Neurology & Pain Management Coding Alert

Don't risk denied claims -- or worse You know that your diagnosis coding needs to support medical necessity for the services and procedures provided. If it doesn-t, carriers can deny claims outright or may require payment -- along with additional fines or even fraud investigations -- at a later date. Faulty ICD-9 coding can derail claims even when a procedure or service is medically necessary and appropriate. Here are some ways to keep your diagnosis coding on-target. Start in the Index The introduction to the ICD-9 manual provides a good summary of "10 Steps to Correct Coding." You should use these steps as a guide when selecting diagnosis codes. The single most important step is to begin your code search by first consulting the alphabetic index, which is arranged by condition. Narrow your search using the index. You should cross-reference the codes using the tabular (Volume 1) listings and read the precise definition of your tentative code selection. The tabular listing provides additional information that will help you pinpoint the exact codes you need. For example: If you need to find a diagnosis for epilepsy related to the abdomen without loss of consciousness, check the ICD-9 index under "Epilepsy." This contains the "general" code 345.x. Looking in the sub-entries, you-ll find the location (abdomen), which also points to 345.5x. Now find 345.5x in the tabular listing. Under this code, ICD-9 confirms "Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures" and provides a further definition, "partial NOS: without impairment of consciousness." You can select 345.5x with confidence now. Play it safe: Never choose a code without referring to the ICD-9 index (Vol. 2) first, then to the tabular section (Vol. 1) for confirmation and specificity. Be sure to read any coding notes to assist in accurate assignment. Always be sure that you report a diagnosis to the highest available and supportable specificity level. You need to use four- or five-digit codes when they are available. Never report a category (three-digit) or subcategory (four-digit) code when ICD-9 lists more specific codes under those headings. Thorough reporting ensures proper coding and timely payment. Use as Many Codes as You Need You should strive to report ICD-9 codes that accurately and completely describe the patient's condition as supported by physician documentation. Using the physician's documentation as your guide, you should bill as many diagnosis codes as you need to establish medical necessity for the services you-re billing. Medicare guidelines now allow up to eight ICD-9 codes on a claim. Tip: "See if the physician has given the patient a definitive diagnosis," says Denae M. Merrill, CPC, coder for Covenant MSO in Saginaw, Mich. " -Rule out,- -suspected,- -probable- or -questionable- are [...]