Oncology & Hematology Coding Alert

Question: Yikes! There are tons of ICD-10-CM changes for oncology this year. More than ever before, our ability to assign the correct codes depends on good clinical documentation. Do you have any tips on revising the documentation templates we provide for our clinicians?

-Practice Administrator in New York State

Answer: Well-designed templates help providers document all the clinical information necessary to assign correct ICD-10-CM codes. As just one example, ICD-10-CM 2018 contains new specificity in the N63.XX series: providers who haven't been documenting laterality and quadrant will need to do so now in order for you to code breast lumps correctly.

At the recent Regional Conference of the American Academy of Professional Coders in Salt Lake City, instructor Rhonda Buckholtz, CPC, CPCI, CPMA, CDEO, CRC, CHPSE, COPC, CENTC, CPEDC, CGSC, shared these template revision strategies:

Harness the reporting abilities of your practice management system. Now that you have the ICD-10-CM 2018, "one of the best things you can do is to run a PM report that shows you how often your practice uses the code series now," Buckholtz told conference attendees. That way, you can narrow your template revision efforts to code series that actually impact your practice.

Even though unspecified laterality is often an optionin the ICD-10-CM code set, don't make it an option in your template. There's often a good reason to use a code that contains the word "unspecified" in the descriptor, but not when it comes to laterality, says Buckholtz. No matter the status of diagnostic testing, providers know what side or sides the problem is on-even at the first encounter. If providers don't documentlaterality and you assign an "unspecified" ICD-10-CM code, the payer will almost certainly deny your claim. So don't make "unspecified" laterality an option on anytemplate. Some coders even have their electronic health records (EHR) vendor remove unspecified laterality codes from the ICD-10-CM codes available toprevent providers from accidentally choosing them.

Watch denial patterns carefully. You should always be tracking denials and looking out for patterns that indicate systemic problems, but you should be extra vigilant during Q4 as ICD-10-CM changes begin affecting your claims. If you see a denial pattern, that could be a sign that you need to tweak a template a bit more to help providers get it right.