Avoiding ICD-19 denials

The ICD-10 honeymoon period will soon be a thing of the past, and we expect to see denials for most or all of the unspecified diagnosis codes being used. Any movement towards stricter diagnosis coding determinations should be a cause for concern among all health care providers who have not been auditing themselves internally over the past year.

The big questions are: How extensive might those denials be? How significantly might they impinge on a practice’s revenue stream? Most importantly, how will your practice absorb the impact if it happens and what can a practice do today to avoid any potential disruptions to cash flow?

Preparation, as always, is the key. While many of the changes may have been ushered in with the original conversion, now is the time to re-visit your plan of action to ensure that:

  • All new policies were adopted and correctly implemented.
  • Everyone is aware of and is following established practice guidelines.
  • No providers have been reverting back to their bad habits when unspecified diagnosis codes might have slipped through.

Take steps to step up ICD-10 accuracy

Additionally, you will want to ask the following questions as they relate to your practice:

  • How often since the conversion has coding been discussed in your practice?
  • Who handles direct coding questions and what happens when a question arises before a patient is seen, during a visit or when documentation is being finalized regarding a diagnosis code?
  • How often is charting and coding reviewed internally or by an external consulting group?

Asking and answering these questions will begin a dialogue that will help ensure that your practice remains on the right path.  You should also do the following:

  • Arm yourself with as much definitive information as you can.
  • Routinely check the CMS website for coding updates.
  • Download any new coding additions that affect your specialty.
  • Review the changes and summarize them for your providers.
  • Contact carrier provider representatives for carrier-produced guidelines and clarifications.

The sooner you gather this information, the more prepared you will be for updates and specificity concerns. Simple, clear, concise steps can lead to the path of accurate coding and claim adjudication success.

More tips for success in ICD-10

  • Make sure that your coding is as specific as the supporting documentation allows.
  • Verify charting protocols and update systems that interfere with accurate and detailed notations or cause delayed charting.
  • Track patterns in your practice’s and providers’ coding habits.
  • Make certain that coding is not left only to the coders. This can cause backlogs, inefficiency and loss of productivity.
  • Add time for coding updates and questions in regular staff meetings.
  • Update cheat sheets to reflect local coding determination (LCD) and national coding determination (NCD) changes.
  • Train staff to regularly review recommendations and initiatives.

Source: Part B News and Fran Wingerter, Medical Business Advisors, LLC (www.mba-md.com)

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