Here are four strategies to make sure the wrong ICD-10 code doesn't mean a payer denial.
There are many details involved in implementing the new ICD-10 coding system, but at its most basic, the new set is much like its predecessor: it's about the codes. If you want to get paid in a timely manner you must get the codes right.
So far (as far as CMS is concerned, until October 2016), payers are going easy on specificity. But this largess will not last. Sooner than you think, the only way to prevent payment delays (and possible loss of payment) will be to code properly. If you don't want your receivables to suffer in the coming months, you need to make sure you are using the right codes now.
Tammie Olson of Ocean Springs, Miss.-based Management Resource Group, a firm offering financial management and support services for the healthcare community, offered some helpful tips for making sure you use the right code to prevent denials, now and in the future.
Daniel Mark Siegel MD, MS
Brooklyn, New York
Remember that for a number of disease states, such as diabetes, there are codes that describe the current control of the disease and specific associations with ocular, renal, vascular, and neurological co-morbidities. (Reviewed succinctly here.)
If you are staying a paper luddite, be sure your encounter forms continue to include all levels of CPT codes for E&M services as auditors may look askance at documents which only allow high level codes.
Nevertheless, it is still best to document what you did, do what you documented and accurately report what using have done that is medically necessary to the highest level of specificity.
Thomas A Marsland, MD
Orange Park, Florida
Be sure to include all the codes necessary in oncology. Some drugs require a "dual" diagnosis.