Otolaryngology Coding Alert

Question: With new ICD-10 codes taking effect in October, what are key considerations and steps we should take to ensure a smooth transition, proper code reporting, and continued claims success?

Mississippi Subscriber

Answer: As you prepare to implement the new ICD-10-CM changes on Oct. 1, there are a few things you need to address, says Robin Peterson, CPC, CPMA, manager of professional coding services, Pinnacle Integrated Coding Solutions, LLC in Centennial, Colorado.

First, review current documentation for each of the expanded categories. As your providers are currently documenting, would the verbiage support the level of specificity required to report the new codes? If not, meet with your providers to explain the new codes and increase their awareness of what the documentation requires.

“You will also address the detail that is needed to support the highest level of specificity,” Peterson adds. “Also remember, the current electronic health record [EHR] templates providers are using may require updates. And lastly, any internal billing or charge systems will need to make the new codes available” as of Oct. 1, 2023.

Remember: Medicare and many other payers use ICD-10-CM to process claims, relying on diagnosis codes to demonstrate the medical necessity for your otolaryngologist’s services. Also, Medicare quality reporting programs rely on appropriate diagnosis coding to evaluate appropriate procedures — so missing the boat now could impact your bottom line later.