MAY 17, 2016 – 08:04 PM for ICD 10 Watch
Healthcare providers should be getting ready for an increase in claim denials.
It was mentioned earlier this week that healthcare payers may be simply gathering ICD-10 data they can use identify problems later — like after Oct. 1. This data could drive denial decisions.
Speaking of data. If healthcare payers are going to be using data to find problems in medical practices, shouldn’t medical practices start looking at data to find those problems first?
That’s what Debi Primeau did in her For the Record analysis of eight potential denial targets:
Sequencing: Review the ICD-10-CM guidelines to make sure right ICD-10 codes are chosen for the primary diagnosis.
Aftercare: The Z codes designate specific instances of aftercare. But usually it is correct to use the injury ICD-10 code with the seventh character designating a subsequent encounter.
Seventh character:Speaking of subsequent encounters. It doesn’t mean what many healthcare professionals think it does when they’re trying to be clever.
Unspecified codes:Yes, they do exist. But will auditors start looking for them?
Laterality: It’s great that ICD-10 codes allow to differentiate between the left and right sides of the body. But sometimes one bilateral code is needed instead of two diagnosis codes to designate the left and right side as affected.
Hip and knee replacements: Use ICD-10-PCS codes for removal and replacement.
Missing codes: This may get some physician push back. But the guidelines require supporting diagnoses in some cases.
Medical necessity: This is going to require keeping up with local coverage determination (LCD) and national coverage determination (NCD) updates. If ICD-10 denials haven’t been a problem, that doesn’t mean medical practices have been doing just fine. There may be problems that healthcare payers will be looking for later this year.
Find them before they do.
Questions about ICD-10 codes and 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 [email protected]