ICD-10 at Heartland – Five Things You Need to Know Today

Posted on in Education/Training

By Beth Cox Hollingsworth, VGM Marketing ICD-10Heartland The change to ICD-10 coding is right around the corner on Oct 1, 2015. The topic of ICD-10 was clearly on the top of many VGM Members’ minds as the educational session was packed full of eager billing professionals. Presenting was Denise Leard of Brown & Fortunato, P.C., who filled in for Mary Ellen Conway, who didn’t make it to Waterloo because of flight delays. The presentation was chock full of coding details and examples, but here are the top five points that resounded strongly in the presentation.

  1. Your staff should understand the basic “whats,” “hows,” and “whys” of the coding changes.

The codes are becoming more specific for all HIPPA-covered entities to better track the details of why health events occur, how often they occur and the laterality of the incident when applicable. Of course, this is what is described in the coding numbers, and now letters. By collecting in great detail the data of injury or illness, payer sources and government officials will be able to more closely monitor health trends for public policy and incorrect billing practices that potentially add up to fraud. In addition the practice should offer the specificity needed for better care and outcomes. We covered more on the coding changes in a previous article that you can access here.

  1. Billing professionals need to double and triple-check physician documentation.

It will not be the role of billers to assign the new, more detailed coding. But it will be imperative that they review the physician coding and notice inconsistencies and errors. Did the physician’s office accurately identify the correct side of the body? Did you hear information about how the event happened from the patient that varies from the documentation received? Your ICD-10 expert must be able to recognize potential errors at a glance to prevent incorrect coding and denials.

Who is the person in your business to have these conversations with physicians? To maintain relationships, they should be conducted tactfully to encourage a team effort between physician and HME.

  1. Designate an ICD-10 expert.

Who has the final say in your office when it comes to ICD-10 coding? Whose role is it to say, “Yes, this is correct.” Or “No, we need to kick this back to the physician.” Today and no later, you need to designate the person whose responsibility it is to know the details, guide other staff and coordinate communication with the physicians’ offices. For bigger offices, this may be a team of people with assigned duties. For smaller ones, you may just have one who will become your ICD-10 guru.

  1. Create a cheat sheet of frequently used codes.

Your billing professionals should know off the top of their heads many of the codes that are used most frequently. Develop a cheat sheet that crosswalks all of those codes to the new ICD-10 codes. Rarely, the old codes will cross over one to one. But more often, one code will cross over to many possibilities, as the new system has thousands more codes. Develop a cheat sheet that includes all of these possibilities and post it on the wall. Make it accessible to all who see patient records and who might notice errors or inconsistencies.

5. Take corrective action when documentation doesn’t add up – right away.

If your billing pro has doubts about the proper coding or notices that something seems wrong, act quickly! Waiting too long to fix the error will make the problem more difficult for the physician to correct. Don’t procrastinate; make the necessary phone calls to correct irregularities or a more glaring problem.

Click here for Mary Ellen Conway’s PowerPoint presentation that is full of information on ICD-10. For more information about ICD-10, take a look at our previous articles. Don’t Be SCARED, Be PREPARED for ICD-10 (Going Live Oct. 1, 2015) ICD-10 Questions and Answers Received from the MAC Advisory Groups ICD-10 Implementation is Six Months Away – Three Steps To Help You Prepare