Neurosurgery Coding Alert

Educate yourself, test your systems, and prepare to embrace ICD-10.

It is now time that you assess how prepared are you to adopt ICD-10. Though in July this year, CMS announced that there would be room to accommodate the ICD-10 transition, you should know what will be the consequences of reporting an incorrect code. You need to prepare to keep denials at bay. Here is what lies ahead for you next month.

Road to ICD-10: You may like to get a current ICD-10-CM book to review not only the codes, but also the ICD-10 directions and guidelines.

As an addendum to the ICD-10 books, CMS has ICD-10 help online. CMS has launched a site replete with ICD-10 review tools, crosswalks, and advice on how to stay ahead of the curve with ICD-10. CMS calls its site, www.roadto10.org , "your one-stop source for all things ICD-10." You'll find advice on building your ICD-10 transition plan and ICD-10 resources, tutorial videos, a template library, Webcasts, and more.

ICD-10 lists: One FAQ asks: "Where can I find a list of ICD-10 codes?" According to CMS, "The ICD-10-CM and ICD-10-PCS code sets, as well as the official ICD-10-CM guidelines, are available free of charge on the "2015 ICD-10-CM and GEMs" and "2015 ICD-10-PCS and GEMs" pages of the CMS ICD-10 website. Additionally, it is important to contact your payers and trading partners to request a copy of the crosswalk mapping tool they are utilizing to ensure its accuracy."

Do Not Fear Denials

In July of this year, CMS provided guidance on four areas of ICD-10 implementation.

1. Claims denials: The CMS document stated that, "While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family."

"The first three characters of the ICD-10 code represent the family.  The exceptions to this allowance are National and Local Coverage Decisions which require a specific diagnosis code for coverage," says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center, Edison.

2. Penalties associated with quality reporting: In a similar move, CMS is giving providers some leeway regarding PQRS and other quality measures. "For all quality reporting completed for program year 2015, Medicare clinical quality data review contractors will not subject physicians or other Eligible Professionals (EP) to the Physician Quality Reporting System (PQRS), Value Based Modifier (VBM), or Meaningful Use 2 (MU) penalty during primary source verification or auditing related to the additional specificity of the ICD-10 diagnosis code, as long as the physician/EP used a code from the correct family of codes," CMS explained. "Furthermore, an EP will not be subjected to a penalty if CMS experiences difficulty calculating the quality scores for PQRS, VBM, or MU due to the transition to ICD-10 codes."

3. Payment miscues: AMA's Steven Stack, M.D., addressed payment timelines in a statement on the group's website. "If Medicare contractors are unable to process claims as a result of problems with ICD-10, CMS will authorize advance payments to physicians," he wrote.

4. Easing the transition: Many practices have been uneasy about ICD-10 because they don't know how easily (or quickly) they'll get help from CMS if needed. The statement included details about a communications center of sorts that CMS will create. One aspect of the center will include an ICD-10 Ombudsman, "to help receive and triage physician and provider issues. The center will also "identify and initiate" resolution of issues caused by the new code sets, officials added.

Are You Good To Go For ICD-10-CM?

With the Oct. 1, 2015, deadline fast-approaching, it is time you assess your readiness for adopting ICD-10-CM. If you still aren't well prepared to transition to ICD-10-CM, you may face challenges like payment denials, increased A/R days, and workforce overload. Here is a short checklist of key essentials that will help you to assess your preparation for ICD-10-CM. It will also help you to identify and deficiencies that might be present.

Clinical documentation should be a prime focus: Nothing can set you on a better path than clean and complete documentation to help you transition to ICD-10-CM this October.

Check your providers' documentation workflows and their needs for ICD-10-CM readiness.  Make sure all your claims not only have the appropriate codes but also have the appropriate clinical documentation from the patient visits and services to support the submitted ICD-10 codes. You may not find it any different from ICD-9-CM, but don't forget that ICD-10-CM often requires much more and sometimes different details and specificity than the provider may be used to with ICD-9-CM.

Listed below are some parameters that will need more details for ICD-10-CM coding:

• Anatomical detail
• Type of lesion or malignant foci
• Laterality, where applicable
• Episode of Care (initial and subsequent encounters, sequela to initial care)
• Classification and staging
• Treatment plan including chemotherapy
• Cause and/or severity

The following are three general principles regarding documentation:

1. Documentation should be legible to someone other than the documenting physician or provider and their staff.

2. Documentation should clearly state: name of patient and name of the provider of the service

3. Documentation should support the nature of the visit and medical necessity of the services rendered by clearly describing the reason/condition(s) and/or signs and symptoms the patient has.