25 Aug How to Avoid Minor ICD-10 Coding Errors
Medical billing and coding errors are serious problems in the healthcare industry. Some experts estimate that 80% of all submitted bills have some type of error, which leads to increased costs for insurance carriers, providers, and patients. Coding and billing errors can lead to reduced reimbursements, coverage denials, and patient care deficits.
Because of the ICD-9 to ICD-10 transition, many healthcare facilities will see a spike in rejected claims. Experts believe that around 20% of all submitted claims will be rejected for coding errors. This will have a notable impact on cash flow for the practice. Because billing errors will affect your physician practice, you should be aware of how to identify them and use certain measures to overcome them.
While the new coding procedures involve practice software updates and much education for billers, you can reduce the overall number of delayed or denied claims by handling errors. Common ICD-10 coding errors include:
- Accurate patient information – Claims can be denied because of clerical errors in the patient demographics, insurance identification numbers, and other information. Before submitting the claim, double check this information. In addition, establish policies and procedures regarding physician referrals that allow for the level of detail required by ICD-10 in your medical records. Adjust processes so you have the right health histories, discharge summaries, and medical documentation.
- Use correct codes – To avoid coding errors, avoid using invalid codes that will result in claim rejections. The billing staff and coding specialists must be aware of the new codes with the ICD-10 system.
- Conduct regular chart audits – To avoid billing and coding errors with ICD-10, the billing service should conduct regular chart audits. The staff will look through claims submitted for incorrect codes that could cause denials during the first year of ICD-10 billing.
Avoid ICD-10 Errors for Common Diagnoses
The National Center for Health Statistics had found that certain common diagnoses will be used more in billing efforts. These include:
Asthma – In ICD-10, you must classify asthma as: mild intermittent, mild persistent, moderate persistent, or severe persistent. In addition to classifying the condition, physicians must document the status of the asthma at each encounter. The risk code Z91.14 (patient’s other noncompliance with medication regimen) can be added when poor compliance is an issue. If you document asthma without a status, coding with J45.909 (unspecified and uncomplicated asthma), you fail to convey assessment of the asthma status, which could lead to lowered reimbursement or claim denial. Using J45.41 (moderate persistent asthma with exacerbation) better describes the problem, and will help you avoid claim rejection.
Otitis Media – When coding for otitis media, you should specify type, laterality, occurrence, and tympanic membrane status. For instance, if the patient has bilateral acute otitis media without ear drum rupture, you will use H66.006, which identifies the need for higher levels of services. With H66.93 (otitis media, unspecified, bilateral), you omit all assessment factors.
|Otitis media type||Code family||Occurrence||Laterality||Tympanic membrane status|
|Serous/nonsuppurative||H65.–||Acute/subacute Acute recurrent Chronic||Right Left Bilateral||Ruptured Not ruptured|
|In a disease classified elsewhere (influenza, measles, viral disease), follow index instruction (combination code or H67)||H67.– or combination code|
Diabetes – With diabetes mellitus, key documentation elements are the type of diabetes, the use of insulin or not, and manifestations of the disease (ulcers, condition status, and related issues). You can choose condition codes, such as E11.40 (diabetes type 2 with neuropathy) and add additional codes to describe other problems related to diabetes, such as no-pressure ulcers (L97.1-L97.9). Certain codes can describe the condition specifically, such as E11.65 (diabetes type 2 with hyperglycemia) and E11.621 (diabetic foot ulcer).
|Diabetes type||Code family||Manifestation||Insulin use|
|Type 1||E10.–||Consider whether the condition is controlled; uncontrolled is a manifestation (hyperglycemia) Make a connection (e.g., diabetic ulcer vs. diabetes, ulcer) Describe the manifestation (e.g., site and severity of ulcer)||n/a|
|Type 2*||E11.–||Z79.4 Long-term (current) insulin use|
|Due to underlying condition||E08.–|
|Drug or chemical induced||E09.–|
Well-child visits. This involves documenting abnormal findings, suspected conditions, symptoms, and established conditions on the problem list. Report Z00.121 (routine child health examination with abnormal findings) or Z00.129 (routine child health examination without abnormal findings). When describing abnormal findings, reference codes Z01.411 – Z01.419.