Medical Billing, Coding and Documentation Services

ICD-10 Planning and Assessment

Posted by Harold Gibson on Tue, Mar 25, 2014

ICD-10 implementationIf your practice or organization hasn’t already begun the processes of assessing, planning and implementing training and other matters related to transitioning to the ICD-10 coding October 1, 2014 deadline, there is still time to become trained, systems-ready and become compliant before then. If you’re not sure where to begin or what considerations and tasks should be on your readiness checklist, M-Scribe and its team of experienced professionals can help make the transition process easier and faster for you and your staff.

Perhaps the most critical part of a practice’s successful transition to the new ICD-10 coding system is the Planning and Assessment stage. Proper planning lays the groundwork for your health care billing team to obtain the necessary upgraded software, equipment, and training as well as to develop staff proficiency with the new coding system well ahead of the October deadline. Waiting until the last minute can result in overlooking necessary tasks and processes, leading to frustration, deficiencies in staff ICD-10 readiness training, unexpected software and other systems upgrades causing billing, posting and other delays, as well as other coding and billing headaches.

M-Scribe’s team can assist you and your staff with the following tasks to ease the transition to ICD-10:

  • Develop a list of tasks that need to be completed prior to implementing the ICD-10 coding in your practice or organization, as well as develop a realistic timetable for completion. These will include identifying tasks, those responsible for executing each task, resources and other dependencies specific to your practice or organization, its existing policies, processes and systems, as well as where the current ICD-9 fits in with the organization, and the expected effects of ICD-10 changes to the practice, including electronic health records.
  • Identify and plan a realistic and comprehensive budget that includes upgrades to software as well as training expenses, coding guides and Superbills.
  • Work with you to designate transition responsibility to either one person among your staff or to a committee, depending upon your organization’s size and budget.
  • Review the facts and background information about ICD-10 and its benefits with both management and billing staff. The new coding’s benefits include expanding the flexibility of coding by increasing the length to seven characters, thus permitting coding specific complications, severity, conditions and other factors affecting accuracy and detail. More detailed reporting as well as analytics outcomes and utilization should result in improved claims reporting and processing on both the practice’s end as well as with the carriers. When your staff understands the reasons behind the new coding, learning the new ICD-10 system will seem less burdensome.
  • Identify necessary changes to systems, as well as costs and testing to successfully transition. You will also need to ask your software and/or systems vendors about the time frame required for testing, including starting and ending dates.
  • Review transition plans and contracts with affiliated physicians and hospitals, trading partners and other vendor agreements, including billing services, clearinghouses, and software or systems vendors for their ICD-10 readiness.

Once the initial planning and needs assessment is in place, M-Scribe’s team can assist you with the implementation and adoption of ICD-10. Your practice should find that with the adoption of ICD-10, with its more sophisticated and detailed coding, it will be easier to establish more efficient payment services as well as weed out fraud and abuse, improve medical decisions on a clinical level, measure the quality of patient care and keep track of issues in public health.

M-Scribe Technologies, LLC has been a leader in the health care billing and documentation services industry since its founding in 1999, serving practices of all sizes and specialties. Contact us today at 888-727-234 or visit us online for an in-depth consultation and evaluation of your practice’s unique needs to ensure that your organization is ICD-ready and compliant before the October 2014 deadline.

Tags: ICD-10, ICD-10 Coding, medical coding

Don't Allow New Documentation Rules Translate to Lower Quality Patient Care

Posted by Harold Gibson on Thu, Mar 13, 2014

New Documentation RulesAccurate patient record documentation requirements hopes to "foster quality and continuity of care." Additionally, medical record standards target improved lines of communication between providers, patients and providers, along with provider to payer communications.

While payers establish their own expectations, all expect accurate evidence-based documentation, preferably electronic. Payers, including Medicare and Medicaid, develop their own checklists, but most requirements include the following items.

Typical Payer Documentation Expectations

Patient medical records should always include the following data.

  • Clear identification of patients on each document component.
  • If kept in "paper" files, legible entries in high contrast ink, preferably black or dark blue, on all documentation to minimize reader error.
  • All recorded entries should be clearly dated and authenticated by the provider.
  • Use accurate codes, supported by equally thorough documentation.
  • Employ on common (standard) medical abbreviations, eliminating misunderstandings in translation or entry.
  • Include every patient "encounter," including phone, fax and electronic messages.
  • Clear recording of problems, medical conditions, medications, allergies, physical exams, immunizations, lab and diagnostic test results, diagnosis factors and treatment plans.

Payers will complete periodic document reviews, to evaluate the accuracy, clarity and thoroughness of submitted provider documentation. Claim delays and/or denials may result if documentation does not achieve, at least minimum payer standards.

Providers and their billing staff are cautioned to pay particular attention to the new coding system, as simple "typos" will typically cause reimbursement delays, at a minimum. Correcting an unjust claim denial because of deficient documentation is more difficult and time consuming than submitting it accurately initially.

Combine Quality Care with Cost Control

Healthcare reform demands delivering quality care, while employing new mandates, including more detailed documentation, seamlessly for maximum patient and provider benefit. Optimizing clinical documentation is a key to maintaining revenues. But, will it affect quality patient care?

The new requirements for "meaningful use" justification, pay-for-performance plans and ICD-10 codes are daunting changes in documentation, but should not result in lower quality care. Providers should find ways to lower and control costs, while maintaining their level of patient care.

Capturing and reporting accurate information has never been more critical to generating revenue, claims submission and patient communications. Medical providers should evaluate the cost management advantages of outsourcing some functions to leading billing, coding and documentation firms, such as M-Scribe Technologies, to remove much of the pressure to improve patient care while also tightly controlling expenses.

Practice staff under additional pressure face major performance challenges. Is it really wise to subject possibly maxed-out personnel to increased pressure of additional, unfamiliar documentation requirements? Probably not.

Similarly, is there any wisdom in medical providers in putting this extra pressure on themselves to lower and control costs, while improving patient care? The answer is easy: No. The bottom line remains the delivery of quality care. The rest of a successful bottom line financial equation will follow.

Increased documentation should not negatively impact quality patient care. Although there is a natural learning curve with any new policies, procedures and requirements, the negative implications can--and must--be minimized. How this goal is reached is typically up to the provider and/or the practice.

However, medical providers will rue the consequences of allowing new documentation necessities to interfere with quality patient care delivery. Even if the immediate concerns are maintaining strong revenue and lowering expenses, delivering quality care will become much more vital in the longer term.

Practitioners delivering consistent, quality care will eventually eliminate the potential negatives in complying with documentation and communication requirements. Just as new coding and digitizing patient medical records is challenging, the future should eliminate these fears, as more providers and practices become comfortable with these realities.

The future health of your patients and practice depends on marrying quality care with cost control and creating clear, accurate documentation. Is this a challenge? Yes. Is it possible? Also, yes.

Tags: ICD-10, ICD-10 Coding, Medical Documentation

Will Pay-for-Performance Techniques Help Control Expenses and Maintain Strong Revenue?

Posted by Harold Gibson on Tue, Mar 11, 2014

Pay-for-PerformanceThe medical provider community is not enamored with the "pay-for-performance" (P4P) initiatives now dominating the payer landscape. Incentive-laden payment schedules dramatically contrast with classic fee-for-service (FFS) payment systems.

Depending on the components used, P4P systems can take various forms. However, regardless of the elements considered by payers, the medical community continues to favor FFS, as it compensates for the quality of services rendered without evaluation of performance.

Medical professionals have multiple concerns with performance-based measurement systems. Often, the primary questions and issues involve two concerns.

  • Will P4P systems help or hurt controlling expenses?
  • Can I maintain current revenue or increase income with P4P payer techniques, in light of healthcare reform, new ICD-10 coding and documentation requirement increases?

Understanding Pay-for-Performance Logistics

The first requirement is to understand the foundation and goal of P4P systems. The goals of P4P systems is rather straightforward: Define incentive rewards for physicians and other medical providers for improving health care for patients.

The measurement details and standards payers use is much more complex and argumentative. This is the primary area of contention, with no consensus among the medical or payer community as yet. The depth and breadth of performance measurement benchmarks, often stated as the "clinical outcomes" of diagnosis and treatment choices, has generated heavy discussion and, sometimes, strong disagreement.

According to leading research institute, RTI International, many payers use the following factors as the foundation for P4P logistics when designing systems.

  • Clinical outcomes.
  • Clinical process quality.
  • Patient safety.
  • Access to and deliverance of quality care.
  • Patient satisfaction levels.
  • Cost of care efficiency.
  • Adoption of and adherence to an "evidence-based" practice.
  • Proper use of information technology.

This list is not all-inclusive, as some payers use performance standards with more measurement factors. Unfortunately, to date there is little agreement on P4P design details or the projected results.

Expense Control

P4P and evidence-based medical practice almost mandate that physicians cut or, at least, tightly control costs. Since payers often use cost-efficiency as a critical P4P component, practitioners' data may be compared to other providers' efficiency as a measurement tool.

While this incentive standard works "on paper," there is medical community concern how it will impact P4P results in the real world. Depending on the payer benchmarks used, the cost-control requirement will have an impact on most practice ratings.

Even if a P4P system is committed to fair and equitable evaluation, will practice personnel understand the necessary expense limitations placed on physicians and practice managers? Maybe, the best way to exercise expense control is to outsource many functions to a top practice management firm, such as M-Scribe Technologies, to handle billing, coding, documentation, etc. This solution gives practices cost-certain control with managing patient- and service delivery-related expenses.

Revenue Maintenance and/or Improvement

The healthcare reforms, new ICD-10 codes and increased documentation requirements are strong challenges to maintaining or improving practice revenue levels. The medical community's concerns appear to be well-founded.

P4P, although touted as an incentive program, can deliver hidden (or not-so-hidden) penalties to medical providers by reducing, not increasing, revenue. Until a consensus is reached regarding standards and measurement techniques, medical providers will continue to debate the merits and detriments of P4P.

The "learning curve" associated with massive reforms, coding and unfamiliar documentation requirements temporarily could generate revenue challenges that practitioners cannot overcome. Should this occur, providers dedicate all efforts to master these necessities as soon as possible to restore former revenue levels.

Once again, it appears wise for providers and practice managers to consider outsourcing functions to top, proven, professional third-party firms to safeguard revenue. Their staffs have been thoroughly trained in billing, coding and documentation changes needing mastery to keep revenue flowing strongly.

Avoiding claim delays and denials with accurate billing, coding and documentation submission is vital with or without P4P systems. Until the longer term results take place, medical providers probably will continue asking if pay-for-performance techniques will help or hurt cost control and revenue levels? Can you blame them?

Tags: ICD-10, ICD-10 Coding, ICD-10 Medical Billing

Making Best use of ICD-10 Index and Tabular Lists

Posted by Harold Gibson on Tue, Mar 04, 2014

ICD 10 Dermatology ClinicsHow can dermatology practices use ICD-10 Index and Tabular Lists to effectively meet conversion challenges?

The ICD-10 Index & Tabular List

The National Center for Health Statistics is the official repository of ICD-10-CM documents. The official source documents are: The ICD-10-CM INDEX TO DISEASES and INJURIES and The ICD-10-CM TABULAR LIST of DISEASES and INJURIES. The disease and injury index shares the same characteristics as most book and document indices. It provides a quick way of referencing code categories. The best way to use the index is to let it guide us as to where to look within the ICD-10-CM tabular list.

The tabular list is comprised of a comprehensive ICD-10 codes listing. Individual chapter breakdowns are typically based on body systems. An example in Dermatology is chapter 12. This is where Diseases of the skin and subcutaneous tissue can be found. This chapter is assigned the letter L, so all codes in this chapter will start with L.

At the beginning of chapter 12 there is an excludes 2 clause including such things as parasitic diseases (A00-B99), metabolic diseases (E00-E90) and viral warts (B07). Notes can provide clarification. Such notes include Includes Notes, Excludes Notes such as Excludes 1 and Excludes 2 and See Notes. The top level heading covering codes L00 to L99 is followed by an excludes 2 note. This Excludes 2 Note clarifies that the listed diagnoses aren’t part of the represented code, and can be made at the same time.

Types of Notes

Excludes1 notes indicate that coding the listed diagnoses together is invalid. Given a patient diagnosis of acquired epidermolysis bullosa (L12.3), it’s invalid for a congenital EB diagnosis to be given at the same time, as congenital and acquired are mutually exclusive. The Excludes1 note guides practitioners to select just one code.

Excludes2 notes indicate that differing codes can co-occur. Diagnoses that aren’t part of the code can be coded at the same time. Acne is in category L70. An Excludes2 note informs the practitioner that acne keloid is not found among L70 diagnoses so it can be listed as well.

See notes indicate places to look for related codes. Poison Ivy is a type of dermatitis. When checking in the Index, you might start at Dermatitis and then under Contact and Allergenic.

See Also notes provide alternative index locations when looking for a code. Looking in the index under papilloma, the index directs you to look under NeoplasmsBenign, or “by site”.

Use Additional Code indicates that an additional code is required. Given a patient with impetigo, (L01), the recommendation to use an additional code identifying the infectious agent (B95-B97) is given.

Code First note urges the practitioner to use an additional code as the first code on the Superbill. Many Code First notes describe variations of a larger disease. In the L14 category of Bullous disorders in diseases classified elsewhere, a patient has a “bullous” subtype of Systemic Lupus Erythematosus(SLE), in which the lupus is causing blisters. The diagnosis associated with SLE (M32.8) is inadequate. Instead, the Code First note suggests using the M32.8 code for SLE, and then adding the L14 code to indicate “bullous changes”.

It’s clear that dermatology practices will make extensive use of ICD-10 Index and Tabular Lists to identify the correct ICD-10 codes for record keeping and claims processing after October 2014. These documents are a primary resource for locating and applying the correct code. Their use will help ensure that comprehensive and accurate medical information is available to help practitioners, patients and researchers.

Tags: ICD-10, ICD-10 Coding, ICD-10 Medical Billing, Dermatology Billing

The Role of ICD-10 in Improving Business Goals

Posted by Harold Gibson on Tue, Feb 25, 2014

ICD 10 business GoalsOpposition to ICD-10 is strong from the AMA and other forces, due in part to the excruciating level of detail the new coding system demands. But that same deep level of detail may eventually be realized as a major benefit for advancing the goals of healthcare practices as well as the industry as a whole. Healthcare data mining and data analysis have already been benefiting the healthcare arena, and the deeper level of details ICD-10 promises to produce may increase the benefits even further.

ICD-10 Enhances Data Analysis

A quick review of some of the changes between ICD-9 and ICD-10 pointed out by the Centers for Medicare and Medicaid Services (CMS) make the increased precision immediately evident. The new system increases the number of codes, the numbers of characters in each code and adds more specificity to the coding process. ICD-10 allows for the description of etiology and causation, manifestations and complications, comorbidities, level of functional impairment, detailed anatomical location and other details not available with ICD-9.

CMS notes the switch can benefit healthcare providers by:

  • Accommodating more recently developed diagnoses and procedures
  • Allowing for innovations in treatment
  • Enhancing performance-based payment systems
  • Providing billing that is more accurate, streamlined and efficient

While such benefits can contribute to advancing the goals of a practice, ICD-10 may bring even greater benefits in the way of healthcare data analysis. An article published in the International Journal of Engineering Research and Applications points out the numerous benefits healthcare data mining can bring to the industry, and those benefits can be multiplied with the implementation of ICD-10.

Evaluation of Treatment

Healthcare data analysis can be a useful tool for determining the effectiveness of specific treatments. By comparing and contrasting the symptoms, causes and courses of treatment, healthcare data mining may play a role in discerning the most successful medication doses, therapies or other treatment modalities.

Management of Healthcare

Healthcare data mining software or applications could help identify and keep track of high-risk patients and chronic diseases. Analytical tools could help healthcare providers develop effective interventions, resulting in a reduced need for hospitalization and fewer overall claims.

Closely tracking specific conditions or ailments could also alert providers of a potential outbreak of infections, whether within the hospital parameters or throughout the community or nation as a whole. In addition to serving as an early warning sign of bio-terrorism or an epidemic, results from data analysis could assist with predicting the risk and survival analysis for patients with AIDS or others suffering from certain injuries or conditions.

Management of Customer Relations

Customer relations may be improved through healthcare data analysis, particularly for predicting specific usage patterns, preferences and needs of individuals. Such information could be applied to customer relations in various arenas, including physician offices, billing departments, call centers, inpatient and ambulatory care settings.

Additional Uses of Data Mining

The adoption of electronic health records has already allowed medical and healthcare facilities to amass large quantities of pertinent patient data. Such data can be analyzed to determine specific needs of patients based on their medical histories and current status.

Examples include alerting healthcare professionals about patients that may benefit from preventive measures, flu shots or a disease management program. Focusing on predictive analytics, providers may be able to assess the likelihood of a particular patient to adhere to his or her treatment program based on past behaviors and other pertinent factors.

Although ICD-10 continues to battle its opposition in the present, it may serve as a valuable implementation going forward. Not only could it help individual practices of facilities advance their business goals, but it could enhance the entire industry.

Tags: ICD-10, ICD-10 Coding, ICD-9, ICD-10 Medical Billing

Tips for Making a Seamless Transition to ICD-10

Posted by Harold Gibson on Tue, Feb 18, 2014

ICD 10 TransitionWith the required implementation of ICD-10 on the horizon, many hospitals, medical facilities and private practices are struggling to make the necessary changes to meet the new standards. While the changes from ICD-9 to ICD-10 may seem varied and complex, the transition need not be a worrisome struggle. It can instead be a rather seamless transition with a few practice management suggestions to help meet the Oct. 1 implementation deadline.

Awareness of Coding Changes

Being aware of two major coding changes can be the first step in effectively implementing them. The federal Medicaid website reports they are:

  • Expansion of code set: Code sets in ICD-10 consist of seven positions, with each position supporting alphanumeric characters. ICD-9 had only five positions, with only the first position open to alphanumeric characters.
  • Increase in number of codes: The number of ICD-10 codes is 68,000 in ICD-10, a substantial increase over the 13,000 codes in ICD-9.

Early Preparation

Although ICD-10 cannot be put into active practice until its official Oct. 1 implementation date, starting the transition as early as possible is crucial step for an effective transition. It gives organizations the opportunity to troubleshoot any issues while ensuring they are not placed on a long vendor waiting list. Vendors specializing in practice management software and electronic health records are likely to be in high demand, which makes early preparation an essential strategy.

Learning the Most Common Codes

Attempting to learn the entire slate of new codes may be impossible as well as unnecessary. Many healthcare professionals may have a handful of codes they consistently use as part of their practice. Making a list of the most common 20 to 25 codes from ICD-9 and then learning the ICD-10 equivalent can be incredibly helpful, especially in the early phases of the transition. Specific hospital or medical facility departments can use the same strategy, focusing on the most common codes needed for effective practice management.

Identifying Gaps in Descriptors

The new coding system demands greater detail in the way of descriptors, and failing to use them could result in the denial of claims. One way to spot check the attention to detail that will be required is to review existing charts and find any gaps that may occur between the new and old coding systems.

Organizations may examine the existing ICD-9 codes used in the charts then match them up with the equivalent ICD-10 codes, taking note of the key words present in the code descriptions. They can analyze the differences by checking how many claims using ICD-9 would be rejected under ICD-10. This can be a vital learning experience for physicians and staff, illustrating the importance of paying acute attention to the additional detail required.

Ascertaining Vendor and Payer Readiness

Even if a hospital, medical facility or private practice has properly prepared itself for the transition, nothing is likely to go smoothly if the facility’s vendors and payers are not equally as prepared. Organizations would do well to inquire about their vendors and payers readiness to embrace the new system. Key inquiries may include:

  • If electronic health record vendors will have revised templates ready
  • The type of testing vendors are undergoing to ensure an efficient transition

One more key fact that may help with transition from ICD-9 to ICD-10 is to remember the overall goal. Regardless of the extra work the ICD-10 transition may be causing in the short-term, the changes were made to ultimately make the billing process more accurate, detailed and reflective of the changes made in the world of medicine over the past 25 years.

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Tags: ICD-10, ICD-10 Coding, ICD-10 Medical Billing

Preparing for ICD-10 testing

Posted by Harold Gibson on Fri, Feb 14, 2014

ICD 10 TestingPrioritizing ICD-10 testing, with the most critical scenarios taking place first, is advisable as a preferred strategy. Areas of focus include business, clinical and operational functionality. Individual health care payers must each schedule their own end to end testing. Test plans, real medical data and collaboration with partners are all part of the process.

Creating accurate test data for ICD-10 is challenging as this type of data has never before been implemented in full-scale production environment in the U.S. For some indication as to what may happen, we should look north: ICD-10 has been in full production in Canada since 2002. According to AHIMA, Canadian productivity decreased from 4.62 charts per hour just before ICD-10 implementation to 2.5 charts per hour 3 months later, but rebounded to 3.75 charts by 2003 (1 year later). Conversion participants note that both analytical tools and human decision making tools are necessary for success.

ICD-10 implementation will ultimately provide precise diagnoses and treatments, more accurate payments and better tracking of treatment results. Coding mismatches are likely to affect operations for some time: the US Dept of Health and Human Services anticipates an increase in claim errors of 6% to 10%.

Positive Outcomes of Testing

Operational Stability - Accuracy measures such as those for claims payment are maintained at productive levels with new codes.

Clinical equivalency - ICD-9 and equivalent ICD-10 codes define the same characteristics of patient care, and the outcomes meet medical requirements.

Benefit consistency - ICD-9 or ICD-10 code equivalents result in the identical member coverage, with no increase in premiums or co-pays.

Financial consistency - This is the state where benefit payment by the insurer together with recipient copay result in payment coverage.

Real Test Data

Real patient medical data from your practice will provide a solid base for your testing. Using records that reflect the types of cases you treat and submit for reimbursement is the best way to asses the impact of ICD-10 implementation on your practice. Use of test scenarios that match healthcare payers' mappings rather than your practice data is unwise.

Test each of the transaction that will include ICD-10 codes. Transactions and work processes should include claims submission, eligibility and quality reporting.

The AMA provides a fact sheet to meet October 2014 ICD-10 readiness.

Testing Readiness for ICD-10 Overview

Software upgrades are likely to be necessary for your current systems in order for you to be able to send and receive the ICD-10 codes required for reporting and transactions. You must test the systems that send and receive diagnosis codes. Your practice management system is an example. Make certain that the ICD-10 codes are sent from your system, received by the target system, and processed appropriately. HIPAA providers, payers, and clearinghouses are responsible for their own ICD-10 compliance.

The three necessary testing areas to cover are:

  • Sending ICD-10 transactions and reports directly or through a clearinghouse
  • Receiving ICD-10 transactions and reports and processing them in your systems
  • Ensuring payments and cash flow will continue after October 1, 2014

Internal testing is conducted inside a practice. Completing internal testing will allow you to identify and ultimately resolve any internal systems issues related to ICD-10 codes. Testing manual and workflow processes is also important. If your practice works with a billing service, coordinate with them on necessary data collection.

External Testing involves sending and receiving ICD-10 related transactions to your business associates and partners. If the test transactions you’re sending with ICD-10 codes include real patient protected health information (PHI), take care to ensure data privacy. This testing will allow you to identify ICD-10 code issues arising in sending or receiving data. Successful completion of “end-to-end” testing with your partners means that you’re ready to process live transactions.

Overall testing can take 8 to 12 months. Compliance is required for payment as of October 1, 2014.

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Tags: ICD-10, ICD-10 Coding, ICD-10 Medical Billing

ICD-10 and Evaluation and Management (E/M) Coding

Posted by Harold Gibson on Fri, Mar 22, 2013

M-Scribe E/M Coding and BillingEvaluation 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.

Tags: ICD-10, ICD-10 Coding, Specialty Billing Service, M-Scribe Atlanta, Internal Medicine Billing, E/M Documentation, E/M coding

Nephrology Medical Billing Services and ICD-10 Coding

Posted by Harold Gibson on Mon, Mar 18, 2013

nephrology medical billingWe’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.


Tags: ICD-10, ICD-10 Coding, medical coding, Medical Billing, Specialty Billing Service, M-Scribe Atlanta, Nephrology Billing Services

Workers’ Compensation Billing and ICD-10 Coding

Posted by Harold Gibson on Mon, Mar 11, 2013

Workers’ Comp BillingSome 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.

Tags: ICD-10, ICD-10 Coding, medical coding, Medical Billing, ICD-9, Specialty Billing Service, Medical Billing Service, M-Scribe Atlanta, Workers’ Compensation Billing

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