The Art of Diagnosis Coding:
Avoid Errors and Reduce Rejection of Claims
Published on Sat Jul 01, 2000
Correct use of diagnosis codes is crucial to any radiology practices reimbursement. According to Medicare, countless claims each year are rejected as unprocessable for two specific reasons:
Coders do not code to the highest order of specificity; or
Coders do not assign the fourth or fifth digits accurately.
Medicare has long made it clear that truncated ICD-9 Codes codes reported with too few digits will be rejected. Nonetheless, many coders are still not coding to the highest order of specificity, says Susan Garrison, CPC, CPC-H, MPC, CPAR, MCS, president of the American Academy of Professional Coders (AAPC) national advisory board and a senior manager with 3M HIS Consulting Services, which provides coding, reimbursement and management support to physicians and practices in the Atlanta area.
In addition, coders often fail to follow the ICD-9 basic coding guidelines for outpatient and physician services, which state that professionals should code to the highest degree of certainty for each encounter. Some coders make the mistake of assuming that this means every diagnostic code should have five digits, points out Garnet Dunston, CPC, MPC, president and CEO of the coding services firm Dunston Enterprises Inc. in Phoenix, and past secretary for the AAPC national advisory board. They will add a decimal point to a three-digit code and then attach one or two zeroes. This is just as inaccurate as truncating a code that does require more digits.
Either error will cost a radiology practice time and money, Dunston says. Medicare and many other third-party payers consider incomplete or inaccurate codes invalid. This nearly always will result in additional denials, correspondence and payment delays.
To minimize errors made in diagnostic coding, experts offer the following three tips.
1. Understand the reasoning behind the ICD-9 coding system. ICD-9 contains codes with three, four or five digits. Most three-digit codes serve as headings for broad categories, which then need to be further divided. The fourth and fifth digits which follow a decimal point added to the core three-digit code were established to provide more detail about the nature of the disease or condition for which the patient is being seen. Typically, codes with a fourth digit are called subcategory codes, while those with a fifth digit are referred to as subclassifications.
Example of codes that require a fourth digit: The three-digit ICD-9 code 162 (malignant neoplasm of trachea, bronchus, and lung) always requires the decimal point and a fourth digit. The fourth digit identifies the subcategory of the malignancy 162.0, for example, identifies the malignancy as occurring on the trachea, while 162.2 localizes it [...]
