Pathology/Lab Coding Alert

Zero in on common codes your lab uses.

If you don’t want a rude awakening next Oct. 1, you need to get ready for how ICD-10 implementation might impact your lab billing staff’s accuracy and efficiency. 

In fact, some experts predict that coders might initially experience a 50 percent or more drop in productivity as they grapple with using ICD-10. That’s why you need to start thinking of ways to maximize efficiencies before the transition begins, if you haven’t already done so. 

Let our experts help you focus on three key ways you can help your coding staff get ready for ICD-10.

Tip 1: Focus on Your Top Codes

The sheer numbers of codes in ICD-10 can be enough to worry any coder or provider. That’s why the first step you can take is narrowing your focus to diagnosis codes that impact your lab or pathology practice the most.

“Practices should closely examine their high volume services relative to changes in coding,” says Duane C. Abbey, PhD, president of Abbey and Abbey Consultants Inc., in Ames, Iowa. Once you identify the high volume diagnoses “then the coding changes can be assessed along with possible increased documentation requirements. By focusing on high volume, and generally high dollar, areas both coding and the supporting documentation can be addressed in a focused manner through increased training.”

Pointer: “Most systems will let you run a report of your most frequently used codes,” agrees Elizabeth Earhart, CPC, coder with a practice in Millersville, Pa. “I also review the code set list for Medicare and make sure I am paying attention to the hierarchy of codes. Coding to the highest specificity now will make it easier for the transition later.”

Good news: CMS is now providing a list of ICD-10 codes that are medically necessary in conjunction with appropriate CPT® codes in the Local Coverage Determination (LCD) data available.

Next steps: Use the general equivalence mappings (GEMs) written by the National Center for Health Statistics (NCHS) as the starting point for cross walking the ICD-9 codes to their ICD-10 equivalents. However, remember that GEMs provide only approximations, and that other, more specific diagnoses might apply in a specific situation.

Tip 2: Rework Your Approach to Documentation

Providers might be able to have less than stellar documentation for ICD-9 coding, but that won’t cut it with ICD-10. Code descriptions will be much more detailed, so start working with your providers now to accurately document conditions so as to match the future code descriptions. 

Labs: This is especially important for labs, because they depend on the ordering physician’s narrative diagnosis or diagnosis code assignment to show medical necessity for ordered tests. Labs can start now to evaluate which ICD-10 codes will demonstrate medical necessity for common tests, and what documentation is needed to support those codes. Then they can work with top clients to ensure that they’re sending the information needed to support the test orders under ICD-10. 

Pathologists: On the other hand, pathologists often provide the diagnosis by evaluating the patient specimen, such as a biopsy. That means your pathologists will need to know how to accurately describe common conditions they diagnose in a manner that supports the ICD-10 descriptors. 

Suggestion: Don’t wait until the new codes are in place to practice better documentation; start adapting to the new documentation style now and it will feel like the transition battle is halfway won.

Step 3: Analyze Your Inefficiencies Now

• If you start with an efficient billing process, you’ll fare better when you make the ICD-10 transition on Oct. 1. That’s why now is the perfect time for facilities to analyze inefficiencies that thwart current performance levels – and strengthen your billing and reimbursement process chain. Abbey recommends that you ask questions such as:
• What are the top reasons you receive denials?
• Does your practice have a strategy to reduce denials?
• How do you address medical necessity issues?
• How frequently must physicians be queried for additional information?
• Is documentation provided in a timely fashion?

Cut denials: If you take the answers to the above questions and use the information to reduce denials now, you’ll be in better shape for the ICD-10 implementation. Even the smallest inefficiencies can multiply, having an exponential effect on productivity slowdown. The more you can begin addressing areas now, the sooner your productivity levels will return to normal under ICD-10.