General Surgery Coding Alert

Compare results for different payers.

Did your general surgery practice lean into the ICD-10 grace period that allowed you to avoid claim denials if you simply reported a diagnosis to the proper family?

If you did, you might expect a review of claims to show a spike in denials since the grace period ended Oct. 1, 2016.

Monitor Returned Claims

Although CMS gave you that “grace” for one year following the implementation of ICD-10-CM, most other payers did not. That’s why you’ve probably been coding correctly anyway. “Many major insurers did not offer coding flexibility, so many providers are already using specific codes,” said CMS spokesperson Jibril O. Boykin.

But the end of the grace period may mean you have an increase in denials if you haven’t been applying the level of specificity ICD-10 truly requires.

Do this: Run a claims audit including all your major payers on claims filed since Oct. 1, 2016, and see if you have a significant change in denial rates based on inappropriate diagnosis code for the procedure. Then use that information to inform surgeons where they need to tighten their documentation to help coders report conditions to the highest specificity available in ICD-10.

Turn On Your ‘Update’ Mechanism

If you’ve gotten lazy about updating your system’s diagnosis code set because CMS froze new updates to ease the transition from ICD-9 to ICD-10, you need to break that habit now.

During that freeze, lots of updates accumulated and came gushing out on Oct. 1. Some of those changes, like those discussed in “Drill Down to Details For Intestine and Pancreas Dx Changes” turn a four-digit code into more specific five-digit codes. Missing those changes means certain denial for filing a “truncated” code.

Do this: Just as you used to update your ICD-9 code sets at least once a year to make sure you were using the most current options, you’ll need to re-start that process for ICD-10. Now that ICD-10-CM 2017 broke the hold, you can expect annual updates each year moving forward.