Many providers and coders are just getting into the ICD-10 groove, but staying there requires a little bit of ongoing training. For coders this means keeping up their certification. What many coders might not be aware of, however, is that time is running out. Most coders must complete a proficiency test or complete certain continuing education credits by Dec. 31, 2015. Otherwise they will lose their credentialing.
Providers need to do a little continuing education as well if they want to stay on top of ICD-10.
"Every now and then you need to look to make sure you are using the most specific code," suggested Barbie Hays, coding and compliance strategist for the American Academy of Family Physicians.
You don't want to fall into a rut of using the same codes when better ones are available. CMS is going easy on non-specific codes for the first 12 months of ICD-10, but next October will come before you know it. And private payers are expected to start tightening up sooner than that. At the moment, very few claims are being denied on the basis of diagnosis codes, but some experts have started to see a slight uptick in these denials. If you're not already using the most appropriate codes available, make sure you start soon, even if that means an ICD-10 refresher course.
Hays said she didn't expect to see much in the way of significant policy changes from payers, but the codes themselves will be adjusted and refined on an ongoing basis. CMS will publish yearly updates to the ICD-10 codes—the flexibility to change as medical science and practice changes is part of the beauty of the new system.
Keeping current and fluent in ICD-10 won't take as much work as making the change in the first place, but it will take a little effort and attention.
Feedback from our ICD-10 Diary physicians:
Maria Chandler, MD, MBA
Long Beach, California
I agree about a "rut" using new codes. My partners have been looking at and testing many codes that are very helpful that I never knew about.
Mohammad Rafieetary, OD, FAAO
This is perhaps easier said than done, when there are so many inconsistencies in the new versus old codes and so many, sometimes useless, variations of these codes and you feel like you have spent more time to figuring what code you should use in addition to all other PQRS, meaningful use, etc. You are almost forced or pushed into the rut.
Thomas A Marsland, MD
Orange Park, Florida
We generally used most generic non-specific codes under the ICD-9 system and have continued that practice. To some extent, which breast quadrant the disease started in … is irrelevant. They have always paid for these codes in the past and indeed they are usually listed in the LCDs. So I will be interested to see if they really start denying these general codes. One of issues is that for new patients we (the doctor) are expected to list the diagnostic code and many times we don't really have all the specifics to determine the more specific code and would have to use our time to go find them. Most doctors are way too busy to do that. I guess it remains to be seen.
Pamela J. Miller, OD
My question is: How does the doctor (or coder) know when better codes are available? And what constitutes a "better code?" Also, just how many codes is the doctor or coder expected to record?
For example, a patient is seen for annual vision examination, is a presbyope, but may have incipient senile cataract right eye. Is the code for presbyopia sufficient or does the doctor have to also include the cataract code even though it isn’t being treated or referred for surgery?
Tammie Olson, of Ocean Spring, Miss.-based Management Resource Group replied:
In this case you would not code the cataract because it is “may have.” You do not code rule out, questionable, or possible. Code all the definitive diseases/disorders that are documented. If there are no definitive disorders/diseases then you would code the symptoms.
If the provider had stated that there was a senile cataract in the left eye, you would code that. “Better codes” would mean the more specific code, in other words if the provider documents a senile cataract, right eye, then the code should be for senile cataract right eye, not cataract unspecified.
The coder should code all documented conditions. There isn’t a magic number. The primary code would be the primary reason for the service, any other codes would be listed as secondary.