Evaluation and management (E/M) coding is the bread and butter of a primary care office’s practice. Internal medicine doctors, family practitioners, pediatricians, and general practitioners all rely on accurate E/M coding and billing. Being able to define the level of professional services delivered, based on documented physician work, requires professional billing staff and a thorough familiarity with the E/M requirements in CPT as well as the documentation requirements for diagnosis coding.
Specificity of diagnosis codes is about to undergo a radical realignment, with greater specificity being the new paradigm. ICD-10 billing is expected to revolutionize how healthcare claims get adjudicated and paid. The greater specificity of the codes found in ICD-10-CM will provide third party payers a more accurate picture of the patient’s health and of the reasons the patient is receiving care. The justification of medical necessity will be more apparent due to the new electronic edits that will read the new codes.
This may be a worrisome development for some primary care providers. Many of them are used to documenting to the level of ICD-9 coding. The whole reason for the new ICD methodology is that ICD-9 has too many vague codes that can have multiple interpretations. What this means in practice is that payers don’t always know why they are paying for procedures. The codes on the healthcare claim don’t provide specific enough information.
A complete medical record will contain all the information needed to render a patient’s diagnosis into a 7-character ICD-10 code. However, not all medical record entries are as complete as they could be. Because ICD-9-CM does not require the same degree of information to support a code, some physicians have gotten used to documenting to support “not otherwise specified” codes. There has never been any penalty for this, nor an incentive to document more completely from a billing standpoint, because ICD-9-CM cannot help but report incomplete information.
ICD-10-CM is going to change that. The specificity of ICD-10 codes means that a third-party payer or auditor will know exactly what the patient’s condition is. The medical record will have to support that degree of specificity. An ICD-10 code contains a lot of information, enough to indicate if a procedure is justified much more so than many ICD-9 codes.
What does this have to do with E/M billing for primary care providers?
A complete ICD-10 code will give a clear indication if a patient’s inherent risk, or the severity of their condition. There are already payers that limit the level of E/M service provided for some diagnosis codes. A common example is an edit to automatically recode an encounter for alopecia 99212. With ICD-10 codes, more payers will be able to tailor their edits to the more specific information.
Accurate coding is the hallmark of a successful medical billing practice. Doing things the right way the first time leads to quicker reimbursement, fewer appeals, and fewer denials. At M-Scribe, our medical documentationists are working closely with our clients to prepare for the ICD-10 transition.
Click here to know more about M-Scribe E/M Documentation and ICD-10
Less-than-thorough documentation is going to lead to less-than-accurate codes being submitted under ICD-10. This in turn can lead to those claims receiving increased scrutiny from payers. The more accurate the coding, the less chance there is for exposure to charges of fraud or abuse. Practices that employ billing and documentation professionals have less need to worry in the case of a RAC or other audit. They already know that their coding matches the medical record, which accurately describes the patient encounter. Good coding comes from good medicine.
For more information about M-Scribe Billing Services please contact 888-727-4234.
We’re a professional medical billing service company, providing speciality specific billing and coding services. It isn’t always easy work, as you might imagine. Every medical specialty has its own quirks and nuances when it comes to specialty medical billing and coding. The documentation needs to match the information that is contained a healthcare claim, and the technical language unique to each specialty needs to be clear and concise for auditors and coders.
What makes our job difficult at times isn’t that we don’t understand nephrology billing. Our expert staff understands it quite well. Sometimes, however, other people have a hard time grasping the ins and outs of this specialty. We can’t blame them. Medical billing overall isn’t the most exciting subject, unless you make it your career, of course. At M-Scribe, professional medical billing is what we are all about.
Nephrology is the study and treatment kidneys diseases. Which is usually affected by other systemic diseases such as autoimmune diseases or diabetes mellitus. It can also cause systemic complications such as hypertension and osteodystrophy. Electrolyte imbalances, acidosis, kidney stones, polycystic kidneys, vasculitis, proteinuria and hematuria can all be linked to kidney dysfunction. In the most extreme cases, chronic renal failure can require dialysis or renal transplant.
A number of procedures are ordered and used to diagnosis and treat renal disease. All of the procedure and diagnosis codes used for nephrology billing are governed by guidelines and medical protocols published by third party payers, including CMS, Medicaid, and commercial healthcare insurers. The codes used to bill for nephrology services need to match a particular payer’s guidelines.
We were talking with a client who has been in renal practice for a number of years. Like many physicians, this nephrologist has been making a comfortable income and meeting financial benchmarks that his accountant set for his outpatient practice. At M-Scribe, we have accounting and bookkeeping backgrounds, but our focus is on legally maximizing reimbursement based on payer guidance and medical record documentation. Many nephrology practices forego potential income by not considering the possibility of add-on services. It takes a professional billing company to be able to recognize opportunities that pre- and post-payment audits reveal.
When a physician encounters a patient face-to-face during a dialysis session, while obtaining a needle core biopsy, or when performing an renal ultrasound in the office, the evaluation and management services related to the primary procedure are not unbundled. They are considered integral to performing the procedure.There are times, however, when additional E/M services are provided. When these are adequately documented, these should be billed with the appropriate modifier to receive payment for medically necessary services provided. There is nothing illegal about this. It is not considered upcoding or overcharging when coded correctly and justified in the medical record. Going over these requirements and explaining them to this provider is what kept us busy this week at our office in Atlanta.
In ICD-10-CM diseases of the genito-urinary system fall under the code sets N00-N99. Like other ICD-10 codes, those used to describe renal conditions are greatly expanded compared to the options available in ICD-9-CM. The additional characters and the increased specificity required under ICD-10 will present a challenge to medical coders and billers as they translate the medical encounter into a reimbursable healthcare claim. Providers need to be familiar with the new coding system, as well. Working together, physicians and medical billers can ensure that clean claims are submitted and cash flow won’t be impacted when the mandated ICD-10 transition takes place in the near future.
For more information about M-Scribe Billing Services please contact 888-727-4234.
Some medical practices deal with many workers’ comp cases. Other specialties see them rarely, maybe only once or twice a year. Workers’ comp billing is different from other medical billing specialties. While it still uses the same codes, workers’ comp payers have additional requirements for the CMS-1500 claim form. Under ICD-10, workers’ comp medical billing and coding will become even more of an exacting factor when submitting claims for payment.
Surgical practices, orthopedic practices, chiropractors, internists, and pulmonologists treat patients who have sustained injuries on the job. These treatments are not paid by the patient’s private health insurance. Instead, a company contracted by the patient’s employer will pay them.
A worker’s comp company is not going to pay for treatments that are not directly linked to the patient’s job-related condition. It is imperative the claim form contain precise information required by the payer to recognize what is being billed. For instance, the patient identification is not a social security number, but a case number assigned by the payer.
Unlike most other healthcare claims, worker’s comp claims require the date of initial injury to be included on the CMS-1500. The date must reflect when the payer initially added the case file. Likewise, the diagnosis code used to justify charges must be the code the payer has on file. Communicating with the worker’s comp payer, understanding its needs, and submitting bills to meet requirements is the key to timely worker’s comp reimbursement.
Many physicians are used to submitting healthcare claims, regardless of payer, using the codes found in ICD-9-CM. They are comfortable with ICD-9 and at ease documenting the patient’s record in a way that supports the assignment of ICD-9 diagnosis codes. On October 1, 2014, that reassurance will be removed. ICD-10 codes will become the law of the land.
Diagnosis codes included in ICD-10-CM are more detailed, precise and specific versus what healthcare providers have come to expect. When an auditor reads an ICD-10 code, the patient’s diagnosis is more understandable as opposed to debatable ICD-9 codes.
Many worker’s comp carriers require a secondary or tertiary diagnosis to indicate the circumstances under which a work-related injury was sustained. Under ICD-9, the appropriate code would be V62.1, Adverse effects of work environment. ICD-10 takes greater pains to match the injury to the adverse effect. Crosswalking V62.1 to ICD-10 reveals the following choices:
V57.0 Occupational exposure to noise
V57.1 Occupational exposure to radiation
V57.2 Occupational exposure to dust
V57.31 Occupational exposure to environmental tobacco smoke
V57.39 Occupational exposure to other air contaminants
V57.4 Occupational exposure to toxic agents in agriculture
V57.5 Occupational exposure to toxic agents in other industries
V57.6 Occupational exposure to extreme temperature
V57.7 Occupational exposure to vibration
V57.8 Occupational exposure to risk factors
V57.9 Occupational exposure to unspecified risk factor
ICD-10 offers eleven qualifying supplementary diagnosis codes. Some of these read like E-codes under ICD-9. The difference between ICD-10 and ICD-9 is that the new coding system is designed to communicate maximum information within a limited space. Because of the greater specificity required under ICD-10, the medical record will need to contain the maximum amount of information needed to assign the most accurate code.
At M-Scribe Technologies, we deal with complex coding issues and payer requirements every day. We know the guidelines and requirements that affect your patient population. Instead of muddling through it after repeated denials, our professional medical billers will submit clean claims the first time, and get paid when payment is due.
For more information about M-Scribe Billing Services please contact 888-727-4234.
As usual, it’s been a busy week at M-Scribe Technologies. While we spent much of our time preparing for RAC audits and reviewing National and Local Coverage Determinations, that isn’t all we do. At M-Scribe, we bill for outpatient services with the big picture in mind. While most medical practices deal with the Medicare program, there is one specialty that sees very few, if any, Medicare patients. Accurate pediatrics billing does not usually require Medicare compliancy, but it has a host of other issues to watch out for.
Medicaid covers a large proportion of many pediatrics practices’ patient population. Every state’s Medicaid program is unique. Each has its own requirements. Some people think commercial insurance coverage is confusing. Some people find Medicare difficult and contradictory. Just about everyone agrees that outpatient pediatrics Medicaid billing is the worst. If you are a pediatrics biller, you know what we mean.
One thing that many pediatric healthcare providers do not realize is that they have an advantage over other specialists when it comes to billing evaluation and management (E/M) codes. Other specialists’ patient population are made up of reasonably knowledgeable adults who have at least a layman’s understanding of medicine. A pediatrician’s patient population is made up of children who cannot be entrusted with detailed instructions, and their caregivers are anxious and inexperienced about their child’s health.
According to CPT, a scheduled pediatric appointment can last a long, long time. In some cases, this time spent in advice and counseling or coordinating care can result in a higher level E/M service. As everyone knows, 99215 pays more than 99212. Physicians deserve to be reimbursed for the professional services they perform at a rate that corresponds to that level of service.
When a client called the other day, he asked if ICD-10 billing would impact E/M coding. We discussed various scenarios this physician felt may negatively change how he is reimbursed. He raised issues that he had read on the Internet from unreliable sources. After he expressed his various concerns, he ended by saying, “This whole ICD-10 is just so complicated.” We assured him things will not be that bad, especially if we both work together to prepare ahead.
Pediatrics ICD-10 billing is going to be more complex than ICD-9, but we wouldn’t say it is more complicated. ICD-10-CM is arranged in a logical sequence. Though there are more and longer codes than we are currently used to, each character has a defined meaning in its place. ICD-9 is comfortable because we have been using it for years, but over time it has become a hodgepodge of codes, many of which do not match current medical use.
Of particular note, the 740-759, Congenital Anomalies, series of codes in ICD-9-CM will be described by the ICD-10-CM codes that fall between Q00-Q99, Congenital Malformations, Deformations, and Chromosomal Abnormalities. Just as the terminology of ICD-10 is more precise, so are the codes. The number of codes to describe these conditions is greatly expanded; take the new codes used to describe a diagnosis of a peripheral arteriovenous malformation, something that is unspecified in ICD-9-CM.
When we finished discussing our client’s concerns, he thanked us and we scheduled a convenient time to meet again. As the ICD-10 deadline approaches, we want to help physicians, in every specialty, become comfortable with the new coding system so they can continue to submit clean claims the first time out.
For more information about M-Scribe Billing Services please contact 888-727-4234.
Neurology billing, primary care billing, and emergency room billing are about to become a bit more complicated when patients present a migraine. ICD-10 billing presents a number of challenges to medical coders and billers. The new methodology will require even greater specificity when it comes to assigning codes to healthcare claims, and will have to be supported by the available documentation.
Diagnosis codes used commonly by outpatient neurology practices tend to fall within the 320-389 range of ICD-9-CM, Diseases of the Nervous System and Sense Organs. Migraines are coded 346, with the actual diagnosis code including five characters. For instance, a patient presenting with an intractable migraine without an aura and without mention of migrainosus, is assigned the code 346.11 on the CMS-1500 claim form. Under ICD-10 methodology, diseases of the nervous system are described by the codes contained between G00 and G99.
When a patient presents with a migraine that needs to be translated into ICD-10 diagnosis code, a total of six characters are needed to reach the greatest degree of specificity in order to create a clean healthcare claim. Migraines fall under the G40-G47 subset of ICD-10-CM codes, Episodic and paroxysmal disorders. By understanding the underlying logic of how ICD-10 is arranged, it is expected that less time will be spent cross-referencing the alphabetic and numeric indices.
Under ICD-10 there are 44 codes dedicated to describing various types of migraines. G43 is used to indicate that the patient was treated for migraine, but this code requires three additional characters to report payable diagnostic information. Each additional character builds on the placeholder before it until the sequence of information provides a complete picture of the patient’s medical condition. G43.0 is a migraine without aura. Adding a 1 to this code indicates an intractible migraine without aura. The final, sixth character is used to indicate the presence of status migrainosus — if a patient is diagnosed with an intractable migraine without aura without status migrainosus, the correct code under ICD-10 is G43.019.
After the transition to ICD-10-CM coding, a coder or medical auditor will review the available documentation in the patient’s medical record in an even more systematic manner in order to come up with the most accurate codes. Less will be left to individual interpretation.
Though the implementation date for ICD-10 is scheduled to occur on October 1, 2014, smart medical practices are preparing now for the change. It is anticipated that many outpatient practices will suffer from an interruption in cash flow due to faulty coding under the new methodology. There is no reason for this to happen. At M-Scribe Technologies, we are reviewing the pertinent issues that will affect the crossover. Our certified medical coders and billers are fluent in the language and concepts of ICD-10. Our documentationists are prepared to make recommendations in current documentation standards, and to help “tighten them up” for ICD-10.
Internal billing and coding audits prior to ICD-10 implementation will ensure compliance with future guidelines, when it is needed. Practices partner with M-Scribe's introductory and ongoing refresher training while their claims are posted and reconciled in real time. Different medical specialties will have different needs, but they all require submitting clean healthcare claims.
Working with a professional medical billing company ensures that claims meet the industry’s exacting standards whether the diagnosis codes are ICD-9 or ICD-10. The foundation of accurate claims, timely reimbursement, and minimal denials/appeals is the goal now, and it will be the goal in the future. Start now!
For more information about M-Scribe Billing Services please contact 888-727-4234.
It’s been a busy week at M-Scribe Technologies. Medical billing is an essential component of running a successful medical practice. When you specialize in coding, billing and EHR technology, you should make sure the job is done correctly the first time.
One of our new clients called with an often-asked ICD-10 billing question. “When should we consider preparing for the ICD-10 transition? We have until October of next year. Is it too early to be thinking about it?”
Our professional opinion is that everyone involved in patient care, medical documentation, and medical coding, should be familiar with the changes that are going to affect the industry in the very near future.
It’s like the old adage; "A stitch in time saves nine times the work." Preparing beforehand for changes in the medical reimbursement industry will always result in increased cash flow and accurate reimbursement. Some smaller practices attempt to adapt to industry changes on their own, waiting until the last minute — resulting in frantic scurrying to catch up with the competition. Outpatient medical practices that employ a professional billing and documentation service have the advantage. They earn more by submitting cleaner claims with fewer denials or appeals.
There is such a thing as being pennywise and pound-foolish. It may cost money to hire a professional biller, but that decision will earn more money for the practice than its cost factor. The success of any outpatient medical practice depends on the billing. When billing is accurate and compliant, more money goes into the bank.
As with every profession, a medical biller needs the right tools to get the job done. With the increased automation the industry is undergoing, software programs used to submit healthcare claims need to be constantly updated to meet changing data requirements.
One of the recent requirements that every medical software vendor had to meet was the 5010 conversion. This action was mandated by the Patient Protection and Affordable Care Act of 2010 (PPACA). While everyone has heard of the new legislation that is changing the delivery of healthcare in America, and every healthcare provider is aware of the ICD-10 conversion, few people realize how far reaching these changes will be.
Billing software and interfacing electronic medical records that are 5010 compliant are also ICD-10 compliant, but what does this mean to an outpatient medical practice?
A healthcare provider cannot be expected to master all the information technology and coding methodologies that go into modern medical billing. It is a confusing field full of specialized terminology and advanced concepts. A healthcare provider should spend the majority of their time treating patients. Other professionals should worry about submitting clean claims for payment.
Is today the right time to prepare for ICD-10? Our answer is a bit more urgent than 2012, but it is a resounding “Yes.” The transition from ICD-9 diagnosis coding to ICD-10 coding will take place on October 1, 2014 — there is no time like the present.
At M-Scribe Technologies, we continue to test and upgrade our software for our clients. Our staff of medical documentation professionals, certified coders, and experienced, qualified medical billers are trained and ready to make the transition to the new diagnosis codes. Some practices will be caught unprepared. Our clients know that we are equipped — if we are prepared, so are they.
For more information about M-Scribe Billing Services please contact 888-727-4234.
There’s never a quiet moment in today’s constantly changing regulatory atmosphere where healthcare reimbursement is concerned. Keeping track of current changes in outpatient ICD-9 and CPT billing is difficult enough. When you think about changes that are right around the corner with ICD-10 billing, it's no wonder successful medical practices rely on professionals dedicated to submitting clean healthcare claims every time.
Recently, one of our documentation and coding specialists received a call from a client. She was in the midst of reviewing charts to prepare for a RAC Audit for another client. No worries. The practice being audited has partnered with M-Scribe within the RAC’s window.
“How can I help you?” our specialist asked.
“My doctor has questions about how to document melanoma under ICD-10-CM,” said the concerned medical assistant. Do you think you have time to talk to her?” We always have time to talk about ICD-10 documentation, coding, and billing.
In ICD-9-CM, malignant skin neoplasms fall under code sets 172 and 173. ICD-9-CM reserves the 172 subset for Malignant melanoma of the skin. In order to report a melanoma diagnosis to its greatest degree of specificity, an additional digit is required to indicate the location of the melanoma. Some possible melanoma locations are not included in the 172 subset. Coders are referred to other codes outside those dedicated to skin melanomas.
ICD-10-CM is more thorough and comprehensive in pinpointing the location and pathology of diagnoses documented in the medical record. An auditor reviewing ICD-10 codes has no question of what medical condition a physician is treating in any given medical encounter. The same cannot be said about ICD-9-CM.
ICD-10 is being implemented to reduce confusion in coding and to increase the accuracy of healthcare claims while providing accurate reimbursement for medically necessary services. The detail contained in ICD-10-CM codes must be supported by a patient encounter’s documentation. When that documentation is in place, assigning ICD-10 codes will be simpler and when done correctly, increase cash flow.
The dermatologist got on the phone. “I’ve diagnosed an anal melanoma and I don’t know how to code it,” she said. This is a real medical condition that dermatologists encounter. Nobody likes to talk about it, including ICD-9-CM, which makes coding this condition confusing.
Under ICD-9, 172.5 describes Malignant melanoma of skin of trunk, except scrotum. Cross-referencing, which any good coder will do, shows this code excludes 154.3, Malignant neoplasm of anus, unspecified site. A review of ICD-9-CM’s text shows that melanoma can be coded as 154.3. Melanoma is not necessarily pertinent data when assigning an ICD-9 code, only malignancy. In the case of anal melanoma, ICD-10 provides more explicit direction.
In ICD-10-CM, C43.51 denotes Malignant melanoma of anal skin. This includes: Melanoma (malignant), anus, anal (skin), Melanoma (malignant), perianal skin, and Melanaoma (malignant), perineum.
In ICD-10, if the skin is involved, there is no question about how to assign a code for anal melanoma. The ICD-10-CM describes the exact pathology of the neoplasm as well as the site.
“Will this change what I enter into the patient’s medical record?” the dermatologist asked.
Accurate documentation is vital to a professional medical practice, and is key to good billing practices. If a diagnosis is documented as the physician would like to read it or written by someone else, it should be accurate enough to translate into ICD-10 codes.
There will be challenges ahead when ICD-10 becomes the coding standard in 2014. M-Scribe Technologies is ready to meet them.
For more information about M-Scribe Billing Services please contact 888-727-4234.
While ICD-9-CM and ICD-10-CM share many similarities, the two coding systems are not identical. It is not a simple matter of swapping out a three-character code for a seven character. Medical billing is already a complex and specialized task. ICD-10 billing is going to increase the complexity of choosing a perfect diagnosis code out of a selection of approximately 13,000 possibilities to selecting an ideal diagnosis code out of 68,000 options. There is a challenge ahead for physicians, coders and medical billers starting on October 1, 2014.
It is not that ICD-9 codes cannot be crosswalked to ICD-10 codes, it’s just the result is usually inaccurate. ICD-10-CM codes are designed to communicate the maximum amount of medical information in their reported characters. The amount of data packed into an ICD-10-CM code assigned to its greatest level of specificity does not contain the same granularity that its corresponding ICD-9-CM code does.
The Center for Medicare and Medicaid Services (CMS), which is charged with managing the final publication of ICD-10 codes, refers to crosswalking from ICD-9 to ICD-10 “General Equivalence Mapping.” This is because very few ICD-9 codes have exact equivalents in ICD-10, and vice versa. Any crosswalk from an ICD-9 code only leads in the general direction of the applicable ICD-10 code. ICD-10 includes more detail abstracted from the medical record. No responsible person would crosswalk an ICD-9 code to its unspecified corollary, but it is expected many people will do just that when the ICD-10 transition takes place.
The person applying the codes needs to be aware of the differences between the two coding methodologies. Whether it is the physician, a certified professional coder, a medical documentation specialist, or a professional medical biller, a thorough understanding of the difference between the two coding systems needs to be applied for services provided after 10/01/14. Preparing beforehand, as the staff of M-Scribe Technologies is doing, will ensure that clean healthcare claims will be submitted, no matter what coding system is used.
Under ICD-9 coding, Emphysema is described by 492, with a subset of two codes to specify the patient’s chief complaint. They are: 492.0, Emphysematous bleb, and 492.8, Other emphysema.
One popular crosswalk program directs coders to code either condition as J43.9, Emphysema, unspecified, as an acceptable alternative. Using general crosswalk software will not result in clean claims. In fact, Emphysema is described by ICD-10-CM as being J43, with a number of subset codes, ranging between J43.0 and J43.9. Where ICD-9 utilizes two codes to specify a patient’s emphysema, ICD-10 uses five. A clean healthcare claim will describe a patient’s emphysema as unilateral, panlobular, cetnrilolobular, other or unspecified. If applicable, concurrent or different codes will need to be used based on the patient’s history and presentation. The medical record should contain the required information to accurately describe the patient’s condition in the codes found in ICD-10-CM, but it can’t be done without prior mastery of the concepts used in ICD-10.
There is going to be a paradigm shift on how diagnosis information is communicated between a healthcare provider and third-party payers. Very few ICD-9 codes are exactly matched by the language and methodology of ICD-10. Auditors will read the medical record differently. If the documentation supports a more specific code, payments may be denied or recouped by payers based on the bills submitted.
There is no substitute for professional skill. Professional medical coders and billers know how to use the available software, but they also know when the easy answer isn’t enough. By preparing now, coders and billers at M-Scribe Technologies are ready to make the transition from ICD-9 to ICD-10 now. They can use code books without relying on algorithms and review superbills and medical records, resulting in submission of a clean claim. They are equipped now and ready for the transition, saving outpatient medical practices valuable time and resources catching up with changes in the industry.
For more information about M-Scribe Billing Services please contact 888-727-4234.
The diagnosis coding methodology used in ICD-9 means that many common medical conditions and situations are assigned vague codes out of necessity. Current medical practice and standards have not kept pace with a coding system that was devised over three decades ago. This ambiguity is the reason that ICD-10 is being adopted by the healthcare industry. When ICD-10-CM becomes the outpatient billing standard in 2014, physicians will need to rethink how to document patient encounters and how their documentation will affect their coding. Clean claims using ICD-10-CM billing practices will require expert knowledge.
Professional billing agencies, like M-Scribe, are already prepared to submit clean claims under the new coding system. The software has been programmed to accept ICD-10-CM codes, this was part of the recent 5010 conversion. Software is only part of the solution, however. No computer program will ever replace the professional skills and judgement of a human being. A HCFA-1500 is only as good as the person who enters the claim information. The coding will only be as good as the contents of the medical record.
Factors Influencing Health Status and Contact with Health Services
Both coding systems are designed to accurately describe congenital or pathological abnormalities in a patient’s health status. There are times, however, when a patient presents for a physician encounter that does not quality as a medical diagnosis.
Under ICD-9, these conditions are coded in the chapter entitled, “Supplementary Classification of Factors Influencing Health Status And Contact With Health Services, V01-V91.” These have always been troublesome when submitting healthcare claims since many of these cannot be considered a primary diagnosis. Some of these codes, such as those for counseling, can be primary diagnoses, such as V26.41, “Procreative counseling and advice using natural family planning.” There are very few codes in ICD-9-CM that indicate counseling is the primary reason for a patient’s visit to his or her physician.
ICD-10-CM on the other hand, utilizes the codes Z00-Z99 to discuss “Factors Influencing Health Status and Contact with Health Services.” As with many conditions that a physician encounters, there is no direct crosswalk between ICD-9 diagnosis coding concepts and those utilized in ICD-10-CM. ICD-10-CM represents a paradigm shift that provides for more granularity of data in the patient encounter reporting process. Consider this scenario in the primary care setting:
A patient reports for a routine three-month follow-up appointment hypertension and hypercholesterolemia. During the review of the patient’s history, the patient confides in his or her physician regarding a private matter, requesting medical advice. The appointment takes longer than 45 minutes, more than half of which is devoted to counseling about this specific issue. CPT allows for billing 99215 for this outpatient service, but the diagnosis needs to justify the high level E/M code. Neither high blood pressure nor high cholesterol can be used to justify the higher charge.
Using ICD-9-CM, only a non-specified code can be used to describe the issue that the physician spent extensive practice resources addressing. In all likelihood, this will be denied by the payer with a request for supporting documentation to audit the claim and determine the level of reimbursement. With ICD-10, the reason will be obvious the first time the claim is submitted.
In ICD-10-CM, Z70 refers to “Counseling related to sexual attitude behavior and orientation.” Unlike ICD-9-CM, ICD-10-CM specifies the exact nature of the counseling. With the required inclusion of additional characters, little is left to an auditor’s imagination. There is no need to review documentation because the diagnosis code tells the whole story. Z70 is broken down into four additional specific codes, one code to catch other specified issues, and one unspecified code:
Z70.0 Counseling related to sexual attitude
Z70.1 Counseling related to patient’s sexual behavior and orientation
Z70.2 Counseling related to patient’s sexual behavior and orientation of third party
Z70.3 Counseling related to combined concerns regarding sexual attitude, behavior and orientation
Z70.8 Other sexual counseling
Z70.9 Sex counseling, unspecified.
Diagnosis codes Z00-Z99 to discuss “Factors Influencing Health Status and Contact with Health Services" are one of the many benefits ICD-10-CM has over ICD-9.
For more information about M-Scribe Billing Services please contact 888-727-4234.
No change comes without costs. The transition from ICD-9-CM to ICD-10 is no exception. It can be comfortably predicted that the upcoming change in the medical billing industry are going to cost unprepared outpatient medical practices. To reduce exposure to reduced revenues after the transition, it is imperative for physician billers to be ready to submit the new codes contained in ICD-10-CM for proper payment.
Industry surveys reveal that many outpatient practices are not taking the necessary steps to prepare for ICD-10. Put a frog in a pot of water and put the pot on low heat. The frog won’t realize the water is boiling until it is too late. That’s what the upcoming ICD-10 transition is like. Time is wasting while few practice managers ignore the heat.
On October 1, 2014, healthcare billing will change dramatically. The coding system that has been used for decades is about to be replaced. Outpatient physician practices ignore this impending change at their peril. Hindsight may be 20/20, but foresight will save the bottom line.
Medical practices that perform all their billing functions in house are at particular risk of losing or delaying payments by not preparing for ICD-10. Some doctors say, “We have over a year until we have to be compliant.” That’s true. In medical school, none of them said, “I won’t have to practice medicine for another six or eight years. Why study now?”
Medical practices that use a third-party billing company are at less risk. Professional medical billers, coders, and documentation specialists are already preparing themselves for the ICD-10 transition. Mastering ICD-10 now will prevent dirty claims from being submitted in 2014 and beyond. The best defense is a good offense. Providing reliable, efficient service, submitting clean claims that don’t need to be appealed, and posting accurate, timely payments to a practice’s A/R is essential to keeping a client’s practice financially afloat.
Is it too early to think about ICD-10?
Is it too early to screen for breast cancer when a woman has a palpable lump? Is it too early to order an ECG on a patient with cardiac symptoms? Is it too early to perform an annual physical exam on an established patient? Is it too early to ask probing questions to evaluate a patient’s current health status?
ICD-10 is coming. Business practice, like clinical practice, requires preventative measures. Now is the time to consider the financial impacts of ICD-10.
While hardware and software requirements for ICD-10 billing should have been satisfied with the recent 5010 transition, medical practices who conduct all their billing operations in house need to be ready for further upgrades once ICD-10 is implemented. It is not too early to consider the expenses needed to be 100% compliant with the new standards. Bad software will cause claims to be denied because they do not include codes to the highest degree of specificity required by ICD-10 standards. In-house back office staff cannot be expected to be able to transition from one coding system to the other without adequate training.
Smaller Private Practices are Vulnerable to ICD-10
Medical practices that contract with a professional billing service have an advantage over the competition. Surveys show that physicians who contract their billing to third parties will have less exposure to a reduction in cash flow and in denied claims after October 1, 2014. This is because third party billers will be fully trained, and the medical record software used to transmit data between medical provider and billing agent will be compliant with the new coding methodology.
Training costs will be negligible for medical practices who use a professional billing service. The billing service will absorb the costs of training because it is in the service’s best interest to provide exceptional value. Healthcare providers will need training to familiarize themselves with the new standards, but the coders who submit claims will already be fluent in the new coding system.
M-Scribe is ahead of the curve. We are anticipating the upheaval that the ICD-10 conversion is going to cause. We are prepared to submit clean claims from Day One of the new era.
For more information about M-Scribe Billing Services please contact 888-727-4234.