Medicare Compliance & Reimbursement

The Centers for Medicare & Medicaid Services (CMS) and many other payers use ICD-10-CM to process claims, relying on diagnosis codes to demonstrate medical necessity for providers’ services. Additionally, Medicare quality reporting programs rely on accurate diagnosis coding to evaluate appropriate procedures — so missing the boat now could impact your bottom line later.

As you prepare to implement the new ICD-10-CM changes on Oct. 1, there are a few things you need to address, says Robin Peterson, CPC, CPMA, manager of professional coding services, Pinnacle Integrated Coding Solutions, LLC in Centennial, Colorado.

First, review current documentation for each of the expanded categories. Would practice providers’ current verbiage support the level of specificity required to report the new codes? If not, meet with the practitioners to explain the new codes and increase their awareness of what the documentation requires.

“You will also address the detail that is needed to support the highest level of specificity,” Peterson adds. “Also remember, the current EHR templates providers are using may require updates. And lastly, any internal billing or charge systems will need to make the new codes available” as of Oct. 1, 2023.