Primary Care Coding Alert

Doctor should always approve ICD-9 codes, experts say

You have a right way and a wrong way to check ICD-9 codes before you send claims out the door. Coders will usually be the last one to see a claim before it heads to the insurer.

For ICD-9 coding to be accurate and complete, there must be open communication among coders, physicians and other office staff, says JoAnn Baker, CCS, CPC-H, CPC, CHCC, an education specialist in East Orange, N.J.

Coder's challenge: "In order to assign a diagnosis code, you have to make sure you can read the medical record, extract that info out of there, and attach a proper ICD-9 code," Baker says. If coders feel as if they're on their own when diagnosis coding, they may not be inclined to ask a nurse or FP when questions arise about a diagnosis.
"Communication is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures," Baker says.

Follow these expert instructions every time you file a claim to ensure accurate and complete ICD-9 coding.

'Hey, Doc, Could You Explain This?'

The physician should always put the diagnosis code on the face sheet, but just in case he doesn't, check all relevant documentation for ICD-9 codes that support the CPT code on the claim.

"If there's any question as to what the diagnosis is, you should query the physician regarding the diagnosis or procedure method," Baker says.

In fact, Baker thinks that the FP should always be the one putting the ICD-9 codes on claims, since he is the one who actually evaluates the patient.

Run Down Available Resources

"If unsure about any coding choice, I utilize the resources available to me: discussion groups, newsletters, other coders, etc.," says Margaret Lamb, RHIT, CPC, coding expert in Great Falls, Mont. "For ICD-9 coding, the American Hospital Association's Coding Clinic is the most respected and utilized resource."

Think All Is Lost? Contact the Carrier

If you've reviewed all the documentation and conferred with the doctor, and you're still stuck, contact the individual insurance carrier.

When you speak with a representative, ask if your ICD-9 code will be accepted for the service. While you've got the rep on the phone, it wouldn't hurt to ask him what other ICD-9 codes are acceptable diagnoses for the service.