Do You Know as Much as You Should About the Medicare Fee Schedule?

 

Get Ready for the Annual Update by Reviewing Current PFS Highlights

It’s not as highly anticipated as the new NFL season kickoff or the return of pumpkin spice, but CMS’ annual revisions to the Medicare Physician Fee Schedule (PFS) are a fixture of the fall season.

We never know exactly what the new year’s PFS will contain, although the 2019 proposed rule’s drastically reduced E/M documentation requirements and single payment structure for level 2 through level 5 visits caused a stir when published last summer. But we see the details every November: the size of any physician payment rate increase, the revaluations of some reimbursement rates for CPT® codes, the addition or deletion of new codes altogether, new and expanded reimbursement opportunities, and more.

Being a busy practitioner, you don’t have time to read the new Medicare fee schedule each autumn. But of course, you want the highlights. No other single document has a more direct impact on how much you get paid for evaluating and treating Medicare beneficiaries. And plenty of private insurers take their reimbursement cues from the PFS, which makes knowing its contents even more important.

 

The 2018 Medicare Physician Fee Schedule in Review

At MDCodePro, we help you strengthen your documentation so you can always assign patient visits their optimal CPT® codes — the codes that bring you the most money you’ve legitimately earned for your work.

So here are some of the 2018 PFS’ many provisions we thought most notable. This year’s PFS:

• Implemented a 0.41% physician payment rate increase. The amount reflects the 0.5% increase for 2018 established in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, reduced as the Achieving a Better Life Experience (ABLE) Act of 2014 requires when the estimated net reduction of PFS expenditures for misvalued codes doesn’t meet a year’s target.
• Raised the PFS conversion factor to $35.99. The conversion factor (CF) is the monetary amount by which relative value units (RVUs) are multiplied to calculate Medicare provider reimbursement. The 2018 CF is one dime higher than the 2017 CF.
• Allowed physicians to report Level II Healthcare Common Procedural Coding System (HCPCS) code modifiers as patient relationship categories. These categories determine which physician is accountable for a patient’s cost of care. They classify services as broad or focused, continuous or episodic, or only as ordered by another clinician. The voluntary period the PFS establishes allows physicians adequate time to practice using them properly before, at some point, they become mandatory.
• Moved closer to site-neutral payments. The 2018 PFS reduced payments to certain off-campus hospital outpatient provider-based departments by 20% as part of CMS’ continuing shift to “site-neutral” payments. This is intended to rein in Medicare provider reimbursement expenses and “level the playing field” between hospitals and physician practices.
• Added new CPT® codes. Providers can now use several new HCPCS and CPT® codes related to telemedicine, including the unbundled CPT code 99091, which lets providers receive separate payment for time spent collecting and interpreting remote patients’ data. The PFS also replaces several Medicare G-codes for reporting care management services with CPT® codes.
• Expanded the Medicare Diabetes Prevention Program (MDPP). CMS’ response to the nation’s diabetes crisis educates prediabetic beneficiaries about health and lifestyle changes they can make to delay or prevent the disease’s onset. The 2018 PFS includes the policies providers need to implement MDPP and get paid for it.

2018’s PFS final rule also summarized comments, solicited in the proposed rule, about revising CMS’ E/M documentation guidelines. The rule noted widespread support for such revision but offered no consensus about what revisions would be best.

You can be sure we’ll weigh in on the revisions the 2019 final rule brings, as well as other provisions specifically affecting documentation and coding.

 

Grow Your Revenue Much Faster Than the Medicare Fee Schedule Can

You can also be sure, no matter what each fall’s final PFS rule holds, that the MDCodePro app can help you and your organization document and code patient visits more accurately, efficiently, compliantly, and profitably starting right now.

Why settle for whichever small physician payment rate increase is in next year’s PFS when you could start growing your bottom line a lot more through better documentation and optimal coding today?

The hundreds of physicians who’ve already learned and started putting the MDCodePro method into practice have grown their revenue, on average, by $30,000 a year.

Discover the difference MDCodePro can make for you. Click here to request more information.

The post Do You Know as Much as You Should About the Medicare Fee Schedule? appeared first on MDCodePro.

source https://mdcodepro.com/blog/physician-payment-rate-increase/

Do You Know These Front-End Fixes for Common Medical Billing Mistakes?

 

Use These Practical Strategies for Keeping Claims from Coming Back Unpaid

Remember the kids’ song, “The Cat Came Back?”

In the song, old Mr. Johnson tried everything to get an unwanted feline out of his home (including, in some decidedly kid-unfriendly versions, tactics that would provoke The Humane Society’s wrath). But, as the refrain repeatedly tells us, “the cat came back the very next day.”

At MDCodePro, we see many healthcare organizations struggling with common medical billing issues, and we can’t help but think of Mr. Johnson’s cat.

Providers submit claims to payers and think they’ve seen the last of them. But soon enough (though not the very next day), the claims come back, rejected or denied, to cause chaos counted in lost time, lost energy, and lost income.

Challenged revenue in today’s healthcare sector amounts to between $11 billion and $54 billion a year. Hospitals and health systems see up to 3.3% of net patient revenue, or $4.9 million per hospital, jeopardized by denials. Even private practices with industry average denial rates of 5-10% can see huge shortfalls due to returned claims, as in a scenario professional coder Yvonne Dailey presented at one conference in which a practice’s $945 daily loss through denials totaled $226,800 by year’s end.

That’s entirely too many “cats coming back!”

While some rejections and denials are inevitable, many are preventable. Investing extra time, effort, and (in some cases) expense to avoid the most frequently found medical billing mistakes before you ever submit your claims can ultimately pay off in greater profitability.

So what can your organization do to correct medical billing errors and get claims successfully out the door so only revenue comes back?

 

Five Ways to Fix Your Billing Problems Before They Begin

Here are a few tips for taking care of medical billing issues commonly responsible for rejections and denials.

1. Double-Check All Patient and Provider Information
   We know; it sounds too simple. But errors as minor as a misspelled name, an out-of-date address, or transposed digits in an insurance ID number can and do get claims rejected and returned. The AAFP recommends strengthening front-end staff’s data entry skills and implementing technological safety nets for catching mistakes as soon as they happen (for instance, alerting users when they enter too many or too few digits in a given field).
2. Verify Patient Eligibility
   A denied claim shouldn’t be your first sign a patient wasn’t eligible for the services you provided. People’s insurance statuses can change quickly, so ask patients about their plans when scheduling appointments and at every visit. Insurers’ website portals, clearinghouses, and some practice management systems will help you verify what services a patient’s insurer will cover, and whether patients have maxed out their benefits. Keep all verification information should you need to prove patients’ eligibility later.
3. Provide Only Authorized Services
   Like it or not, you’ve got to treat patients by their insurers’ rules if you want to get paid. That means ensuring patients obtain a referral (if you’re a specialist) and providing only those services you’ve received prior authorization to provide. As a 2017 AMA survey shows, the prior authorization process is slow and burdensome, but until reform happens (and some positive changes may be stirring), ignoring it will only cost you time and money.
4. Avoid Duplicate Billing
   It’s often hard enough to get insurers to authorize a service once. They’re not eager to pay for the same service twice. Granted, many “duplicate” bills result from simple human error—for example, no one removed a canceled procedure from a patient’s account. But payers are vigilant to the threat of fraud, and duplicate bills raise big red flags. Establishing and sticking with an internal audit system can cut down on your risk of submitting duplicate claims.
5. File Claims On Time
   Most private insurers don’t share Medicare’s year-long window for filing claims. Time limits of 30, 60, or 90 days are more typical. Failing to file claims on time is a surefire way to see them come back denied. And once deadlines have passed, you can’t appeal or bill the patient. Make sure your billing staff knows how quickly the insurers with whom you regularly work expect to see claims while generating and saving electronic proof of timely filings.

 

Fix Number Six: Equip Practitioners to Avoid Medical Coding Errors

Whether they’re too high (overcoded), too low (undercoded), mistakenly applied (as modifiers often are), or missing altogether, diagnosis and procedure codes often get claims returned unpaid. Incorrect coding is one of the most commonly cited medical billing issues keeping providers from getting paid the first time around.

Ensuring quality coding isn’t just a job for your staff’s professional coders or a third-party coding and billing service. Quality coding only happens when physicians and other practitioners provide quality documentation. The more your clinicians know about how to document a patient visit accurately and code it correctly, the more clean claims you’ll submit, and the faster you get paid.

Why not find out for yourself? The MDCodePro app is the proven way to translate practitioners’ improved documentation and coding into more revenue. Hundreds of doctors who’ve learned and started using the multiple audit-validated MDCodePro approach have seen their annual incomes increase by $30,000 on average.

Sign up for your MDCode subscription today, and see what a difference it makes in helping you avoid the consequences of inaccurate coding and incorrect billing by steering clear of those inaccuracies to start with. You’ll have far fewer claims come back… except in the form of payment!

The post Do You Know These Front-End Fixes for Common Medical Billing Mistakes? appeared first on MDCodePro.

source https://mdcodepro.com/blog/common-medical-billing-issues/

What Makes Physician Coding Education Key to Practice Profitability?

 

Fill This Hole in Med School Curricula to Manage Revenue More Effectively

What didn’t your organization’s doctors learn in med school that they wish they had?

Physicians know they have knowledge gaps—from data science and information technology skills to being able to talk about nutrition with patients. Medical schools are changing to help students master more of what they must know, turning to team-based. cross-disciplinary “flipped classrooms” and more hands-on learning.

But physician coding education, which no medical practice can afford to ignore, continues to go neglected.

Barbara Fontaine, an AAPC Coder of the Year, compares medical coding and billing to “a language in which all doctors should be proficient.” Unfortunately, even though students would like to learn it, medical schools don’t usually offer physician coding classes to expose future doctors to this language they’ll have to use to translate their expert knowledge and hard work into revenue.

The MDCodePro app is one way physicians can get the coding education med school never gave them. And because strong cash flow in medical practices depends, in large part, on strong coding, the app can also play a key role in profitable revenue cycle management.

 

How Training Physicians in Medical Coding and Billing Enhances the Revenue Cycle

Several recent developments in U.S. healthcare have made revenue cycle management an especially pressing challenge. But better medical coding education for doctors helps practices meet the challenge at every turn.

Here are just four examples:

• The Affordable Care Act – More Patients Mean More Codes to Correctly Submit
  The Tax Cuts and Jobs Act effectively repealed the ACA’s individual mandate, but “Obamacare” still means the number of Americans without health insurance has dropped from 45 million to 27 million. Providers are seeing more patients, nearly half of whom (46.2%) are covered by Medicare and Medicaid combined. Given the government’s low reimbursement rates, you don’t want to forfeit any legitimately earned revenue, which means the coding in your submitted claims must be precise and optimized every time.
• Value-Based Payment – Raising the Stakes for Documentation and Coding
  Under CMS’ Quality Payment Program (QPP), which implements MACRA (the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act), providers are paid on the basis of effective use of resources, clinical improvement, and improved patient outcomes. In the “pay-for-performance” model, only targeted diagnostic and procedural coding grounded in accurate, comprehensive documentation will demonstrate value and quality. Many auditors are already looking beyond transactional coding for evidence of how a practice’s coding reflects efforts to improve clinical documentation. Teaching physicians stronger documentation and coding skills now gives you an advantage.
• ICD-10 – Diagnostic Specificity Demands Appropriately Matched Procedure Codes
  After three delays, the U.S. implemented ICD-10 in October 2015. The extensive set of 69,823 diagnostic codes and 71,924 procedure codes enables coding with extreme specificity, which leads to better patient care and better clinical data. Providers must make sure the procedural code aligns with the diagnostic code’s specificity. A mismatch can mean rejected claims and less reimbursement. Educating practitioners how their documentation can support the most specific code will guard against reduced revenue.
• EHRs – Costly Adoption Makes Coding Accuracy Matter More
  Medicare’s Electronic Health Records incentive program, or “Meaningful Use,” is now part of the Merit-Based Incentive Payment System (MIPS). EHR adoption is often expensive, costing as much as $32,500 per physician in 2015. So it’s essential practices train practitioners to take full advantage of EHRs’ automated documentation, coding, and billing features, all of which can increase efficiency and revenue. But clinicians can’t substitute automation for their own coding know-how, and must learn how to avoid such frequent EHR mistakes as copy-paste errors that lead to rejected and denied claims.

Accurate, optimal coding isn’t the only factor in medical practice profitability. But, as you can see, it is an indispensable one.

 

Give Your Physicians a Practical, Profit-Enhancing Coding Education

At MDCodePro, we want to help medical practices operate more profitably by improving their documentation and coding in revenue-enhancing ways.

Our innovative, user-friendly app is one way we do it. Its short video lectures break down CMS’ complicated coding guidelines into an easy-to-understand, easy-to-implement approach for improving documentation. And its intuitive, step-by-step code generator lets you convert that documentation into the CPT® code that captures the maximum appropriate revenue for every patient visit. The MDCodePro app is the coding class physicians never had but urgently need to increase practice profitability.

We also continue physicians’ coding education with webinars.  Please reach out to us at info@mdcodepro.com to sign up for our next webinar.

Don’t let the coding education hole in med school curriculum keep your practice from developing a healthier revenue cycle and achieving greater profitability. Register for the webinar today.

The post What Makes Physician Coding Education Key to Practice Profitability? appeared first on MDCodePro.

source https://mdcodepro.com/blog/physician-coding-education/

Better Physician Coding Helps You Earn Maximum Revenue the Right Way

 

There Is a Better Way to Make More Money Than Filing Iffy Top-Dollar Claims

It’s probably happened to you more times than you could count. You’re seeing a patient for “routine” reasons, only to discover you’re dealing with quite a complicated case.

Have you had enough physician coding training to code visits like those correctly?

Do you code the visit as it deserves, confident you can back up your judgment?

Or are you tempted to stick with a level 3 code because it’s the norm for (so-called) “routine” visits, and you don’t want to appear to be overcoding?

 

Doctors Who Bill Medicare For Top Dollar

You don’t have to take a medical coding course to know overcoding is a problem, especially in the Medicare system.

In recent years, independent investigative news site ProPublica has been shining a critical spotlight on providers who routinely bill for patients’ office visits at the highest level Medicare allows.

For example, the site reported one Alabama physician billed 4,765 office visits at level 5 in 2015—more than any other U.S. doctor—and received almost $450,000 in Medicare reimbursement.

And an OB-GYN in Michigan billed almost 201 Medicare beneficiaries’ visits at the highest level, the site states, and got paid “for an average of eight such visits per patient” in 2012.

ProPublica says its analysis of publicly available Medicare data revealed over 1,200 health professionals billing “only at the highest level” in both years, and another 1,800 doing so at least 90% of the time. In contrast, only 4% of office visits nationally were billed at the top rate in 2012.

Many consistently top-billing doctors defend their charges, citing an aging population that lives with multiple chronic conditions.

But Dwayne Grant, an HHS regional inspector general, told ProPublica he doesn’t think it’s “very probable” that some providers treat only the sickest, most complex patients. And several physicians ProPublica points to have faced complaints or disciplinary charges.

According to HHS, providers are billing with high-level E/M codes more often and Medicare is paying more for E/M services, which are 50% “more likely to be paid for in error than other Part B services.” So it’s no wonder billing outliers like the doctors in ProPublica’s reports get scrutinized. Persistent patterns of top-dollar billing seem like logical places to look for fraud.

But do news stories like these make you too reluctant to code your patients’ visits as level 5, or even level 4, when those levels really do apply?

After all, you don’t want to end up the target of a medical coding audit—let alone an exposé on a major website like ProPublica.

 

MDCodePro Strengthens Documentation and Medical Coding for Doctors Like You

Deliberate undercoding isn’t the right choice. It’s just substituting one extreme for the other, plus it’s unethical and illegal.

The best way to avoid seeming like anything but the responsible, conscientious practitioner you are isn’t to hedge your coding but to hone it.

And better coding begins with better documentation. The more your notes and charts comply with the E/M coding guidelines, the more confident you will be that you can fully justify any CPT® code your patient’s complexity actually warrants—and the more legitimately earned revenue you’ll receive as a result.

The MDCodePro app will help you do it.

With MDCodePro, you get a manageable and memorable approach to the often bewildering E/M documentation rules so you can use them as helpful guides for quality patient care and practical tools for securing all the revenue you’ve earned.

The hundreds of doctors who’ve started using MDCodePro’s proven physician coding methodology have seen their annual income go up, on average, by $30,000.

Thanks to MDCodePro, they’re not afraid to bill Medicare and other payers top dollar when their patients’ complexity calls for it and their documentation supports it.

You don’t have to be, either. Fill out this form now to find out how our medical coding training for physicians can help keep you fully compliant and fully reimbursed.

The post Better Physician Coding Helps You Earn Maximum Revenue the Right Way appeared first on MDCodePro.

source https://mdcodepro.com/blog/physician-coding/

Five Key Questions for Tackling Aging Healthcare Accounts Receivable

 

Pursue These Strategies for Getting Outstanding Balances Paid Faster

Your organization’s practitioners know the challenges of caring for an aging patient population.

But as a billing administrator, you may feel challenged by another aging population—the outstanding balances piling up in accounts receivable (A/R).

When insurance claims and patient bills go unpaid for too long, your organization loses money. Treating patients, buying supplies, paying wages and salaries (including yours), keeping the lights on and the doors open . . . aging accounts receivable pose serious challenges if ignored.

Fortunately, a mix of traditional and innovative healthcare business solutions, including our own MDCodePro medical coding app, can help you “turn back the clock” on aging A/R and keep your revenue healthy and strong.

 

Faster Medical Billing Solutions Urgently Needed

Fighting the effects of aging healthcare accounts receivable should be one of your top priorities. The longer it takes you to collect an unpaid balance, the less likely it is you ever will.

The Fox Group healthcare consulting firm says the benchmark for a high-performing medical billing department is 30 days or fewer. Average departments take 40-50 days from sending a claim to collect it. Below average departments take 60 days or more.

Which of those buckets does your organization’s billing department fall into?

If it’s not where you need it to be, don’t give up hope. With innovative healthcare business practices and hard work, organizations can turn things around. One practice in Lacey, Washington, for example, got its A/R older than 90 days down from 40-50% to 10% in a year, as Physicians Practice reported.

But you don’t want to wait for your aging A/R problem to become so dire before taking action. After all, by the time A/R hit 90 days, they could be worth as little as 20% of what they first were.  

Start Planning Your Improved Medical Billing Processes

Here are five questions to help you take stock of your current A/R and start thinking about how to bring in more revenue more quickly:

1. Are you routinely reviewing your A/R aging report?
   Yes, as a busy billing administrator, you’re buried under physical and digital piles of paperwork each day. It’s easy, and understandable, to set some spreadsheets aside for later in favor of reports you think are more pressing. But your organization’s A/R aging report always warrants your personal attention.Because it classifies the amounts you’re owed into standard “buckets”—overdue by 0-30 days, 31-60 days, 61-90 days, and so on—the report shows at a glance how your billing department is doing, and where to focus collection efforts to make the most difference in the quickest time.
2. Is your organization’s billing focused on the patient’s experience?
   More Americans are using high-deductible insurance plans, so patients’ out-of-pocket responsibility now makes up 18% of healthcare provider revenue, according to athenaInsight. Don’t resign yourself to recovering a mere fraction of those balances.Train front desk staff to diligently verify patients’ insurance status and coverage, and to talk with patients about financial obligations. Send patients easy-to-read bills—people are naturally reluctant to pay confusing ones—and work with them to establish affordable payment plans. Surveys show patients are willing to switch providers in order to find payment plans they can manage, so why shouldn’t they switch to you?
3. Have you automated your claims management as much as possible?
   Although providers use a lot of advanced technology to care for patients, they don’t always use high-tech healthcare billing solutions to get paid faster. For example, 52% of providers in one survey didn’t automate patient payment plans. The Council for Affordable Quality Healthcare found “adoption levels of fully electronic transactions actually declined for claim payment and prior authorization” in 2017.Managing patient bills and payer claims manually makes you less efficient and less profitable. Automation can help you manage claims more quickly, with more accuracy and less potential for time-wasting human error like missing information or missed deadlines.
4. What are you doing to bring down your denial rate?
   Denied and rejected claims mean delayed or forfeited revenue. Outstanding balances keep aging while claims get reworked, and reworking and resubmitting claims isn’t free: Each one costs $25 on average, which adds up quickly.Ensuring timely filings, complete and accurate information like patient identification and eligibility, and proper navigation of tricky issues like bundled services and CMS billing modifiers can keep your denial rate low and your cash flow steady. Every 15 denials you prevent each month get unpaid balances paid faster and save $4,500 in rework costs annually, according to AHIMA trainer Richelle Marting in FPM.
5. How are you training your clinicians in better documentation and coding?
   Inaccurate medical coding is a key culprit behind organizations’ reduced and missed revenue. If physicians and other practitioners aren’t submitting the optimal codes for the work they do—the codes that bring the most amount of money warranted by their patients’ risk and the complexity of their own medical decision-making—they’re sacrificing legitimate revenue for no reason. But when practitioners receive training in documenting and coding their visits thoroughly and in full compliance with regulations, they’ll be able to act as a front line against aging A/R. Claims will be cleaner, which means they’ll be paid faster.

 

Make the Connection Between Coding and A/R Work for Your Bottom Line

The MDCodePro app can’t review your A/R aging report for you, or counsel your patients about finances. It’s not an automated claims management system.

But it can indirectly help you lower your denial rate by directly equipping your practitioners with practical knowledge about and powerful tools for optimal medical coding. That makes MDCodePro one of the most innovative business solutions your healthcare organization can use to turn unpaid A/R into more robust revenue.

Once your physicians and other clinicians watch the app’s short series of video lectures and start using the documentation approach they learn—a methodology validated in audit after audit—they’ll be able to code visits comprehensively and cleanly. Their notes and charts will support any visit’s optimal CPT® code. And they’ll have no problem confirming or finding those codes with the app’s easy-to-use, step-by-step code generator.

Stronger documentation means better coding in your claims, which goes a long way toward turning that aging population of A/R balances into the revenue your practice needs and deserves.

Ready to find out more? Then click here to arrange a free demonstration and a 30-day free trial.

The post Five Key Questions for Tackling Aging Healthcare Accounts Receivable appeared first on MDCodePro.

source https://mdcodepro.com/blog/innovative-healthcare-business-solutions/

Know Why Those “Absurd” ICD-10 Codes Aren’t So Funny After All?

 

“Struck by Duck” Makes a Good Meme, but Specific Coding’s a Serious Thing

In October 2015, U.S. healthcare providers started using the ICD-10 coding guidelines. But even before the much-delayed implementation took place and even since, this system of over 69,000 diagnostic codes and nearly 72,000 procedural codes has been giving the internet a lot to laugh about.

Search the web for ICD-10 codes, and it won’t be long before you find cherry-picked lists of codes labeled everything from “funny” and “silly” to “wacky” and “absurd,” even “ridiculous” or “outlandish.” These aren’t adjectives you’d normally expect to find in healthcare discussions, let alone discussions about a subject as technical as medical coding.

Now, we at MDCodePro enjoy a good joke. And it’s hard to deny some ICD-10 medical coding examples sound… well, odd… out of context and in isolation. But even the seemingly strangest ICD-10 codes start to make sense when you consider the guidelines’ commitment to and capacity for specificity.

We value specificity, too, and stress it in our physician coding training, because caring for patients and submitting medical claims to your payers without sufficiently specific documentation and codes is no laughing matter.

 

5 Much-Mocked Entries on the ICD-10 Code List

So what are some diagnoses from the ICD-10 coding guidelines frequently singled out for ridicule?

• W61.62XD – Struck by duck, subsequent encounter
  “Struck by duck” shows up on most lists of “bizarre” ICD-10 codes, maybe because it conjures mental images of a certain supplemental insurance mascot angrily and repeatedly pecking a potential customer while loudly quacking the product’s name. Plus, it’s an undeniably memorable rhyme.
• V91.07XA – Burn due to water-skis on fire, initial encounter
  The flaming water-skis draw plenty of online potshots. Did some water-skiing daredevil attempt a stunt that went horribly wrong? Or did a beach bum suffer too close a brush with unconventional bonfire kindling?
• V97.33XA – Sucked into jet engine, initial encounter
  Here’s another one on the web to make fun of. It might even evoke designer Edna Mode’s firm rule about superhero costumes in The Incredibles:  “No capes!”
• Y92.241 – Library as the place of occurrence of the external cause
  This one sometimes gets glossed as “hurt at the library” in selections of “weird” ICD-10 codes, as though it’s absurd to think a safe, quiet haven for books could present any dangers. What injury code would accompany this circumstantial one—a paper cut (W26.2)?
• Z63.1 – Problems in relationship with in-laws
  One last example: The code that may seem to scream for a punchline from a vintage Henny Youngman routine.

Lists of “laughable” ICD-10 codes seem to imply the quest for specificity in diagnosis and coding can be taken to outrageous extremes. But is snickering at specific codes justified?

 

“Funny” ICD-10 Coding Examples Don’t Make Everybody Laugh

As you may already know from your own practice, one person’s “funny” code is another’s all too serious problem.

“[W]e can be [a] bit too flip when we encounter ICD-10 codes that sound rather zany or absurd,” ICD10 Watch editor Carl Natale wrote for Healthcare IT News. He talks about two people who have, in fact, survived being sucked into jet engines—and about as many as 40 cases annually of young children who did not survive drowning in five-gallon buckets of water (W16.221).

Or consider code Z63.1, or others along the same lines like Z62.891 (sibling rivalry) or Z62.1 (parental overprotection). These codes represent real, problematic family dynamics taking a serious toll on people’s health, or their access to health services. Providers must consider these factors to give patients the holistic healthcare they want (and that value-based payment rewards).

 

Why Getting Detailed Matters in Medical Coding and Billing

Even setting aside empathy as a reason for not mocking ICD-10 codes, the system’s ability to capture more information for better patient care, richer clinical data, and improved revenue makes these codes matter.

Medical writer Jennifer Della’Zanna urged readers to focus not on “crazy things” but “critical things [that] can be coded with ICD-10 that could not be coded with ICD-9,” such as Ebola (A98.4). She points out the “funny codes” people snigger at are all external cause codes most coders seldom if ever have to deal with. The remaining 91% of the codes prove the system’s worth.

Because they are capturing more data when using ICD-10 coding guidelines, providers can, as AHIMA’s Sue Bowman explains:

• Track patient outcomes more effectively and gain more insight into improving them.
• Identify patients needing disease management more easily and customize their care in more appropriate ways.
• Contribute to researchers’ clearer understanding of diseases, which can ultimately improve public health and influence more informed health policymaking.
• Evaluate new medical procedures and technologies more accurately, investing their time and money in those proven to impact patient care in positive ways.
• Reduce ambiguity and increase consistency in their documentation and coding, which means a lower coding error rate and fewer rejected claims.

Granted, none of these or ICD-10’s other benefits come automatically. Providers must take advantage of the opportunity the system offers for higher specificity, as Dr. Joseph Nichols emphasized for ICD10monitor. But those whose documentation supports its more specific diagnosis codes should ultimately see those codes pay off for their patients and their practices—no joke!

 

The Fastest Way to Make Your Documentation and Coding More Specific

The MDCodePro app helps you assign each patient visit its optimal CPT® code. It assumes your correct knowledge and use of diagnostic codes.

But its emphasis on charting patients with greater accuracy, comprehensiveness, and specificity will also serve you well as you work with the ICD-10 coding guidelines, not just the CMS E/M documentation rules. Documenting visits in enough detail to support the most specific and highest appropriate codes possible is key in both systems.

The easy-to-use principles you’ll discover in MDCodePro’s short video lectures and watch at work in its powerful Code Generator will make your documentation and coding more specific. You’ll capture more of the hard work you do treating your patients, and claim more of the reimbursement you’ve legitimately earned.

Want to find out more? Click here to connect with us so we can answer your questions.

The post Know Why Those “Absurd” ICD-10 Codes Aren’t So Funny After All? appeared first on MDCodePro.

source https://mdcodepro.com/blog/icd-10-coding-guidelines/