CODING CORNER….FOCUS ON ICD-10 NOVEMBER 2015

By Tom Maher, President and CEO

ICD-10 HAS ARRIVED!!

By now, ICD-10 is likely fully operational in your practices.  Practicefirst’s offers you the following tips while using the new code set:

  1. BE SPECIFIC-the layers in ICD-10 are deep. Accurate reporting is a CMS expectation.
    1. Tell us if a motor vehicle accident happened in a car, suv, pickup truck or van
    2. Cellulitis vs. Abscess
      1. ICD-10 gives different codes for each whereas they were combined in ICD-10.
      2. Do NOT use the term CELLULITIS & ABSCESS in your documentation interchangeably.
    3. Sprain vs. Strain:
      1. ICD-10 classifies these as different.
      2. Specify STRAIN vs. SPRAIN
    4. FRACTURES:
      1. More specificity, please! See the fracture section of your ICD-10 manuals for elaboration.  This is a highly expanded section containing much detail.

Diagnosis Coding Tips:

  • Always code each health care encounter to the level of certainty known for that encounter. All providers are expected to code correctly and have sufficient documentation to support the codes selected.
  • Medicare did not require external cause reporting in ICD-9-CM and does not require external cause reporting in ICD-10-CM. Similar to ICD-9-CM, there is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless you are subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, you are not required to report ICD-10-CM codes found in Chapter 20 of the ICD-10-CM, External Causes of Morbidity.
  • In both ICD-9-CM and ICD-10-CM, sign/symptom and unspecified codes have acceptable, even necessary, uses. While you should report specific diagnosis codes when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, in some instances signs/symptoms or unspecified codes are the best choice to accurately reflect the health care encounter.
  • If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for sign(s) and/or symptom(s) in lieu of a definitive diagnosis. When sufficient clinical information is not known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate unspecified code (for example, a diagnosis of pneumonia has been determined but the specific type has not been determined). In fact, you should report unspecified codes when such codes most accurately reflect what is known about the patient’s condition at the time of that particular encounter. It is inappropriate to select a specific code that is not supported by the medical record documentation or to conduct medically unnecessary diagnostic testing to determine a more specific code.

If you are not currently a coding client of Practicefirst, call us to find out how you can become one!

If you would like more information about how we can tailor our services to meet your needs, please contact Practicefirst at 716.834.1193 or tom@pracfirst.com

BILLING UPDATES OCTOBER 2015

Billing Updates
By Tom Maher, President and CEO
 
MEDICARE – NATIONAL GOVERNMENT SERVICES (NGS)
HEPATITIS AND PNEUMOCOCCAL VACCINES DENYING IN ERROR
On 10/19/15, NGS notified the provider community regarding claims denying in error for the following CPT codes: G0010, G0009, 90630, 90669, 90670, 90732, 90739, 90740, 90743, 90744, 90746, and 90747.
The error deals with claims submitted under ICD-10 Z23. NGS has indicated that a mass adjustment will soon be completed for those claims that denied in error.
BLUE CROSS (BCR)
2015 PHYSICIAN PERFORMANCE AND QUALITY INITIATIVES
BCR issued a STAT Bulletin on October 23, 2015 to PCP’s, OB-GYN’s, Endocrinologists, Orthopedists and Behavioral Health Practitioners regarding a change to the Performance and Quality Programs Measures. The National Committee for Quality Assurance (NCQA) recently announced the following HEDIS measure will no longer be used: Use of Appropriate Medication for people with Asthma. Effective November 1, 2015, this measure will be removed from the BCR 2015 Pay for Performance Incentive Program.
PAPER CHECKS RELEASED
One cycle of BCR payments were paper checks vs. EFT. The check cycle was the week of 10/04/2015 and has since been corrected.
INDEPENDENT HEALTH (IHA)
REMOVAL OF MEDISOURCE AND CHILD HEALTH PLUS REFERRALS
Effective immediately, referrals will no longer be required for IHA MediSource and Child Health Plus members.  Based on feedback from providers, IHA removed the referral requirement to ease the administrative burden in your offices.  IHA encourages providers to coordinate your patients care to ensure the best possible outcome. It is important to note that primary care physician referrals are still required for members in the Restricted Recipient Program.
DUAL DIFFERENCE TO BE DISCONTINUED AT THE END OF THE YEAR
IHA currently offers the Dual Difference Medicare Advantage HMO product in Erie and Niagara counties to Medicare beneficiaries who also qualify for Medicaid coverage. However, they will discontinue offering Dual Difference as of December 31, 2015. They will be working closely with their community partners and their members to help them find a plan that meets their needs.
For Billing questions, please contact Tom Maher at 716-834-1193 or

tom@pracfirst.com

CODING CORNER…FOCUS ON ICD-10…OCTOBER 2015

The wait is over! ICD-10 has arrived!

Practicefirst’s is pleased to announce that all coders coding beyond 10/1/2015 are ICD-10 proficient!

REMINDERS TO ALL CLIENTS:

  1. EXERCISE CAUTION when choosing ICD-10 codes from your EMR. The lists are VERY detailed and it is very important the chosen code contains ALL characters and that it does not conflict with any other documentation in the patient’s record.
  2. UNDERSTAND CODING GUIDELINES AND SEQUENCING RULES!! Every practice should have a current ICD-10 book and/or subscribe to an online service such as encoderpro.com.
  3. Be sure your SUPERBILL’s dated 10/1/2015 (date of service) and forward indicate ICD-10 codes otherwise they will be returned to you.
  4. Ask these questions before assigning an ICD-10 code:
    • Presence or absence of complication = potential combination code?
    • Any Manifestations?
    • Is there a causal relationship?
    • Have I indicated the episode of care (initial, subsequent, late effect) where appropriate (e.g. injuries?)
    • Have I defined subsequent fracture care appropriately (healing status)?

 

Last minute TIP….ASTHMA:

Have you classified the patient’s asthma properly? Please see the guidelines below

Stages of asthma

National Asthma Education & Prevention Program Guidelines

CLASSIFICATION SEVERITY OF SYMPTOMS NIGHT SYMPTOMS FEV
Mild Intermittent Symptoms < 2X week asymptomatic Symptoms < or = 2X monthly >80%
Mild Persistent Symptoms > 2X daily to < 1X daily Symptoms > or + 2X monthly >80%

>Variability 20-30%

Moderate Persistent Daily symptoms

Daily use of beta 2 agonist

Symptoms > 1X week 60-80%
Severe Persistent Continual symptoms

Limited physical activity

Frequent <60%

WHY CHANGE? Because

  1. ICD-9CM is outdated and has obsolete terminology
  1. ICD-10 provides more specific data, better reflects current medical practices, contains updated medical terminology and has improved accuracy in the definition/classification of diseases.
  1. Expanded data capture for reimbursement and data reporting!! Do not miss this!
  1. Continued reporting of ICD-10 codes that lack specificity may contribute to a downward adjustment (Value Based Modifier) and may impact any PQRS reporting your practice is currently doing or would like to do in the future.
  1. Quality is being measured!

If you are not currently a coding client of Practicefirst, call us to find out how you can become one!

If you would like more information about how we can tailor our services to meet your needs, please contact Practicefirst at 716.834.1193 or tom@pracfirst.com