News from NEPHO – AUGUST 2020 Edition


Look for more New Providers in our next issue.


  • Effective immediately, Amy Esdale, MD of Lahey Health Primary Care, Gloucester 298 Washington Street (1st Floor), Gloucester, MA 01930 has closed her panel and will be seeing existing patients via TeleHealth.


Guest Speaker: Reid Plimpton, North East TeleHealth Resource Center (NETRC)
Wednesday, September 16, 2020 @12:00 noon
GoogleMeet Conference Call

RSVP: judith.o’
or 978-236-1739

Have Your Practice Prepared for 2021 Evaluation Management (E/M) Updates
Wednesday, September 23, 2020 @10:30 a.m.
GoogleMeet Conference Call

RSVP: judith.o’ or 978-236-1739

Date: Tuesday, September 29, 2020 @7:30 a.m.
Location: GoogleMeet Conference Call

RSVP: or 978-236-1784

Please check the meeting calendar on our website to get the latest meeting status, notification of the Coding and Billing webinars,  Specialty Specific meetings, and POD/IPA meetings.   


The NECoMG 2020 Annual Meeting physician evaluation feedback has been reviewed in detail and NEPHO has started to work on next steps from feedback collected. The overall satisfaction with the virtual meeting set-up was high with requests to have future virtual meeting options. Results overall rated the NECoMG 2020 Annual Meeting as “Good” or “Excellent”. The Physician feedback that was below “Good” was followed up directly by a NEPHO team member.

The following detail highlights the positive feedback collected and the areas of improvement for NEPHO to work on for future virtual meetings:

Positive Feedback:

  • Convenience of GoogleMeet
  • Virtual meeting format
  • Speaker (Dr. Pierre Ezzi and Dr. Alexa Kimball)
  • Presentation Topic

Areas of Improvement for NEPHO:

  • Use of visual aid during speaker presentation
  • Share presentation material prior to meeting
  • Have more interactive topics to drive Physician discussion
  • Review other potential technology platforms for virtual meeting support

Most comments collected by the NEPHO team from below “Good” ratings related to technology that included: audio and visual quality, GoogleMeet access, and WI-FI issues. The feedback regarding the speaker and presentation was positive and Dr. Alexa Kimball was well received by Physicians. The BILH Affiliation topic was of interest by a majority of Physicians and there was a suggestion to have a follow-up meeting in 3 months to review updates and changes within the system. The evaluation had a section requesting Physicians to provide areas of interest for future meeting materials and topics.

Areas of interest from physician evaluation requests include:


AllWays Health Partners

COVID-19 Commercial FAQ: Questions from Providers about Coronavirus (COVID-19)

The Questions from Providers about Coronavirus (COVID-19) has been revised, effective 7/15/2020. Revised question: What are your prior authorization requirements during the COVID-19 state of emergency.  For the period March 23 through September 30, 2020, AllWays Health Partners is removing prior authorization requirements for post-acute care including: home health care, skilled nursing facility, in-patient acute rehabilitation at an acute rehab, long term acute care (LTAC), and chronic disease hospitals. For additional information and to view the notification, click here.

Coming soon: New tools to simplify the prior authorization process

During this unprecedented time, we understand that it’s more important than ever for providers to spend less time on administrative work and more time on what matters most – your patients. To support this, AllWays Health Partners is launching several enhancements to our digital prior authorization tools and removing prior authorization requirements for certain services.

We’ve created a webpage to highlight all the enhancements. The latest updates and resources will be added as they become available. 

Removing prior authorization requirements

As part of the efforts to improve the provider experience, there will be several changes to the authorization requirements for services managed by eviCore effective July 1, 2020.

AllWays Health Partners will be lifting the prior authorization requirement across all lines of business for several services that are currently managed by eviCore. This includes:

  • Diagnostic heart catheterizations
  • Nuclear medicine
  • Radiation therapy
  • Diagnostic ultrasound
  • And more

There are no changes to all other services managed by eviCore. These services will continue to require prior authorization. The list of services that will continue to require prior authorization through eviCore is available on eviCore’s webpage.

Blue Cross Blue Shield of Massachusetts

A new way to submit and view authorization requests

Starting Monday, November 9, 2020, you’ll have a new way to submit and view the status of your authorization requests for our members. The new tool, called Authorization Manager, will allow you to submit authorizations for a greater range of services than you can submit today through Online Services.

To read your News Alert, log in to Provider Central and go to News.

We’ve also posted a message to your My Alerts inbox. Log in to read it.

COVID-19: Resuming Provider Audits and Claim Reviews

On April 8, 2020, BCBSMA notified providers that it is pausing the following activities for 60 days or until the end of the public health emergency, whichever came first. Effective immediately we will resume these activities: Retrospective provider audits for: Professional providers; Inpatient and outpatient facilities; Prepayment reviews for forensic claims; any other claim recovery activities. To view the complete notification, click here.

COVID-19- BCBSMA is Extending Prior Authorization Waiver

BCBSMA understands that this is a trying time for all medical care providers due to COVID-19. To better support providers, BCBSMA continues to waive referral and prior authorization requirements for all inpatient levels of care. This includes acute, long-term acute (LTAC), acute and subacute rehabilitation (rehab), and skilled nursing facility (SNF) admissions. Starting with dates of service on or after October 1, 2020, providers will need to submit authorizations. To view the complete notification, click here.

Increased Fees for COVID-19 Lab & Specimen Collection Codes

BCBSMA is increasing the reimbursement for COVID-19 lab and specimen collection codes, retroactive to their effective date, in response to the Massachusetts Division of Insurance (DOI) Bulletin 2020-16, issued May 18, 2020. BCBSMA will reprocess all claims for these testing codes back to the code effective date. BCBSMA will continue to monitor our reimbursement for these codes as new information becomes available. This change applies to all products except Medicare Advantage. To view the complete notification, click here

Temporary Payment Policy Update: COVID-19

Addition of reimbursement information for C9803. To view the complete policy, click here.

Boston Medical Center Health Net Plan

Electronic Claims Clearinghouse Update

BMC HealthNet Plan (BMCHP) has partnered with TriZetto Provider Solutions (TPS) to manage its electronic data interchange (EDI) transactions exclusively. Effective September 2, 2020, all clearinghouse service organizations and billing agencies that submit EDI transactions must send through TPS. To view the complete notification, click here.

Timely Submission of Clinical Documentation

Effective 9/1/2020, BMC HealthNet Plan Inpatient Utilization Management department requires that clinical documentation be submitted to the Plan within 24 hours from the submission of the Notification of Admission. For additional information, click here.

MyHealthNet: User Roles

We wanted to spotlight the new User Roles feature. Office Managers/Administrators can now assign portal access based on a staff member’s job function. You may have already noticed that your provider portal homepage is different from that of someone else in your office. That’s because different User Roles have different homepage widgets depending on their access level.

Feature Highlights

  • New User Roles define portal access based on job needs
  • Access levels streamline the user experience by only showing the functionality a job requires
  • Provider Office Staff roles include Office Manager/Administrator, Super User, Claims, Auths, Claims and Auths, and Eligibility Only

To learn more about the User Role assigned to your account please consult your Office Manager/Administrator. The Main Office Contact is considered the Office Manager/Administrator in MyHealthNet and they are tasked with validating and assigning User Roles. They will be able to ensure that you have the appropriate access level should you have any concerns.  If you have any additional questions, please contact your Alycia Messelaar, .

You can now enter your PCP Select Change Form on the HealthTrio Portal.  The instruction begins on page 4. 

You can also file appeals online as well under Office Management Request For Claims Review. You can now upload your documents.

Here is the link of instructions for your PCP Select Change Form.

Center for Medicare & Medicaid Services (CMS)

New FAQs – COVID-19 Frequently Asked Questions (FAQs) for State Medicaid and Children’s Health Insurance Program (CHIP) Agencies 

An updated document has been posted to the website. To view the document, click here.

Proposed CY 2021 PFS

On Monday August 3rd, CMS Administrator Seema Verma released the proposed Calendar Year (CY) 2021 Physician Fee Schedule (PFS) for public comment period; (for full code document, click here ; For fact sheet synopsis, click here)

The Public Comment Period is open as of August 8th, (8/08/2020) until October 5th (10/05/2020), click here for instructions on how to submit comments.  Foley and Lardner LLP released a great brief on Friday, which clearly highlights how folks should prepare any comments they’re submitting regarding the codes that CMS has identified as temporary, or “Category 3”.

For a Category 3 service to become permanent, stakeholders will need to submit to CMS:
1) a description of relevant clinical studies that demonstrate the service, when furnished via telehealth, improves the diagnosis or treatment of an illness or injury, or improves the functioning of a malformed body part (including dates and findings of those studies); and
2) a list and copies of published peer reviewed articles relevant to the service when furnished via telehealth.

Medicaid Massachusetts / MassHealth

COVID-19 Public Health Guidance and Directives

The COVID-19 Guidance and Directives has been updated. 1) DPH Guidance, July 6: Defining Aerosol Generating Procedures and Recommended PPE 2) DPH Guidance, July 6: Updated Comprehensive Personal Protective Equipment a) This guidance replaces Comprehensive Personal Protective Equipment guidance published on May 21 3) EOHHS Guidance, updated July 1: Notice of Dedicated Care Capacity at Nursing Facilities for Patients Who Do Not Have COVID-19 4) EOHHS Guidance, updated July 1: Notice of Dedicated Care Capacity at Nursing Facilities for COVID-19 Patients 5) BSAS Visitation Guidance effective July 1, 2020 6) BSAS Offsite Visitation Attestation Form effective July 3, 2020 a) This guidance replaces the BSAS visitation guidance issued June 6, 2020. For additional information and to view the notification, click here.

All Provider Bulletin 298: MassHealth Telehealth Policy

The purpose of this bulletin is to consolidate and restate, with some modifications, MassHealth’s current telehealth policy (as reflected in All Provider Bulletins 289, 291, and 294), and extend that policy through December 31, 2020. This extended policy will help ensure members retain access to covered services, promote social distancing, and mitigate the spread of COVID-19 both before and after the expiration of that state of emergency, enabling members to remain in their homes to reduce exposure and transmission, to the extent possible, and to preserve health system capacity. For additional information and to view the notification, click here.

Fallon Health

Fallon begins CAQH pilot

Fallon Health is committed to increasing the accuracy of our provider directories. As we have shared previously, we are working through Health Care Administrative Solutions, Inc. (HCAS) and Council for Affordable Quality Care, Inc. (CAQH) to continue to improve the experience of providers and help members access the most up-to-date information when seeking care.

When a provider reviews, updates and attests to the demographic information through the CAQH ProView® tool, Fallon—as well as other health plans—receives the updates to make changes in our system. We began piloting this process with a small group of providers on June 30, 2020 and will be expanding access to more providers moving forward. Visit the following websites for the latest training videos, announcements and directory information:

Electronic (ACH) Payments and Remittance Advice Summary (RAS) Access

Providers have access to electronic payments, payment history, status and Remittance Advice Summaries at their fingertips with partner Payspan. Follow the steps in the attached to navigate the system and access the Remittance Advice Summaries. For additional information and to view the notification, click here and scroll to related title.

Sampling and Extrapolation Process

As part of the Program Integrity initiative, Fallon conducts post-payment reviews to validate payments Fallon Health has made. When there is a large volume of claims involved in a population, auditing the entire population is typically not viable. Pursuant to the CMS Program Integrity Manual (Chapter 8) for guidelines regarding Statistically Valid Random Samples (RVRS), a random sample of claims can be selected for the audit. When calculating the amount to be recovered, Fallon ensures that all improper payments are totaled and extrapolated to the claims universe from which the sample was drawn. If a provider is selected to be audited and there are questions regarding the sampling or extrapolation process, reach out to the contact on the request letter. For additional information and to view the notification, click here and scroll to related title.

EDI 276 Claim Status Inquiry Patient Identification Issue

Fallon has identified an area of opportunity for improved member matching criteria for the 276/7 responses. When making a claim inquiry using the 276/7 follow the member matching criteria. Fallon Health requires providers to use a unique Fallon Health member identification number found on all Fallon Health ID cards. These member ID cards each have a 13-digit number. Providers should also enter the member’s first name, last name, middle initial and any special characters found on the Fallon Health ID card. When following this process, providers will have more successful 277 responses when searching for claims. For additional information and to view the notification, click here and scroll to related title.

Changes to Claim Reversals on the EDI 835 Remittance Advice

Effective August 26, 2020, Fallon Health is making a change to the coding of its Electronic Data Interchange (EDI) 835 Remittance Advice. As requested by providers for ease of posting claim reversals, Fallon Health is updating its core code to route Reversal claims through the same Claim Adjustment and Service Adjustment Segment (CAS) logic used for Original and Adjustment claims to determine the Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC). The Reversal claim will now have a CAS segment that matches the same CARC/RARC present on the claim it is reversing. For additional information and to view the notification, click here and scroll to related title. Posted to the Connection July 2020 Newsletter.

Revised Telemedicine Payment Policy

The Payment Policy has been revised. Added Preventive visits and COVID-19 Remote Patient Monitoring. To view the entire policy, click here.

COVID-19, HEDIS 2020 and Pay for Performance

As expected, Fallon’s HEDIS hybrid measures were compromised due to the challenge of accessing charts for abstraction while administrative measures, those calculated by claims alone, were not impacted. Fallon Health has opted to rotate all of its hybrid measures and report HEDIS 2019 rates to NCQA. In an effort to be fair and equitable to providers — its provider community—Fallon Health intends to take the same approach with the Pay for Performance program. Fallon Health’s plan is to calculate P4P settlements using HEDIS 2019 rates for hybrid measures and HEDIS 2020 rates for those measures calculated using only claims. Additionally, NCQA is unsure at this point if they will be able to calculate national percentiles for 2020. For additional information and to view the notification, click here and scroll to related title.

Revised Aging Service Access Points (ASAP) Payment Policy

The Payment Policy has been revised. Update Policy and Billing and Coding sections related to COVID-19 temporary retainer payments. To view the entire policy, click here.

Tufts Health Public Plans

As previously communicated, and effective July 18, 2020, Tufts Health Provider Connect, the secure Provider portal previously used for all Tufts Health Public Plans products, will be replaced by the secure Provider portal utilized by Tufts Health Plan’s other lines of business (Commercial products [including Tufts Health Freedom Plan] and Senior Products). This change applies to Tufts Health Direct, Tufts Health Together – MassHealth MCO Plan and Accountable Care Partnership Plans (ACPPs) and Tufts Health Unify.

Tufts Health Provider Connect claims data for Tufts Health Public Plans Massachusetts products from on or after April 26, 2019 will be available on the secure Provider portal. For more information, including how to access claims data for members of Tufts Health Public Plans Massachusetts products before April 26, 2019 if necessary, refer to the FAQs on Tufts Health Plan’s public Provider website.

For more information on this change, refer to the article and the FAQs on Tufts Health Plan’s public Provider website.

If you have any questions, feel free to reach out to Alycia Messelaar, 

Imaging Services Payment Policy Update

Policy reviewed by committee; removed NIA prior authorization requirements to redirect to landing page; consolidated individual Commercial, Senior Products and Tufts Health Public Plans policies into one document; updated policy to reflect existing processes for claim edits for all lines of business. To view the complete policy, click here.

ClaimCheck Software Removed from Claims Processing System

Effective June 2020, Tufts Health Plan made the decision to remove ClaimCheck, the primary code auditing software for medical claims. Tufts Health Plan now exclusively uses the code auditing vendor Cotiviti. Note: This change impacts the message codes providers see on claim lines. To view the complete notification, click here.

Avoiding Administrative Claim Denials

The attached is a list of administrative claim denials that Tufts Health Plan providers may receive when submitting claims, along with tips on how to correct/avoid them. To view the complete list, click here.


Please reach out to Alycia Messelaar at  978-236-1784 or to keep NEPHO informed of changes in practice schedules due to COVID-19 (office closures, limited office hours, scope of appointment, telehealth use, phone line to reach staff, etc.) or if you have questions about other practice schedules.

CLICK HERE  to access a list of practices who are scheduling in office visits and/or TeleHealth visits at this time.

Please take a moment to review your practice information and reach out to Alycia Messelaar, with update requests.


The Northeast PHO is here to ensure you are not alone and that we are in this together. We are doing our best to keep your practice as updated as possible with all things COVID-19.   Please take a moment to visit the COVID-19 tab on our website.

Click here to find the most recent links to COVID-19 specific health plan materials and updates. Please note, we have included health plans that NEPHO does not contract with in an effort to help keep you well informed of current COVID-19 updates we have been made aware of. If you have questions or concerns, please reach out to Alycia Messelaar,

Since July, Massachusetts Healthcare Quality Partners has fielded a pilot survey to collect clinician feedback on their experiences with telehealth during the pandemic.  This initiative is called “Together for Better Telehealth,” and is a feedback process intended for rapid collection and sharing of what clinicians are learning to help with the continued adaptation to the present challenges.

MHQP received 120 responses to the pilot survey from clinicians across a variety of specialties.   The responses contain interesting insights and not surprisingly, wide variations in experiences.    Use this link to view a summary of the comments:  Select “Results from Pilot Survey to view the summary of themes from the comments.   Clicking on any of the summaries will allow you to view the comments.

MHQP is asking your feedback on a second survey which explores topics on a deeper level that clinicians have expressed wanting guidance and suggestions from peers on practical solutions, useful ideas and tips and tricks for how to make telehealth better.   If you are a clinician and are willing to give 5-10 minutes to share your ideas and experiences in these areas, please click here

Group Purchasing

Addison Gilbert and Beverly Hospital affiliated independent physician practices are welcome to join AdvantageTrust (HealthTrust) as independent practices.  Members of  AdvantageTrust (HealthTrust) have access to the singular HealthTrust portfolio of contracts.  HealthTrust is an exclusive GPO (group purchasing organization), meaning that members cannot access other GPOs’ portfolios.

CLICK HERE for an informational brochure about AdvantageTrust.  If you are interested in becoming a member, you can go to, click on Learn More, and then click on Become A Member.  You can also email Will Stanke, the AdvantageTrust  Account Manager at


Pharmacy Update 

Harvard Pilgrim Health Care (HPHC) NEW Medical Drug Dose and Frequency Guidelines for High Cost Medications 

As of September 1, 2020 HPHC will require additional information for several high-cost medication prior authorization approvals. In addition to clinical indication, dosing and frequency will be required.  See the attached Medical Drug Dose and Frequency Guidelines for more information.

BILHPN Pharmacy Newsletter – August 2020

For questions or more information contact Carol Freedman, NEPHO Pharmacy Manager 978 236 1774 or


Diabetes Management and Nutrition

According to the American Diabetes Association (ADA), “What can I eat?” is the #1 question asked by people with diabetes when they are diagnosed.

The American Diabetes Association created a consensus report which reviewed hundreds of research articles with a panel of scientists, doctors, nutritionists, endocrinologists and diabetes educators to see what dietary patterns work well for people with diabetes. Everyone’s body responds differently to different types of foods and diets, so there is no single “magic” diet for Diabetes. But your patients can follow a few simple tips to find out what works for them to manage their blood sugar.

You can see the ADA’s quick-tips on this video

For the full ADA consensus report click here

The ADA Certified Diabetes Care Center at Lahey Outpatient Center in Danvers and Addison Gilbert Hospital in Gloucester offers comprehensive programs for the management of Diabetes. The Certified Diabetes Care and Education Specialists (CDCES) follow National Standards for Diabetes Self-Management Education.

Some of the services include but are not limited to:

  • The Diabetes Care Clinic is staffed with Registered Nurses and Registered Dietitians who are Certified Diabetes Care and Education Specialists. The specialists will identify key educational components to self-manage your diabetes.
  • Diabetes Group Classes include a 9 week program led by a Certified Diabetes Care and Education Specialist that covers the most recent technologies and therapeutics available including Continuous glucose monitoring (CGM’s), latest advances in insulin delivery and pump therapy.
  • Gestational Diabetes patients are managed from diagnosis to delivery and thereafter as needed. This multidisciplinary approach includes glucose monitoring, nutrition and diabetes counseling.
Diabetes Care Center
Lahey Outpatient Center, Danvers

480 Maple Street
Danvers, MA 01923
TTY: 978-304-8016
Diabetes Care Center
Addison Gilbert Hospital

298 Washington Street
Gloucester, MA 01930
TTY: 978-491-6733

As the NEPHO Health Coach I am more than happy to help your patients navigate the system by facilitating appointments or helping with accountability when needed, as a complement to your care and the services the DCC offers.

Lucia Kmiec
NEPHO Health Coach


The August quality update provides detail to the Blue Cross Blue Shield (BCBS) proposed accommodations for the 2020 Ambulatory quality measures in the Alternative Quality Care (AQC) contract.

  • For process measures such as cancer screenings, well visits, etc BCBS will utilize our 2019 performance for 2020.
  • For outcome measures, BCBS will utilize values obtained in 2020 when available for Hypertension, A1c control, and Diabetes Mellitus (DM) Blood Pressure (BP) control measures. When not available, 2019 outcome values will be used for 2020.
  • Additionally, Ambulatory Patient Experience will be excluded for 2020.
  • Improvement in performance will be capped at 0.2 gate score improvement.
  • NEPHO will continue initiatives to improve patient care and prepare for 2021 performance year.
  • NEPHO will also continue to produce patient lists for diabetes and hypertension so that care gaps for these higher risk patients can be addressed.
    • Please use the patient lists to identify those who would benefit from a PCP visit, either in person or via telehealth (i.e. A1c > 9, BP >/= 140/90).
    • Please outreach these patients to schedule in person, telehealth or lab visits.
  • PLEASE NOTE this important update regarding the blood pressure quality measures:
    • The BP measures have been updated to allow for patient reported BP measurement with a digital device. 
    • The value can be verbally reported or shown to a provider in a Telehealth visit. 
    • Manual BP readings are not accepted.
    • Please document acceptable BP readings in a structured field in the medical record.

Please reach out with questions to Liz Isaac at


OPTUM Newsletter – August 2020 –  Personality disorders

Get Ready for ICD-10 Clinical Modification (CM) Updates 

The new 2021 ICD-10 CM codes have been released and updates are set to be significantly larger than 2020.
Updates will be effective on October 1, 2020.

Summary of updates by chapter are:

  • Chapter 1: Certain Infectious & Parasitic Disease
    • Has a new section for reporting Coronavirus infections.
  • Chapter 3: Diseases of Blood & Blood-forming organs
    • Has 18 new, detailed codes available for sickle cell anemia.
  • Chapter 4: Endocrine, Nutritional & Metabolic Disease
    • Includes new coding instructions to follow for diabetic patients treated with insulin, oral hypoglycemics and injectable non-insulin drugs
  • Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders
    • Contains 21 new codes that describe withdrawal from substances including alcohol, cocaine, and opioids.
  • Chapter 6: Diseases of the Nervous System
    • Has added “pseudotumor” as a clarifying term to G93.2 (Benign intracranial hypertension).
  • Chapter 9: Diseases of the Circulatory System
    • Contains many revisions to the “includes” and “excludes” notes for existing codes.
    • A new hypertension guideline provides instruction that when a patient has hypertensive chronic kidney disease and acute renal failure, code both conditions and sequence the codes based on the reason for the encounter.
  • Chapter 10: Diseases of the Respiratory System
    • Now has code also instructions for cases of acute laryngitis and tracheitis (J04) and acute obstructive laryngitis (croup) and epiglottitis (J05).
    • This chapter also has a new section specifically for vaping-related disorders.
  • Chapter 13: Musculoskeletal System
    • Several updates this year including 12 new codes to capture other pathological fractures (M80.8AX- and M80.0AX-).
    • Updates include an expanded list of codes for rheumatoid arthritis, as well as primary and secondary arthritis, and arthritis caused by trauma.
    • New codes in the M24 category for other articular cartilage disorders, disorders of ligament, pathological dislocation, recurrent dislocation, contracture and ankyloses.
  • Chapter 14: Disease of Genitourinary
    • Has two new sub-stages to Stage 3 chronic kidney disease (CKD).
    • New codes are: N18.30 (Chronic kidney disease, stage 3 unspecified), N18.31 (Chronic kidney disease, stage 3a) and N18.32 (Chronic kidney disease, stage 3b).
  • Chapter 15: Pregnancy, Childbirth, and the Puerperium
    • Contain new language that warns coders they should not report O85 for sepsis that follows an obstetrical procedure.
      • A note points them to the Sepsis due to a postprocedural infection of Chapter 1 Certain Infectious and Parasitic Diseases (A00-B99), U07.1
    • There is a new section that provides instruction on reporting COVID-19 infections in pregnancy, childbirth, and the puerperium
  • Chapter 16: Certain Conditions Originating in the Perinatal Period
    • Has a new section for reporting COVID-19 Infections in newborns.
  • Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified
    • Has several changes. Code R51 (Headache) will be split into two codes: R51.0 (Headache with orthostatic component, not elsewhere classified) or R51.9 (Headache, unspecified).
  • Chapter 19: Injury, poisoning & certain other consequences
    • Has 128 additions that include new codes for adverse effects and poisoning by fentanyl and tramadol as well as other synthetic narcotics.
  • Chapter 21: Factors influencing health status and contact with health services
    • Include new observation language.
    • The new language creates a second exception to the rule that observation codes are primary.
    • Guidelines state, “An observation code may be assigned as a secondary diagnosis code when the patient is being observed for a condition that is ruled out and is unrelated to the principal/first-listed diagnosis.”
  • NEW Chapter 22: Codes for Special Purposes
    • (U00-U85) includes just two codes: U07.0 Vaping- related disorder and U07.1 COVID-19, these codes took effect in the earlier this year.

2021 ICD-10 CM Code Changes

NEPHO will be providing Coding and Billing provider and practice education webinars that are focused on the new ICD-10 CM changes effective October 1, 2020. Webinars will provide a detailed review of the official ICD-10 CM coding guidelines, highlight areas of significant change, and address areas that have been impacted due to COVID 19. Please contact Shawn Bromley at 978-236-1704 and/or if you are interested in learning more about the specific changes coming and how they will impact your specific practice.



Brian Orr Pediatrics – 1 Blackburn Drive
I am very grateful to have Dr. Brian Orr here to care for my children.
I trust him completely.

Danvers Family Doctors – 140 Commonwealth Avenue
Dr. Subroto Bhattacharya is always punctual, friendly, and provides a very
clean environment.

Garden City Pediatrics – 83 Herrick Street
• Dr. Elizabeth Humphreys is so sweet, thoughtful, and thorough. We have
been so thankful for her care.
Dr. Sheryl Silva responded to a medical concern via portal on the same day
that I called and spoke with a triage nurse – very pleased.

Lahey Health Primary Care, Beverly – 900 Cummings Center
Dr. Daniel McCullough provided excellent care and understanding.

Lahey Health Primary Care, Beverly – 30 Tozer Road
Dr. Susan Deluca answered all my concerns, she is very professional and
caring.  I would recommend her to everyone I know.
Dr. Tina Waugh is the most committed and caring PCP I have had.

Lahey Health Primary Care, Danvers – 480 Maple Street
Dr. Kristina Jackson is very knowledgeable and always considers patient
readiness and opinions regarding treatment plans. She is awesome!

Lahey Health Primary Care, Danvers – 5 Federal Street
I always receive superior medical care from Dr. Mauri Cohen.  He’s
thorough, warm, kind and prompt with communications.

Lahey Health Primary Care, Gloucester – 298 Washington Street 4th Floor
Dr. Victor Carabba and his office staff are helpful, timely professional and

Lahey Health Primary Care, Hamilton – 15 Railroad Avenue
A visit with Dr. Hugh Taylor is always, a uniformly positive
experience with a GREAT provider.
Dr. Laurence Gordon is the best doctor I have ever had he is extremely
thorough, concerned, beyond competent, and the best at follow-up.
Dr. William Medwid is outstanding and I am lucky to have him as my

Lahey Health Primary Care, Manchester – 192 School Street
Dr. Nicholas Avgerinos is excellent.  He cares – He listens – He is an
 •excellent doctor.

Mindful Medicine – 900 Cummings Center
Dr. Spencer Amesbury works very hard to get to know his patients. He
listens carefully to everything that I say.

North Shore Pediatrics – 480 Maple Street
Dr. Lance Goodman is an excellent doctor who always shows care and
concern for my children and our family, he is very knowledgeable and
Dr. David Danis and his staff are amazing. Very thorough.


The Northeast PHO recognizes colleagues who provide a positive experience for our patients, help us keep care local, and meet our quality targets.

This month’s winner is:

Emily Eastman, Lahey Health Primary Care, Gloucester, was recognized for effectively collaborating with NEPHO Referral team re-directing patients to in-PHO Specialists.

Denise Ryan, Cape Ann Medical Center, was recognized for collaborating with the practice providers to support improvement in the quality measures.

Please let us know if you would like to nominate a team member in your practice or another practice for the recognition program.

We will deliver gift cards to the winners each month, and they will be announced here and in our website “Hot Topics” section.

Please be sure to look for the new winners in next month’s issue!

L-R: Ashley Gleason, Sylwia Chilinska-Curcuru, Emily Eastman, Laurel Dalgewicz, Erin Leblanc, Jen Krasowski, and Meghan Dann
L-R: Denise Ryan and Dr. James Maguire