Neurosurgery Coding Alert

MACs make demand for signatures on appeals.

Practices have experienced the transition to ICD-10 with cautious optimism. It is good news that revenue cycles have not been disrupted and denials did not dramatically shoot up. It is evident that practices were prepared to welcome this change.

CMS and commercial payers have offered flexibility in processing claims to aid a smooth transition by inclusion of less-than-perfect ICD-10 coding at the outset. CMS announced early on that the agency, for the first 12 months of the ICD-10 rollout, would not deny claims based solely on code specificity as long as the physician submitted a valid code from the right category for the diagnosis.

“The first three alphanumeric characters before the decimal represent the diagnostic family,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison. “For the first year, CMS is only requiring accuracy of the family and not to the specificity of the fourth or higher characters. An exclusion applies when a National Coverage Decision or Local Coverage Decision requires a greater specificity of reporting.”

CMS has declared success for ICD-10, at least for now. The agency released some stats about the new diagnosis coding system on Oct. 29, and those numbers are quite positive. Between Oct. 1 and Oct. 27, Medicare processed 4.6 million ICD-10 claims per day, and only 10.1 percent of them were denied. Out of the denials, 0.1 percent were rejected due to an invalid ICD-10 code, and another two percent were denied because of incomplete or invalid information. During this period, rejections due to incomplete and invalid information, for example, a wrong code, were two percent. This is comparable to rates prior to ICD-10 implementation.

“CMS has been carefully monitoring the transition and is pleased to report that claims are processing normally,” the agency said in the news release. “Generally speaking, Medicare claims take several days to be processed and, once processed, Medicare must — by law — wait two weeks before issuing a payment. Medicaid claims can take up to 30 days to be submitted and processed by states.” So, we can anticipate more details on claims processing and payments very soon.

Contributory to this success are the preparedness and willingness of payers, physicians, vendors, and practices to promptly fix ICD-10 problems as and when confronted with one. However, a word of caution is that this initial success may not be taken as a promise for future success. Providers, billers, and payers need to strive for excellence by continuously addressing needs and meeting any challenges that may arise.

This MAC Wants Signatures on Appeals

Don’t shoot yourself in the foot on your Medicare claims appeals. Medicare administrative contractors (MACs) are specific about signatures. “A paper appeal (faxed or mailed) must contain a handwritten or electronic signature of the appellant,” MAC Palmetto GBA notes on its website. “If you are currently typing a name in the signature field, copying and pasting an image of a signature, or submitting a form that contains a copy of a signature, in the near future, Palmetto GBA will be returning those appeals for proper signatures,” the MAC says.