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Since the implementation of the ICD-10 coding system, most claims are processing smoothly and rejection rates have been minimal.
There was so much hype leading up to the implementation of ICD-10 that when Oct.1 2015 arrived, many individuals in the healthcare industry expected disaster: systems shutting down, claims not going out, patients not being seen, etc.
In truth, ICD-10 implementation was fairly pain free. Although we are still waiting for some health plans to fix their medical polices, overall the CMS and the Medicare Area Contractors (MACs) responded beautifully.
In some instances, some policies are "forcing" physicians to use an unspecified code because the more specific code was missed when the ICD-9 to ICD-10 mappings were created. That's a shame because using unspecified codes teaches bad coding and documentation habits. We know that these policies will be fixed during quarterly changes. In the meantime, we must "dummy down" our coding, or chance having our claims denied.
For example, some medical policies have codes included for unspecified hearing loss, but not for sensorineural hearing loss or sudden hearing loss. Yet from the intent of the policy language, and the inclusion of the unspecified option, it is clear the other conditions should have been included, as well. In some instances entire code blocks have been left out of the mappings.
In other instances, interim guidance has caused issues. For example, although the guidelines state that "Excludes1" means you should never code conditions together, there were many issues found with those notes; therefore, interim advice is to ignore the "never" part of the instruction and do code conditions together, when it makes sense. This can cause difficulties for physicians trying to get claims approved or paid, and may cause claims to become hung up in claims scrubbers and encoders.
Overall, however, rejection rates have been minimal, despite all the "moving parts" of ICD-10 implementation. That is a huge testament to the healthcare industry. It was really amazing to see everyone working together; reaching out to make sure everyone was prepared. CMS did an excellent job, as well, rising to this challenge and keeping providers informed.
But now is not the time to sit back. We still need to do due diligence. The codes and coding policies will be revised many times over the coming years; and, with the implementation of advanced payment models, it's important for physicians to document well so that their records capture all of the data from the patient encounter. It's even more important that providers have skilled coding staff to help them capture the correct coding.
Remember, it's our claims data that payers and auditors will analyze first. Therefore, it's important to make sure that what goes out the door on the claim form matches what is in our records. Clinical documentation improvement in the medical practice is necessary for us to elevate our practices to be prepared for these changing payment models. We must continue to work ICD-10 documentation concepts into our existing templates, not only to keep us compliant in ICD-10, but to prepare us for future changes.
Rhonda Buckholtz, CPC, CPCI, CPMA, CRC, CHPSE, CENTC, CGSC, CPEDC, COBGC, is vice president, strategic development for the AAPC. She may be reached via firstname.lastname@example.org.