Gastroenterology Coding Alert

Asking just 2 questions can help you get the most specific code Reporting your diagnoses to the highest level of specificity that the gastroenterologist's documentation will support is a surefire way to prevent denials based on incomplete diagnosis codes. Times Have Changed -A lot of us didn't pay attention to ICD-9 coding in the past because Medicare was the only carrier that cared if you used the correct codes,- says Victoria Jackson, owner of Omni Management, which provides practice management services for 15 medical offices in the Los Angeles area. Now, all insurance companies are looking for ICD-9 codes, and coders must be more vigilant about the diagnoses they assign. Take Time Out for ICD-9 Accuracy
 
You should always report the ICD-9 code that provides the highest degree of accuracy for the condition the gastroenterologist is treating.
 
-That -highest degree- means that you should assign the most precise ICD-9 code that most fully explains the narrative description of the symptom or diagnosis,- says JoAnn Baker, CCS, CPC-H, CPC, CHCC, a coding education specialist in East Orange, N.J.
 
Strategy for success: To ensure you use the most accurate ICD-9 code every time, Margaret Lamb, RHIT, CPC, coding expert in Great Falls, Mont., suggests asking two questions before sending out a claim:
 
1. Do I have a complete code?
 
2. Do I have the most specific complete code?
 
Rely on your ICD-9 manual's instructions to ensure you-re listing complete ICD-9 codes. If you see a check mark with a -4th- or -5th- next to a code, ICD-9 is telling you that the code requires a fourth or fifth digit. Anything less would result in an incomplete claim.
 
For example: If you find the tabular listing for abdominal pain (789.0), you-ll see a box with a checkmark  printed to the left of the code. This box indicates that a complete ICD-9 code for an abdominal pain diagnosis must be five digits.
 
Why? You need five digits to reflect the subclassification, such as right upper quadrant.
 
Key idea: If the ICD-9 code you submit is not as specific as carrier rules require, the carrier may reject the claim for lack of medical necessity and/or a truncated code, Lamb says. Use Care When Selecting Symptoms
 
When working with diagnosis coding, you must remain up-to-date with your codes and read through a code listing entirely, or you may find yourself forgetting a fourth or fifth digit.
 
This past October, ICD-9 added many new codes, some of which were the result of expanding four digits to five digits, allowing you to specify conditions that you previously couldn-t.
 
Good news: The increased detail of the codes will help you to prove medical necessity for a procedure that a carrier could assume was merely cosmetic, says McCoy Rockefeller, CPC, coding specialist with [...]