Physicians locked into ICD-10, but codes may miss the mark

Lambert, MDCarla J. Lambert, MD
Family medicine
Beltsville, Maryland

Vague specificity

Nov. 5, 2016

I'm questioning why some ICD-10 codes are extremely specific and others are nonspecific with no ability to be more precise (e.g. I10 for all hypertension codes). Not that I'm complaining, but it just makes it more time consuming researching whether a code can be more specific or not.

Are we supposed to code two separate codes or the unspecified code when there is no code for bilateral? It seems silly to code right leg pain and left leg pain separately when one code for bilateral leg pain would make sense.

I'm glad that fibromyalgia finally has its own code (M79.7)!

So far, so good regarding payments. We have been getting paid without incident. Unfortunately, we're having other payment issues due to a non-related insurance mix-up. So I'm glad we didn't have to deal with this plus ICD-10 issues.

NEXT: Bring on the challenges

Miller, ODPamela J. Miller, OD
Optometrist
Highland, California

Exceptional Codes

Nov. 2, 2015

So far, nothing new. I am still forgetting to code about 5% of the patient records, but generally remember by the time I start the next patient.

Nov. 3, 2015

So far, it looks like we have been paid for services rendered in October, at least by the major carriers we accept in our office. Of course, they basically are only paying for "refractions and eye examinations." I'm not seeing reimbursements yet for any medical charges-a very small part of our practice-due to the way that Obamacare is structured in our area; almost all patients have to be referred down to their primary for care and then obtain a referral to ophthalmology.

Nov. 4, 2015

I've been having some interesting patients lately, which require different coding. Guess we will see relatively soon if we get paid for the non-ordinary in our office.

Nov. 5, 2015

Patients don’t know about the new ICD-10 coding, although some have heard about it. So I end up explaining briefly why it takes a bit longer at the end of the exam, to make certain I do the correct coding.

Nov. 6, 2015

I'm still using a lot of the basic codes, but definitely branching out as more unique presentations come through the door. I am waiting to see what the codes are when we see patients referred by other doctors. The more specific their specialty, the more interesting it should be and a great learning tool for me too.

I'm looking forward to another challenging week and by this time I think I have the ICD-10 coding under control. Hopefully, I am making few errors which can be corrected quickly and easily.

NEXT: Somewhere between victory and defeat

Hungerpiller, MDJeanne Hungerpiller, MD
Family medicine
Savannah, Georgia

Matching Diagnosis to Codes

Oct. 30, 2015

While, in general, I have found the logic behind ICD-10 to be relatively easily understood, I find it difficult as a general practitioner to accurately code certain findings which have not yet been worked up to the point of diagnostic specificity. For example, a patient recently presented with vertigo as a symptom without hearing loss and with little on physical exam to firmly establish an actual diagnosis. I was unable to find an ICD-10 code for vertigo. I hesitate to assign a working or differential diagnosis code as "possible" since it seems that follows the patient forever in claims-based reviews, even if it was disproven. I wonder how others are handling this.

I think it is too soon to call things a "win" yet, though I would not label it a total "fail" either. I think it will need work on both sides to iron out the wrinkles. I have had issues with little things in terms of choosing codes. The other day, I had a patient with what I felt was a repetitive use injury of the wrist which I was attempting to call a "strain," but the ICD-10 codes that were retrieved in my search were all "subluxation of…" and "dislocation of…" I finally had to use "tendonitis." I hope that will be acceptable, although I’m not sure how we will know (unless the claim is rejected).

Nov. 6, 2015

We are running into continuing delays trying to find the most specific codes for each patient, mainly just due to the sheer number of available codes and having to sort through them in search of the "one perfect" code that says everything we are trying to convey regarding diagnosis. My billing and collections person has not noticed any change in denial patterns, but we are waiting to see what happens as the insurance companies and CMS grow less lenient … time will tell.

NEXT: Watch those claims

Marsland, MDThomas A Marsland, MD
Oncologist
Orange Park, Florida

Matching Diagnosis to Codes-Part II

Nov. 5, 2015

Happy Guy Faulk’s Day (my dad was a Brit).

It's hard to believe that Thanksgiving is two weeks away and 2016 is just around the corner, and we are almost six weeks into ICD-10. Well, the first shoe has dropped.  

We are now receiving denials for Procrit and Aranesp because some of the correct ICD-10 diagnoses were not added to the local coverage determinations. Surprise, surprise,   the carrier is working to get this corrected (projected date sometime in 2017). So people, be sure you are watching your claims … and if you get denied, appeal.

My only other minor observation is that it is still easier in our EHR when adding a diagnosis to first go to ICD-9 and then the crossover, finding a new diagnosis in ICD-10, that doesn’t seem as complete. 

NEXT: Crowdsourcing denials

Ellis Jr, MDGeorge G. Ellis, Jr., MD
Internist
Youngstown, Ohio

Matching Diagnosis to Codes-Part III

Nov. 6, 2015

All of my claims to date for ICD-10 have been paid without delay and those not scrubbed by my billing software have been reimbursed.

There are still some delays in selecting ICD-10 codes, as there are some diagnoses which have upward of 100 different codes. There are multiple different disorders with close to 100 different codes underneath the specific diagnosis. The delay is sifting through the different codes, making sure it is accurate for the disease being treated.

Documentation has also been more extensive, and more specific regarding injuries, etc.

NEXT: Crowdsourcing denials

Siegel, MD, MSDaniel Mark Siegel MD, MS
Dermatologist
Brooklyn, New York

Conspiracy or common problems?

Nov. 6, 2015

What a dull week on the ICD10 front.

There's been a little more confusion as I hear from friends in Florida that some claims on melanoma in situ and squamous cancer in situ are being denied. Is it a clerical error or planned attack on the specialty? Stay tuned on this channel too.

Maybe it's time for a hashtag #ICD10CLAIMNOPAY where everybody can share the CPT code and linked ICD-10 code to see if big insurance or CMS is playing with our heads and livelihood.

Or an online repository with habit more detail:

• CPT code 1 – ICD-10 (code 1) ICD-10(code 2)… ICD-10 (code N) - Insurer - Specific plan - Any comments from the payer...

• CPT code 2- ICD-10 (code 1) ICD-10(code 2)… ICD-10 (code N) - Insurer - Specific plan - Any comments from the payer…

• CPT code N- ICD-10 (code 1) ICD-10(code 2)… ICD-10 (code N) - Insurer - Specific plan - Any comments from the payer…

Also, an upload of de-identified claim forms (HIPAA violations can be expensive!)  and correspondence. 

NEXT: When you can't find the words …

Drummond, MDHarry Drummond, MD
Family medicine
Simi Valley, California

No delays, no denials

Nov. 4, 2015

I've had no serious problems with coding; seeing patients as usual and no delays thanks to our IMO code finder.

Nov. 5, 2015

Occasionally, I cannot find some codes with wording that I need to describe my patient's condition.

Nov. 6, 2015

Not much problem with ICD-10 coding except that it takes a few extra clicks on the EHR. I'm still having problems finding the wording of the diagnosis that I am used to.

NEXT: Claims accepted … but no payment yet

Chandler, MD, MBAMaria Chandler, MD, MBA
Pediatrician
Long Beach, California

1.43% Victory Thus Far

Nov. 5, 2015

Our billing director reports that claims are being accepted with ICD-10 and we've seen no denials so far, but we are told that denials could be delayed, so we’re waiting and watching!

We have billed over 7,000 claims since Oct. 1, but have only received about 100 paid since our payers have over 30 days to reimburse.