Has It Just Been a Year?

Hard to believe but a year has passed since the implementation of ICD-10.  Many were filled with anxiety that this transition would cause chaos to coding productivity, excessive costs, and add tremendous delays in reimbursement.

Thanks to the diligent training, dual coding with provider feedback, and dedication of so many, the transition for abeo and our client base was successfully and almost seamlessly made.  The added detail required to assign accurate codes has caused significant changes in the documentation habits of providers all across the country who have graciously “bowed to the inevitable”.

Code Freeze

Prior to the implementation of ICD-10, codes were added, deleted, and revised each year to keep pace with changes in medicine, conditions, and technology.  In 2011 a code freeze for both ICD-9 and ICD-10 was enacted that was to end one year following the implementation of ICD-10.  As a result of the code freeze, five years of those yearly changes began to back up, resulting in the 2,670 code changes to ICD-10 we will be experiencing on October 1st of this year.  No updates will be added to ICD-9 going forward as it will no longer be used for reporting.

While the large number of code changes may seem initially overwhelming, the laterality and encounter options for many of the codes have contributed to the increased volume just as they contributed to the huge volume increase from ICD-9 to ICD-10.

“Flexibility” Is Ending On October 1st

In July of last year, Medicare Contractors conducting medical review (Medicare Administrative Contractors, Recovery Auditors, and Supplemental Medical Review Contractors) were instructed not to deny claims solely for the specificity of the ICD-10 code as long at the codes were within the same family of codes and a valid code.  This was to continue until October 1st of this year.

There was hope that the flexibility would be extended but, per an 8/18/16 update from CMS, that flexibility will end as scheduled.  Medicare contractors can, at that time, deny claims for a lack of specificity as long as the diagnosis is available to the physician at the time of the encounter.  Do not misunderstand; unspecified codes DO have a place when a definitive code is NOT available to the provider at the close of the encounter, but should not be the norm.

Per CMS:  “Providers should already be coding to the highest level of specificity. ICD-10 flexibilities were solely for the purpose of contractors performing medical review so that they would not deny claims solely for the specificity of the ICD-10 code as long as there is no evidence of fraud. These ICD-10 medical review flexibilities will end on October 1, 2016. As of October 1, 2016, providers will be required to code to accurately reflect the clinical documentation in as much specificity as possible, as per the required coding guidelines.”

So What Does All Of This Mean To You?

Essentially, it will probably mean very little despite the fears and rumors to the contrary.  As stated by CMS, since many major insurers did not choose to offer coding flexibility; you have probably already been adding sufficient detail to your documentation to enable your coders to code to the highest level of specificity.

That being said, abeo would caution that there are still some conditions that seem to be consistently missing coding specificity that may now come under closer scrutiny by CMS.  Many of these codes were addressed during abeo’s ICD-10 training just last year.

We do more than provide the certified and experienced coding one should expect from a professional billing company.  abeo delivers personalized reports aimed to identify your problem areas and includes improvement tips.  We are consistently well above the industry average with a 98% coding accuracy rate.  Plus, we provide U.S. based ASC and anesthesia specific expertise so that you have the answers and the full explanation behind the recommendations you receive.  Contact us today for more information on our coding.

Has your practice navigated through 2016 by leaning too heavily on “unspecified codes”?  Find out what we mean in our next blog post.  If you wish to receive these as email alerts as they are released, subscribe to our email alerts.

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