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Opinions on specificity of coding.

CPS, C-EMR, PM

Last Post by Anonymous 1 second ago

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petemarkey

(@petemarkey)

Posts: 373

Honorable Member

Topic starter

Got in a heated debate with the folks at the office about if we can roll with the mapped ICD10 codes or not.

Example:

We have just been using 789.00 for adominal pain. Which accurately by GE got matched to R10.9

Maybe we have been lazy in the past, but it worked.

Do you think we will still slide by with R10.9? It is a lowest category code (not missing digits), but in the book highlighted as yellow as "unspecified Dx"

All long as it is not missing digits do you think it will get paid, or do you think they are going to look for the equivalent of a 789.04 (which maybe we should have used before)/R10.32 before we are going to get paid?

Posted : August 26, 2015 4:51 pm

mjharunk

(@mjharunk)

Posts: 191

Reputable Member

Unfortunately, there is going to be a lot of trial and error with coding specificity and reimbursements. CMS's "grace period" is nebulous and only applies to medicare claims. Private payers have been silent on what their expectations are. I am suggesting that all of our practices have extra cash-on-hand to deal with the uncertainty post 10/1.

When in doubt plan for the worst case scenario. Coding to the "highest level of specificity clinically available" is the safest bet.

Posted : August 27, 2015 2:23 am

sborchardt

(@sborchardt)

Posts: 218

Reputable Member

We have also had the discussion in our multi-specialty clinic. Even with the CMS "grace period" we are asking our providers to code to the highest level of specificity. We believe it will be easier to train the providers once and do it correctly, rather than let them slack for the grace period and then try to change bad habits.

Good luck,

Steph B.

Posted : August 27, 2015 3:07 am

Scott Forest

(@sforest)

Posts: 527

Honorable Member

With CPS 12 sp9 the specificity is lacking. GE has been working on a more accurate form of DX search which should arrive with sp10. The issue there is the clinics with LA releases of sp10 have reported incorrect dx coding which has since pushed back the GA release of sp10. We aren't waiting for GE to get its act together. We are going with a 3rd party to walk our coding.

Posted : August 27, 2015 4:27 am

pdangelo

(@pdangelo)

Posts: 140

Estimable Member

An ICD-10 with "unspecified" means the provider is UNABLE to specify further (i.e. they don't know). As I've told my staff, an unspecified otitis media, for example, is unacceptable. You should know at least if we are talking about the right ear, left ear, or bilateral ears.

That being said, unspecified codes may end up being acceptable for some dx's, especially when you have to refer to a specialist or order tests to find out more about the problem (i.e. your provider really does not know more). However, codes ending with a 9 are usually a red flag to check for a code with higher specificity as mentioned above.

In the example you gave, there are codes that specify quadrants and pain vs. tenderness. It is likely that, upon exam, the provider would know some of these things. For example, right lower abdominal tenderness would be coded as R10.813. While R10.9 is "technically" an available code, insurance carriers are looking at claims edits that will weed out these unspecified codes because in many cases, we should know more about the patient's dx. How soon these types of claim edits will hit the private carriers is truly anyone's guess. Months? Years? However, if we are going to invest the time now to train our staff, we should train them correctly. Otherwise, we are opening ourselves up to claim delays, denials, and headaches throughout this process. There is something to be said for doing it right the first time.

We split up our top 100 ICD-9 codes and gave them to all of our front end staff to code. (One ICD-9 code may yield many new ICD-10 codes, so we gave them 11-12 each.) They were responsible for opening the ICD-10 book and finding the new codes and putting them in a Word document. We put everyone's together to create an alphabetical "cheat sheet" custom to our office. This is a great way to get your staff comfortable with coding and to present your clinical staff with a customized tool that will help point them in the right direction for their top codes.

Posted : August 27, 2015 4:42 am

sborchardt

(@sborchardt)

Posts: 218

Reputable Member

We have also gone to a third party option, we started a trial of Blackbird and so far the physician response has been positive (or as well as to be expected). I have built VFE problems forms to replace our CCC. I have set up buttons to have a 1 to 1 match when possible (this has come from working on our coders). For those dx that don't have a 1 to 1 match I use the problems button to launch the blackbird program into the section we want, then the physicians can add any additional information.

Steph B.

Posted : August 27, 2015 4:45 am

pdangelo

(@pdangelo)

Posts: 140

Estimable Member

In response to Scott - there are few ICD-9 codes that have a 1-1 crosswalk to ICD-10. One ICD-9 code may yield many results in ICD-10, especially for ortho codes. No matter what software you use or what SP you get, no one is going to be able to give you 1-1 crosswalks. We have encouraged our staff to use the ICD-10 shown in the "crosswalk" as a starting point. So if Centricity gives you a crosswalk to R10.9, they should search R10 and find a more specific code from the list.

Posted : August 27, 2015 4:47 am

Scott Forest

(@sforest)

Posts: 527

Honorable Member

pdangelo, completely agreed and if there were 1-1s, then there wouldn't be a need to change. GE is coming up with a new walk through which asks questions and has a specificity meter to tell you how close you are to selecting the most accurate and highest reimbursing dx code. Its not being introduced until sp10.

White plume rebuilds your superbill electronically with ICD9 coding, you select the old ICD9 code and it begins crosswalking to the ICD10 code, again, asking questions until it hits the ICD10 code of most specificity and highest reimbursement.

I also like your post above that.

Posted : August 27, 2015 5:21 am

tcross

(@tcross)

Posts: 165

Estimable Member

Want to see what eveyone is saying on this issue. We have rebuilt our problems template with custom lists for diagnoses that have exploded from one code to multiples andthat seems to be working so far. It is a work in progress though. We are a small multi specialty office.

Posted : August 27, 2015 5:40 am

pdangelo

(@pdangelo)

Posts: 140

Estimable Member

We are scheduled for SP10 next week, so I will be interested to see how the coding works!

Posted : August 27, 2015 6:10 am

petemarkey

(@petemarkey)

Posts: 373

Honorable Member

Topic starter

I am on SP10. The Magical "walk you through the specific coding" mechanism is not available to all users, only a chosen few... just FYI

The search is better.

Posted : August 27, 2015 6:28 am

petemarkey

(@petemarkey)

Posts: 373

Honorable Member

Topic starter

thanks sborchardt for the tip on blackbird, just got it installed this morning and trying it, seems to work very well.

Posted : August 28, 2015 4:51 am

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