ICD_10 revalidation Credentialing

by CARL NATALE  OCT 28, 2015 – 05:51 AM

U.S. healthcare is waiting to see how ICD-10 implementation affects reimbursements. The fear is that ICD-10 claims will be denied at a greater rate than before Oct. 1 — either by design or error. And that is going to trickle down to physicians in the form of queries.

And if a medical practice wants to avoid an increase in denials, it needs to help physicians provide more clinical detail to support the proper ICD-10 codes. That will most likely come in the form of queries.

Do you really need to query?
But medical coders need to make sure they really need to query. Pamela Haney lists four tests of whether an ICD-10 query is needed:

Does the medical record contain conflicting information?
Are there elements or information missing from the medical record?
Are there conditions or procedures that need more detail to support a specific ICD-10 code?
If there is an unspecified diagnosis, is there information that suggests a more specific diagnosis is possible?
The Journal of AHIMA published guidelines that explain writing a query is needed when clinical documentation:

“Is conflicting, imprecise, incomplete, illegible, ambiguous or inconsistent”
Describes clinical indicators that don’t clearly support the underlying diagnosis
Includes clinical indicators, evaluation, and/or treatment that does not seem related to any medical condition or procedure
Does not support or validate a diagnosis
Does not support the present on admission indicator
If you have to query
Review some quidelines on how to write better queries for information that supports ICD-10 coding:

Be written in clear, concise and precise language
Contain evidence specific to the case
Be non-leading
Be part of the clinical documentation
Include ICD-10 language

But even these optimized queries will be a drain on medical coder productivity and take physicians’ time away from patient care. The best practice is to take time before physicians write their notes to explain what clinical documentation is needed to avoid the queries and denials.

Questions about ICD-10 reimbursement? Physician Credentialing and Revalidation ? or other changes in Medicare, Commercial Insurance, and Medicaid billing, credentialing and payments? Call the Firm Services at 512-243-6844 or credentialing@thefirmservices.com 
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