increased claims rejections and denials Increased delays in processing authorizations and reimbursement
claims Improper claims payment Significant coding backlogs Compliance issues Decisions based on inaccurate data Severity of illness and Risk of Mortality data may be inaccurate
(Benchmarking Data) Profiles will be incorrect Accounts Receivables may drop significantly IT systems may not be ready AVOID THESE ISSUES BY BEING PREPARED!
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Conclusion
• Create Implementation Team
• Assess your physician practice where ICD-9 diagnosis codes are currently being used.
• Analyze your current information systems and contact your vendors.
• Evaluate current documentation practices.
• Educate, Educate, and Educate your office staff and providers.
• Be prepared!
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• Medicare MedLearn Matters on ICD-10 http://www.cms.gov/MLNMattersArticles/downloads/SE1019.pdf
• ICD-10 Definitions/GEMs http://www.cdc.gov/nchs/icd/icd10cm.htm#10update
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References
Resources
THIMA http://www.thima.org/resources/icd-10/icd-10-resources/
TMA http://www.tnmed.org/professional-development/icd-10/
National Center for Health Statistics – CDC
www.cdc.gov/nchs/about/otheract/icd9/icd10c m.htm
Centers for Medicare and Medicaid Services ICD-10-PCS
www.cms.hhs.gov/ICD10
ICD-10 Overview, CMS
www.cms.hhs.gov/ContractorLearningResources/Downloads/ICD-10OverviewPresentation.pdf
AHIMA
http://www.ahima.org/education/onlineed/Programs/ICD10
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• http://www.gkcmma.com/sites/www.gkcmma.com/files/resources/ICD-10_OBGYN_Fact_Sheet.pdf
• http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047548.hcsp?dDocName=bok1_047548
• Ingenix 2012 Comprehensive A&P for ICD-10-CM Coding
• Contexo/Media Advance A&P for ICD-10-CM/PCS
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References/Resources
WATCH FOR EMAIL WITH EVALUATION FORM/CEU FORM
IF YOU NEED CME:
https://www.surveymonkey.com/s/ICD-10OB-GYN
SEND QUESTIONS/COMMENTS TO
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