Sunday, October 2, 2016

“Fixing” past issues to embrace the “Future” -- ICD-10cm: In our sights…

.. Originally published by as written by me...  

“Fixing” past issues to embrace the “Future” --  ICD-10cm: In our sights…
Lori-Lynne Webb
August 1, 2015

As coder and billers we are a pretty flexible group.  Overall we are excited to get started and forge ahead with ICD-10.  However, before we can fully embrace this future of great documentation, with new and different coding strategies, we must “Tidy up”  after ourselves, and not leave our “coding house” a mess before ICD-10 arrives.  

Too often we get busy, lazy, complacent, or just don’t realize what is still left out there to do before we begin anew with ICD-10cm.  All of us have our “bad habits” and science has proven it takes at least 4-6 weeks to change a bad habit.  We will begin a quick run-down on some “quick fixes” to jump start your “clean up” before ICD-10 arrives.   These areas of improvement are not in any specific type of “order”, just good places to begin.

Update Encounter/Superbill forms:
When was the last time you took a good, hard look at your encounter/superbill forms?  If they haven’t been updated lately, you may be leaving $’s on the table.  Most importantly, if you’re not getting a good diagnosis code to go with the office visit or procedure that has been performed, no only are you potentially missing revenue, but the patient care is affected when the diagnosis is not clearly specified.  

ICD-10cm and the large volume of specificity this code set brings for diagnosis coding will make it a lot more difficult to easily have diagnosis codes included on paper encounter forms.  If this is the case, you may want to consider dropping the diagnosis “check boxes” from encounter forms and ask the provider to give you a “handwritten” specific diagnosis, that can be corroborated with review of the actual documentation.  These handwritten diagnoses will need to include laterality and specificity. 

The coder then is able to take these handwritten diagnoses and do what a coder does BEST -  Code the claim based upon the documentation provided.    If the physician is the one to actually “choose” the code or “enter” a diagnosis code  into the EMR/EHR, you may need to provide a good cross/reference tool for the provider to refer to that is NOT a part of the encounter/superbill form.    By “cleaning up” this process you can potentially see for the practice:  a) more accurate diagnosis documentation b) more accurate claim submitted c) less claim rejections, d) revenue stream flows more smoothly with less “outstanding” claims.

What is in your top 25?
If you don’t know what your top 25 diagnoses are, you should make this a priority to find out.  Most practices submit many of the same diagnosis day in and day out.   Take the time to find out those diagnosis codes and create a good, cross reference tool to be used that gives the provider the “old” ICD-9 code and the potential “new”  ICD10cm codes.  In some cases, you may be able to give the provider a direct 1-1 match, in other cases it may be far more.  Once you know your top 25,  then dig into the documentation of those case files to see if the diagnosis documented in the old files really stand up to what will be needed in ICD-10.  If not, this is the prime time to get that “fix” put in place.  Communicate with your providers to create good macro’s, templates, and verbiage to help them with documenting clearly and concisely to jointly create good patient care outcomes, in addition to good claims and reimbursement outcomes.

GIGO?  Garbage In, Garbage Out
If you’ve not heard this term before, it is something to think about.   GIGO is an acronym that stands for "Garbage In, Garbage Out." GIGO is a computer science acronym that implies bad input will result in bad output.  In regard to coding and billing, If you put “garbage in the revenue stream, you are going to get garbage back out”.   As coders, we want to be putting in the best information possible to have the best outcome on our revenue and claims payments.  In July 2015, CMS came forth and stated that when ICD-10cm is implemented they will not deny claims if the billed code is in the “family” of codes.  This can be confusing for coders who rely on specificity and want to have the best code chosen for what is documented.  CMS did clarify what is meant by “family of codes”  in a Q&A release updated on July 31, 2015.  (

“CMS has defined the “Family of codes” to be codes within the same as the ICD-10 three-character category. Codes within a category are clinically related and provide differences in capturing specific information on the type of condition.” 

 Even though CMS has stated they will not “deny” the claim if your diagnosis is within the family, however, the best option is to code to what is documented.  The G.I.G.O. theory goes hand in hand with the adage “if it wasn’t documented, it wasn’t done”.  As a coder, perform your due diligence and be sure that you are currently coding to the best of your ability and coding to the best specificity NOW, and don’t wait till implementation date to make this change. 
If you are putting good information in, you will have cleaner claims coming out, and less “fixes” and “appeals” to be done on the backside.  Anytime you have to re-code and re-submit a claim it not only costs you time, but costs your practice money as well. 

What is happening on your “front end”?
In regard to the GIGO theory, be sure to check what is happening on the “front end”.  If patients are not being registered into the demographic/patient management system correctly, this can be another “glitch”.  Eliminating and avoiding demographic claim denials is essential to a good coding and billing  team practice.  Demographic errors can hold up revenue, and saddle your coding/billing staff with unnecessary work to clean them up and rebill those claims.   
This is now the perfect time to work with the front end/front office staff to spruce up and smooth out any demographic hold-ups in the registration and check in processes prior to the ICD-10 go live.  Work with your front office colleagues to get good documentation reported and documented in the patient medical and billing record.  Always ask (each visit) for the patient’s most current address, phone, e-mail, work, insurance, payment plans, or other pertinent information to help create a good medical information record/documentation file. 
Many patients have changing insurance carriers and coverage with the implementation of Obama-care.  If the front office staff can't gather current pertinent information before the appointment, have them ask for it as soon as the patient arrives.  If you need a referral or pre-authorization before the patient is seen, obtain it as soon as possible, in addition to collecting co-pays, verifying deductible status,  verifying eligibility and benefits.  And, don’t forget the importance of the ABN/waiver form if a service is not covered.  Patients need to be informed and understand their financial responsibility to the clinic if a service is not covered.  

Last but not Least….
Coders have an extremely important role in the medical office, and with the upcoming ICD-10 roll out, this last list of tasks may seem obvious, but the importance cannot be discounted to having a successful transition to ICD-10
1.     Focus on “Quality” not “Quantity” or other measures of coder productivity. The quality of coded data is more critical considering the amount of new codes in ICD-10 and specificity. 

2.     Try to eliminate as many of the daily distractions and disruptions in the workplace as possible. (eg avoid GIGO to ensure clean claims the first time through)

3.     Communicate, Query and Educate all members of your office team.  Be exceptionally diligent, yet helpful,  with the providers when you find conflicting and incomplete diagnosis documentation in the patient record.  We are all in the learning curve, in trying to master coding with the new ICD-10 codeset.
4.     Fix it first – Submit it second.  If you find an error, fix it when you find it.  If you wait, it may get lost in the shuffle, then create more work, later. ( eg wrong patient address, wrong insurance, etcc)

5.     Take time to educate and review the official ICD-9cm AND ICD-10cm coding guidelines for both outpatient and inpatient diagnosis billing.  If you review both sets, you will be able to clearly understand the similarities and differences that can be critical to your claim and diagnosing success.

6.     Perform full-spectrum chart audits in your practice to help resolve and create good coding and billing success. A good plan includes pre-claim, and post claim audit.  Closely look at the medical necessity and linking of diagnosis to documentation.  Follow up your audits to see if they were submitted correctly, adjudicated correctly and paid correctly.   

7.     Provide “coding tools” in an electronic format.  Have the ICD-10 codeset available to providers and staff  in a PDF form on their computer desktop, have a handy top 25 cross-coder available for them. Share helpful hints with everyone.  A good “team” approach to collaboration and communication enhances the potential for better office flow and successful patient experiences and care.

8.     CELEBRATE YOUR SUCCESSES!!!   Celebrations don’t have to be “expensive”  but a quick “good job”, “Thank you for your help”, “Great Idea - let’s try it”, or even a simple “high-five”  go a long way when entrenched in the stresses of change. 

Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC and ICD10 cm/pcs Ambassador/trainer is an E&M, and Procedure based Coding, Compliance, Data Charge entry and HIPAA Privacy specialist, with over 20 years of experience.  Lori-Lynne’s coding specialty is OB/GYN office & Hospitalist Services, Maternal Fetal Medicine, OB/GYN Oncology, Urology, and general surgical coding.  She can be reached via e-mail at or you can also find current coding information on her blog site:  

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