Well, whether your office is ready or not, ICD-10-CM is coming. While its implementation has been delayed over the past few years, it's not going away. This update is more complicated than the ICD-9-CM. Things change. Diagnosis and treatment both have gotten more complicated in the past 25 years since the ICD-9 was introduced. That is why it is time to learn how to code and implement ICD-10.
What does ICD-10 affect?
Don't make the mistake of thinking ICD-10 is only going to affect coding and billing specialists. It will affect everyone from the provider through the claim denial manager.
The effect of ICD-10 starts with the provider's documentation. The provider sees the patient. He or she goes through the diagnosis process and arrives …show more content…
The codes have become much more specific. The coder is going to use the provider's notes to arrive at the appropriate code. That means the provider is going to have to provide enough detail for that to happen.
So, instead of just saying the patient had a headache, the provider is going to have to document the potential source(s) of the headache to the degree that the coder can document it for the payer. Plus, there is the treatment coding. The provider offered either an aspirin or an ibuprofen to the patient. The patient chose the aspirin. The provider must note this so the coder can indicate which one was used for treatment.
The effects go further. Not only do the changes affect the provider and coding staff, it goes out to clearinghouses and payers also. The clearinghouses will scrub the claims to ensure they are valid and ready for payment. If the coding is not correct, or not specific enough, the clearinghouse may send the claim back. The payer can do the …show more content…
There are options for both in-person and online training. There are also plenty of training books out there to get everyone up to speed.
Identify the General Equivalency Mappings for the practice. Medicare published a guide that indicated how to translate ICD-9 codes into their ICD-10 equivalents. These mappings are known as the General Equivalency Mappings (GEMs). Only a portion of those codes affect any given specialty. Identifying and documenting the GEMs that affect the practice will save time and effort.
Tie the codes with the published guidelines. Each code, or section of codes, has certain guidelines the provider and coder must follow as far as documentation. No one is going to memorize all the guidelines for every code. Being able to reference the guidelines for a particular code quickly will speed things up.
Set up clear guidelines for provider documentation. With the ICD-10 implementation, the need to document specifics is non-negotiable. Unclear documentation means the practice is not going to get paid, or will have payment
What does ICD-10 affect?
Don't make the mistake of thinking ICD-10 is only going to affect coding and billing specialists. It will affect everyone from the provider through the claim denial manager.
The effect of ICD-10 starts with the provider's documentation. The provider sees the patient. He or she goes through the diagnosis process and arrives …show more content…
The codes have become much more specific. The coder is going to use the provider's notes to arrive at the appropriate code. That means the provider is going to have to provide enough detail for that to happen.
So, instead of just saying the patient had a headache, the provider is going to have to document the potential source(s) of the headache to the degree that the coder can document it for the payer. Plus, there is the treatment coding. The provider offered either an aspirin or an ibuprofen to the patient. The patient chose the aspirin. The provider must note this so the coder can indicate which one was used for treatment.
The effects go further. Not only do the changes affect the provider and coding staff, it goes out to clearinghouses and payers also. The clearinghouses will scrub the claims to ensure they are valid and ready for payment. If the coding is not correct, or not specific enough, the clearinghouse may send the claim back. The payer can do the …show more content…
There are options for both in-person and online training. There are also plenty of training books out there to get everyone up to speed.
Identify the General Equivalency Mappings for the practice. Medicare published a guide that indicated how to translate ICD-9 codes into their ICD-10 equivalents. These mappings are known as the General Equivalency Mappings (GEMs). Only a portion of those codes affect any given specialty. Identifying and documenting the GEMs that affect the practice will save time and effort.
Tie the codes with the published guidelines. Each code, or section of codes, has certain guidelines the provider and coder must follow as far as documentation. No one is going to memorize all the guidelines for every code. Being able to reference the guidelines for a particular code quickly will speed things up.
Set up clear guidelines for provider documentation. With the ICD-10 implementation, the need to document specifics is non-negotiable. Unclear documentation means the practice is not going to get paid, or will have payment