Anesthesia Coding Alert

Focusing on these areas will get you ready.

The final countdown to ICD-10 is on, so it’s time to take a serious look at how you can best handle the transition. Here are three key areas where you can work to prevent your practice from being caught unprepared.

Check Your Approach to Documentation

The single biggest challenge in shifting to ICD-10 may come not from the coding perspective as much as from providing the requisite documentation.

“The granularity of ICD-10 will require more descriptive documentation to allow for matching to the right diagnostic code,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center, in Edison, N.J.

Providers might be able to have less than stellar documentation for ICD-9 coding, but that won’t be the case with ICD-10. Code descriptions will be much more detailed, so start working with your providers now to accurately document procedures and services so as to match the future code descriptions. 

Remember: You need not wait until the new codes are in place to practice better documentation. Start adapting to the new documentation style now and it will feel like the transition battle is halfway won.

Focus on Your Top Codes

The sheer numbers of codes in ICD-10 can be enough to worry any coder or provider. Whittling the possibilities to ones you’ll use most often helps relieve some of the potential “code overload.” 

“Most systems will let you run a report of your most frequently used codes. This is a great way to determine which codes you use,” says Elizabeth Earhart, CPC, with Godshall Chiropractic in Millersville, PA. “I also review the code set list for Medicare and make sure I am paying attention to the hierarchy of codes. Coding to the highest specificity now will make it easier for the transition.”

Good news: CMS is now providing a list of ICD-10 codes that are medically necessary in conjunction with appropriate CPT® codes in the Local Coverage Determination (LCD) data available.

Next steps: Use the general equivalence mappings (GEMs) written by the National Center for Health Statistics (NCHS) as the starting point for cross walking the ICD-9 codes to their ICD-10 equivalents. However, remember that GEMs provide only approximations and that other, more specific diagnoses might apply in a specific situation.

“I personally do not like using GEMs because it does not always recognize the best codes or gives you several to choose from,” admits Earhart. “I actually created my own cheat sheet linking the codes that apply using the list of codes we use the most.”

That means use the information you collect to create your very own crosswalk knowledgebase for the most frequently used codes in your practice.

“Practices should closely examine their high volume services relative to changes in procedure coding,” says Duane C. Abbey, PhD, president of Abbey and Abbey Consultants Inc., in Ames, IA. “Computer reports can identify high volume areas and then the coding changes can be assessed along with possible increased documentation requirements. By focusing on high volume, and generally high dollar, areas both coding and the supporting documentation can be addressed in a focused manner through increased training.”

“Fortunately, most physicians use a manageable number of diagnostic codes in caring for patients, so the initial focus should be on learning the crosswalks for the most commonly used,” Przybylski says.

Analyze Your Inefficiencies

A chain is only as strong as its weakest link, as the old adage says – and the same applies to coding and reimbursement. Now is the perfect time to analyze inefficiencies that thwart current performance levels – and strengthen your billing and reimbursement process chain. Abbey recommends that you ask questions such as:

• What are the top reasons you receive denials?
• Does your practice have a strategy to reduce denials?
• How do you address medical necessity issues?
• How frequently must physicians be queried for additional information?
• Is documentation provided in a timely fashion?

Final take-away: Even the smallest inefficiencies can multiply, having an exponential effect on productivity slowdown. The more you can begin addressing areas now, the sooner your productivity levels will return to normal under ICD-10.

“Some EMR software has already been loaded with ICD-10 codes, allowing you to see both the old and new version(s) of the diagnoses. This can provide a great opportunity to become familiar with the crosswalks,” Przybylski says.