Cardiology Coding Alert

Remember the big picture as you work on documentation and coding accuracy.

With ICD-10 in full effect, you should already have done a lot of the heavy lifting in terms of working with vendors, taking care of processes like forms and clinical documentation improvements, and training. To help you with keeping all that hard work from slipping away, consider these three tips.

1. Match Documentation to Code Terminology

If you’re given the opportunity to participate in clinical documentation improvement training for the cardiologists you code for, be sure they’re aware of the language ICD-10 uses for your most common diagnoses. This can be especially important if you’ve noticed providers using terms interchangeably that ICD-10 considers to be distinct diagnoses or if the providers tend to leave out an important detail.

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

Example: Your cardiologists may have a habit of documenting congestive heart failure without mentioning systolic or diastolic, leaving you to ask for clarification or report unspecified code I50.9 (Heart failure, unspecified). If you touched on this issue in your clinical documentation improvement training sessions before ICD-10 implementation (and perhaps even back when trying to improve documentation for ICD-9), watch to be sure providers are following through and offer refreshers if you find documentation issues are slowing down your coding speed.

2. Give GEMs Limited Power

You can use the General Equivalence Mappings (GEMs) as the starting point for crosswalking 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.

Best bet: For absolute certainty in code choice, follow the same good practices you used in ICD-9. Search for the term in the Index, and then confirm your choice in the Tabular. Be sure to review instructions with the code and any applicable Official Guidelines, too.

3. Don’t Let Other Details Slide

A successful claim is all about being careful not to make mistakes in what you do regularly.

“I think we are concentrating so hard to make sure we get the ICD-10 codes right that we forget to audit the claims for the everyday housekeeping that needs to be done,” says Elizabeth Earhart, CPC, in Millersville, Pa. “We should remember to check everything on the claim, not just the diagnosis.”

“Don’t let your other checks and balances slide just because we are switching over codes,” emphasizes Earhart. “Use the same checklist you had for ICD-9 for ensuring a clean claim but think ICD-10 instead,” she adds. “Your timely filing guidelines are not changing. Your NPI is not changing. How your doctor treats is not changing.”