ICD 10 Coding Alert

Denials could skyrocket if your specificity isn’t up to scratch.

CMS and the CDC have released the final ICD-10-CM 2017 addenda, which has many coders thinking about Oct. 1, 2016, when the codes become effective.

Another change that will happen at that time is the end of the CMS “grace period” for ICD-10, which prevents MACs from denying claims based on ICD-10 specificity, as long as your code is in the right category, or “family.”

Caution: The end of the grace period may result in an increase in denials if you haven’t been applying the level of specificity ICD-10-CM truly requires, says ICD-10 trainer Monica Smith, RHIT, CPC, CRCR, an associate in Kraft Healthcare Consulting’s compliance services division.

Take the time between now and Oct. 1 to be sure your documentation has the specificity ICD-10 requires and that you have the tools you need to find the most specific code.

Connect Related Conditions for Better Coding

Providers need to be specific about the patient’s diagnosis, but they also need to be sure to be clear about whether any co-existing conditions are related, Smith says.

Example: If a patient has a heart condition and hypertension, your coding varies based on whether the provider documents a causal relationship between the two. ICD-10 Official Guidelines for 2016 state that “Heart conditions classified to I50.- or I51.4-I51.9, are assigned to category I11, Hypertensive heart disease, when a causal relationship is stated (due to hypertension) or implied (hypertensive).” But without the causal relationship stated, you’d code the conditions separately.

Begin Preparing for ICD-10 2017 Now

Even if your coding and documentation were perfect in 2016, you’ll need to put in some work to be sure you can maintain your accuracy rate once the 2017 changes go into effect.

“Educate and train on the 2017 ICD-10 CM changes,” says Marchelle Cagle, CPC, CPC-I, PCS, of Cagle Medical Consulting in Birmingham, Ala.

Ensure that you’ve ordered your 2017 ICD-10 CM books, Cagle says. The ICD-10 CM changes are also published here: www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-CM-and-GEMs.html. “The sooner the practice gets to know how any change affects them the better,” Cagle says.

“There are many free webinars out right now to ensure a practice gets ICD-10 CM change training,” Cagle adds.

Tip: To see some cardiology changes to watch for, see “Size Up These 7 Cardiology Changes Planned for ICD-10-CM 2017,” in Cardiology Coding Alert, vol. 19, no. 5. And check future issues for details about changes to the Index and notes in the Tabular.

“Another important thing to remember is to make sure the practice management systems are going to be fully updated with the 2017 codes as of Oct. 1. Some software companies have their clients download these files themselves,” Cagle says.

Bonus Tip: Compare Your Denials to Payer Policies

The CMS grace period did not change requirements to follow LCDs and NCDs, so it’s possible you received denials for not adhering to a coverage policy. To get a handle on where your coding and documentation need improvement, review the payer denials coming in now, Cagle advises.

Compare your denials to the coverage information in the LCDs and NCDs for your most frequently performed services, Cagle says. Knowing the coverage requirements and the specificity required for diagnosis coding to support your procedures can be a great help, she says.