Oncology & Hematology Coding Alert

Preparation, education, and testing will help you to make a smooth transition.

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.

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.”