Five Costly ICD– 10 Mistakes

Five Costly ICD– 10 Mistakes

The implementation of ICD- 10 in October has been overall successful and fairly painless. There were a lot of medical professionals saying that the transition would be difficult, that it would drastically slow down the processing of claims, and that a wide range of mistakes would bring healthcare in the US to grinding halt. But none of that occurred. In fact, there have been very few problems caused by the new system.

But, there are those, as would be the case when anything new is put in place, who have had challenges and seen claims questioned and declined due to their inability to use the system properly. Mistakes can be costly, as, at the very least, they can delay payments, and, at the very worst, negate one’s ability to get paid. Here are five costly mistakes to avoid when it comes to working with ICD- 10.

Partial, Incomplete Coding

ICD- 10 is much more comprehensive that ICD- 9. In the past, when one code was required, now there may be three, four, or more. It’s important that practitioners and those working with them include all necessary codes, as partial or incomplete coding will result in a claim being disallowed. ICD- 9 was never intended to be used for billing purposes, although eventually it was. ICD- 10 was created for many reasons, and one of them was to justify reimbursements by payers.

Overcharging by Not Bundling

Many times if a practitioner is offering various services simultaneously, those services cannot be billed individually. They must be bundled. Doing so discounts those services. If you don’t properly bundle services when required and, thus, improperly code them, chances are the claim will not be paid. If it is paid, you may, after an audit, be ordered to reimburse the payer. If you engage in this practice habitually, you’re opening yourself up to an audit, possibly an investigation, and perhaps fraud charges. Know when to bundle services and do so.

Old Coding Practices

This is not so much using old codes, as it is related to utilizing former practices, which were far less specific. ICD- 10 can be agonizingly specific and detailed. Over the past 30 years new procedures, technologies, drugs, and treatments have been developed, changing the manner in which services are delivered, and, often raising the cost of visits, tests, procedures, and supplies. You and your coding and billing professionals need to consider the breath, depth, and specificity of the care you are offering and document it in the new manner.

Inaccurate Coding

In terms of inaccurate coding, this is simply using the wrong code or codes. This may occur due to a lack of knowledge concerning ICD- 10 or due to perfunctory coding practices. Make sure codes are accurate and properly coordinated. Not doing so will confuse payers and result in the claim having to be redone.

Not Using Codes as Intended

As noted, ICD- 10 is intended to be used in various ways. It may be used in assessing the effectiveness of treatments, progress of patients, and success of practitioners. Because ICD- 10 is so detailed and complete it serves as a way to monitor and assess performance, procedures, and success.

Health insurance providers will be using it in this way and so too should each healthcare practitioner. ICD- 10 can be utilized in comparing your performance to that of your peers, in determining how to best use and reallocate your resources, and towards refining your services and treatments. Don’t underuse the new system.

Work with Your Billing Office

If you’re a medical practitioner, ICD- 10 can be utilized to your benefit. In order to do so, take time to coordinate your efforts with your coding and billing office. This includes refining your use of the coding system, utilizing data associated with it, and creating a system of communication that benefits your ability to provide medical services and your billing and coding professional’s capabilities for processing claims effectively and efficiently.

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