Documentation; Diagnoses and CPT: difficult choices…….

Originally posted by Justcoding.com as written by me...    Enjoy! 

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Documentation; Diagnoses and CPT:  difficult choices…….

August 11, 2016

Coding in the outpatient realm can be a challenge.  One of the areas that coders struggle with is when there are two or more choices for similar procedures.  This creates a dilemma for the coder, as the documentation and diagnoses attached to those codes can mean a huge difference to the practice, or physician in terms of reimbursement based upon the RVU values.  In some instances, this could also mean that the choices presented in CPT may not be well represented, and the coder is then faced with the decision to go with a code that is "close", or do they choose an "unlisted" code, then have to figure out how to "price" it for payment and still get the provider/physician good reimbursement.   However, when coding with the ICD-10pcs for hospital services, it is much more clear-cut and straightforward, than those codes for physician based services that are coded from CPT.

Within the CPT code-set there are many options to code from especially when it comes to codes and procedures that can be used from the integumentary system and/or from one of the specialty organ system chapters.  Outlined below, some of the codes in the integumentary section of the CPT book , (codes 15830 – 15839) some  payers have "tagged" these codes as being not medically necessary and or cosmetic based procedures.  However, the CPT definition states nothing in relation to that assumption of that in the coding guidelines.  The codes of 15830 – 15839 the base code of 15830 states "excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilcal panniculectomy .

If you compare and contrast the CPT procedure codes of 15839 and 56620, it is clear how difficult coding choices are, if the documentation is not clear, or the physician has not included or “tied together” a straightforward diagnosis and medical necessity for the surgical procedure. 

15839 56620

excision excessive skin&subq tissue other area simple vulvectomy (Note Work RVU only)

RVU = 10.50 RVU = 08.44

The lay descriptions for codes 15830-15839 is

“The physician removes excessive skin and subcutaneous tissue (including lipectomy).  In 15830, the physician makes an incision traversing the abdomen below the belly button in a horizontal fashion. Excessive skin and subcutaneous tissue are elevated off the abdominal wall and excess tissue and fat are excised. The flaps are brought together and sutured in at least three layers. The physician may also suture the rectus abdominis muscles together in the midline to reinforce the area. Report 15832 for removal of excess skin and subcutaneous tissue on the thigh; 15833 for the leg; 15834 for the hip; 15835 for the buttock; 15836 for the arm; 15837 for the forearm or hand; 15838 for the submental fat pad (inferior to the chin); and 15839 for any other area.”

The Lay description for code 56620 is

“The physician removes part or all of the vulva to treat premalignant or malignant lesions. A simple complete vulvectomy includes removal of all of the labia majora, labia minora, and clitoris, while a simple, partial vulvectomy may include removal of part or all of the labia majora and labia minora on one side and the clitoris. The physician examines the lower genital tract and the perianal skin through a colposcope. In 56620, a wide semi-elliptical incision that contains the diseased area is made. ….”

Now to compare and contrast what happens in the real world of coding, take a look at a case study of the CPT code 15839 and CPT code 56620 vulvectomy simple;partial.   As you can see the work RVU for the code 15839 is more than the code for the 56620.

Case study comparison:

History: Patient presents with labial hypertrophy (congenital) and wishes to have a labiaplasty to even up both sides of the labia.  Patient reports tearing due to excessive length on the left side, excessive skin gets caught in clothing, and is uncomfortable when sitting for long periods of time, or becomes irritated due to her clothing.  Upon examination patient has a class 3 hypertrophy, involving the clitoral hood.   ICD-10cm diagnosis = N90.6 Hypertrophy of vulva; Hypertrophy of labia.  The physician and patient formally decide to do a labiaplasty as an outpatient procedure . The physician schedules the surgery and performs a labiaplasty.

Procedure: The risks, benefits, indications and alternatives of the procedure were discussed with the patient and informed consent was signed. The patient was then taken to the procedure room and prepped and draped in the usual sterile fashion. The labia and clitoris were then marked using the marking pen to the patient's specifications.   The perineal area was infiltrated first with the creation of a small bleb followed by infiltration of the labia majora up to the clitoris on the left side. The labia minora was then infiltrated along the lines of demarcation.  It was then clamped using Heaney clamps and the tissue excised. The clamped tissue was then cauterized using a single tip Bovie.  Excellent hemostasis was confirmed. The clitoral hood was then trimmed using scissors. The exposed tissue of clitoral hood and labia were re-approximated using 3-0 Monoderm.  Excellent hemostasis was noted. This completed the procedure. The patient tolerated the procedure and was discharged home in stable condition.  Tissue sent to Pathology – no neoplasm noted, no abnormalities noted.

In the above scenario, the coder is confused regarding which code to use, and queries to provider.   The physician responds to the query and states CPT code 15839 with dx code N90.6 is the procedure and DX that should be billed.  The physician also responded back to the coder, that he did not feel that he performed a “simple vulvectomy” because only a minimal portion of the labia was involved, as the tissue that was removed was not diseased or compromised by lesions, or other symtoms, as borne out by the pathology report.   He stated this was simply a congenital abnormality of one side was “longer” than the other. 

A few weeks later, the coder then has another labiaplasty operative report, from the same physician,  however this one is for a patient who has an ongoing issue with syringoma of the vulva (as borne out by pathology biopsy)  In this operative scenario, the coder chose to code the 56620, as this was clearly a disease process. 

Operative Report:   Patient had previous biopsy for syringoma(confirmed) D28.0 Benign neoplasm of vulva.  The labia has become enlarged and patient opted for removal as it was becoming bothersome and growing at a rapid rate. 

Findings:  three 5 mm intradermal lesions on the patients left labia and two 3mm intradermal lesions on the patients’ right laboria majora approximately 2 cm posterior to the clitoris. 

Procedure:  The patient was taken to the operating room with an IV in place.  MAC anesthesia was begun.  Pt placed in lithotomy position, prepped and draped.  Area was previously identified and marked with marking pen.  Two small elliptical incisions approximately 3cm were made on either side of the lesions.  A 15 blade was used to make an incision.  The lesions were excised from the underlying tissue .  Incisions were sewn back totether with running subcuticular stiched with 3-0 vicryl.  The patient tolerated the procedure and was discharged home in stable condition.  Tissue sent to Pathology – confirmed all lesions were denoted as syringoma. 

If the coder were coding for this procedure in ICD-10 pcs it is much more straightforward, as the code would be OUBMXZZ, where as with CPT, it is subjective between diseased tissues and normal tissues.

Another coding and billing issue that these two codes (15839 and 56620) can present, is code 15839 has a larger RVU, and could be billed as a bilateral procedure, which would have a higher financial reimbursement, than the 56620 code, which cannot be billed as a bilateral procedure and has a lower RVU value attached.  Therefore, the coder must make sure that the code choice for billing is based purely upon documentation and physician notation reflected in the operative reports, and not based upon obtaining a higher reimbursement strictly for financial purposes. 

OB/GYN is not the only specialty where this type of issue is found.  Coding for the excision of soft tissue tumors are found in the musculoskeletal section of CPT.  A soft tissue tumor,  such as a lipoma  that is in the subfascial, or subcutaneous area should be coded to the musculoskeletal section with the code range of 22900 – 22905.  Whereas,  if the lesion is a sebaceous cyst, the code choice should be from the 11400-11406 integumentary codes.  If the diagnosis is a melanoma of the skin, it might be more appropriate to use 11600-11606 for a radical resection.   If the tumors are intra-abdominal (not cutaneous or musculoskeletal) then the codes 49203 – 49205 would be more appropriate. 

Again, this is where the coder needs to truly understand the anatomy of “what” was excised, “where” it was excised, and the pathology of the tissue or masses/lesions that were excised.  The physician is responsible for documenting clearly the diagnosis, the procedure and medical necessity.  This also includes “connecting” the pathological findings back to the operative notes.  Good clinical and operative documentation is imperative for the coder/biller, the medical record documentation, the payer/insurance carrier and the patient.  The coder has the ethical and moral obligation to code what is documented without regard to financial gain.  With this in mind, the coder also needs to be aware that CPT has many surgical codes that “overlap” or are very similar.   As a coding practice standard, all coding possibilities should be reviewed carefully, then code based upon the clinical documentation.

If you are in doubt, query the provider!  Many coders rely on the old adage of “if it wasn’t documented, it wasn’t done”.   This type of coding should no longer be the rule of thumb or status quo.  If the clinical documentation denotes a service/ procedure was performed,(but poorly documented) it is well worth the time to investigate, confirm, and/or have the operative record amended by the provider, then coded and billed with accuracy.   If the insurance carriers deny your coding/billing as a “cosmetic” procedure, and the clinical documentation supports true medical necessity (not just convenience for the patient) be sure to appeal and provide the substantiating medical records to support your coding.

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 webbservices.lori@gmail.com or you can also find current coding information on her blog site: http://lori-lynnescodingcoachblog.blogspot.com/.  

Computer Assisted Coding – Where are we today?

Some good Information for us that actually work with computer assisted coding.  

*********************************************************************************Originally posted from Justcoing.com August 19, 2016 (as written by me!) 

In our computer-saavy tech world, the medical field has been notoriously slow to respond to newer technologies and applications of computer assisted enhancements.   However, in the HIM market, computer-assisted coding , (aka CAC)  has been touted to boost coding accuracy and productivity, in addition to being a terrific tool for the “remote” or “at home” HIM/inpatient coder. 

Background

“The term computer-assisted coding is currently used to denote technology that automatically assigns codes from clinical documentation for a human…to review, analyze, and use.”   Currently,  there are a variety of methodologies software, and integration interface applications that enable a CAC  application to  “read” text and assign codes.  This type of software “reads” the information in a similar way to how a “spell-check” application works on a traditional computer.    According to some users, the data driven documentation (eg.  dictated/typed etc.) is more accurate from the CAC than documents that are scanned into the matrix for the CAC to utilize.   

CAC software works on a recognition premise, and “learns” words and phrases, as well as “learning” the areas within a  specific document as to where standardized words and phrases appear, (eg similar to a macro).  CAC software also has the ability to discern the context and or “meaning” of specific words and phrases.   The CAC then analyzes and predicts what the appropriate codes (ICD-10cm and pcs) should be for the documented procedures and diagnoses it finds within the specified documents.  

Computer-assisted coding (CAC) software has been available for over 10 years, but has really come to the forefront of inpatient coding with the implementation of ICD-10cm and ICD-10pcs and a way for hospitals to reduce charge lag-times and enhance DRG’s and find those “missed” MCC/CC diagnoses.  The usage and integration of an electronic health record (EHR) into a CAC has also been a factor for better code assignment and usage by the CAC for data analysis and outcomes.  However, it is yet to be shown that a CAC actually “enhances” a coders’ productivity rate.  On the up-side a CAC does give the coder a great place to “start” when working on a large difficult inpatient record.   A CAC is now where we were 20+ years ago when “encoders” were first introduced into the inpatient hospital marketplace for coding, abstracting and data analysis.

Pros and Cons of CAC 

Due to the complexity of inpatient care records, clinical documentation and the complexity of medical terms and abbreviations used, many hospitals don't have,  or only use the CAC with “real coder”  intervention.  However, the latest CAC software technology employs a type of natural language and syntax processing to compare, contrast and extract specific medical terms from the electronic data or typed text.   The CAC stand-alone technology does exist, however in studies by AHIMA, the “combination” of a CAC with a coder/auditor has been proven to be as good or better than a “coder” alone,  or a “CAC” alone. 

Yet, the biggest Pro/Cons of a CAC is getting the buy-in of the hospital coding and HIM staff.  As the medical field is ever-changing; the HIM, coding and clinical staff must all be a part of the changes and be on-board to this new technology enhancement to their job.  In the past, there has been some uncertainty and fear related to job-elimination of coders in regard to a CAC implementation at the facility.  However, a good CAC  in conjunction with  HIM management utilization of both, allows coders to apply their critical thinking and analytical coding knowledge skills to create a well coded documentation of the patients’ care.  This in turn,  relates to better DRG and reimbursement for the facility. 

The HIM and coding staff responsibility and role in the fiscal revenue stream will change.  With this change comes the acceptance that it takes both a “human” and a “computer” to successfully transform a CAC product into good financial outcomes and even better coding documentation.  

Coders are quick to agree that the final code selection for inpatient records should be based upon their knowledge of coding guidelines, clinical concepts, and compliance regulations.  When working in tandem on a CAC, the coder has the ability to override and agree/disagree with the codes that the CAC determines.

    

Coders have the education to understand why a diagnosis or procedure is, or is not coded, and with that by using the CAC, they can help the CAC “learn” to distinguish the importance of specific documentation and it’s relation to ICD-10 cm/pcs codes. 

Many CAC vendors will try and “sell” their product based upon this listing of “Pros”…

·         Increased medical coder productivity

·         Return on investment that quickly pays for CAC system

·         Faster medical billing

·         More revenue from more detailed bills

·         Greater medical coder satisfaction

·         Better  medical coding accuracy

·         Identification of clinical documentation gaps

·          

It has been highly touted that CAC’s in optimize coder productivity.  However, in reality, productivity will probably stay the same, as the coder will still have to “audit” the information to determine if, in fact, the CAC code is correct.   In regard to the other “pros” on the vendor list, coder satisfaction should not be overlooked. 

According to AHIMA’s pilot testing of CAC’s , they weighed in on some of the potential issues with a CAC use only.  However, these potential areas of concern can be addressed quickly if the coder uses the CAC to audit the case prior to any claims sent to insurance carriers.   AHIMA noted that within “specific” areas of the pilot CAC testing in ICD-10, the coders did not accept 75% of the diagnosis codes presented, and did not accept 90% of the procedure codes presented within the ICD-10cm and ICD-pcs codesets.   However, the information that the CAC presented, did give the coders a good “starting” reference to drill down to a more comprehensive code for both diagnosis and procedures. 

Coders and CDI personnel will still need to be the ones charged with

·         Ensuring clinical documentation is complete and query when appropriate. 

·         Ensuring complete coding (eg for 4^th and 5^th digits/specificity)

·         Ensuring correct sequencing of diagnosis and procedures

·         Reviewing of correct MCC/CC’s  and DRG assignments with case complexity and severity

CAC, Clinical Documentation, EHR, and Providers’

Integration of clinical documentation by provider and physicians has always been a challenge combined with the  and the implementation of ICD-10 in 2015  has been a huge impetus for CAC utilization for hospital and facility based organizations.  Unfortunately, physicians still don’t provide thorough documentation and rely on CDI and coding staff to guide them.  There has always been a HUGE disconnect in the language spoken by “providers” and the language spoken by “coders”.  Physicians document in their comfort zone, and fall back on those terms such as “pneumonia”.  Whereas a coder, they are looking for much more specificity.  The integration of an EHR based program for the physician/providers to use and a CAC providers a good “team relationship” for both parties. 

Many CAC programs extend out and integrate well with hospital based CDI programs and EHR’s.  These combination computer interfaces allow more “real time” processing of “possible” code selection prior to the final code selection being audited and reviewed by the coder.  When the CAC identifies these “possibilities” the opportunity exists to identify and improve the DRG’s with MCC/CC’s , and address more quickly areas for query, and missed procedures or diagnoses. 

Case Study to make It work:

The scenario below (provided from  Smith, Gail I.; Bronnert, June. "Transitioning to CAC: The Skills and Tools Required to Work with Computer-assisted Coding" Journal of AHIMA 81, no.7 (July 2010): 60-61.)

ICD-10-CM CAC Example

In the example below, the CAC software assigned the code T15.91A based on documentation in the emergency department record that states the patient had a "foreign body in the right eye." The coder is presented with the decision to accept the code or reject it based on further analysis.

Emergency Department Record

A patient is brought to the emergency department due to a foreign body in the right eye. He was working with metal, and a piece flew in his eye. He reports slight irritation to the right eye but no blurred vision.

A slit lamp shows a foreign body approximately 2–3 o'clock on the edge of the cornea. The foreign body appears to be metallic. The iris is intact.

Procedure: Two drops of Alcaine were used in the right eye. Foreign body is removed from the right eye.

CAC: Computer-Generated Codes: T15.91xA, Foreign body, external eye, right.

Final Coding Decision: T15.01xA. Foreign body of cornea,

Review of the documentation in the record by the coder and then the information from the CAC,  revealed that the foreign body was located on the edge of the cornea, which changes the fourth character in ICD-10-CM from 9 to 1. The coding professional replaces the T15.91xA code with T15.01A, Foreign body in cornea, right eye.

Wrapping it all up

The above scenario is a very simplistic case study, but an important one, as it shows and validates the importance of the coder as the “knowledge” behind the “technology”.   Coders and HIM professionals need to make a commitment to embracing change which includes “new” technologies and integration of learning processes and opportunities.  A hospital’s success depends on the “knowledge” worker as part of the ongoing and ultimate team member for successful outcomes for both patients and hospital fiscal solvency. 

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 webbservices.lori@gmail.com or you can also find current coding information on her blog site: http://lori-lynnescodingcoachblog.blogspot.com/.   

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

.. Originally published by JustCoding.com as written by me...  

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“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.  (https://www.cms.gov/Medicare/Coding/ICD10/Clarifying-Questions-and-Answers-Related-to-the-July-6-2015-CMS-AMA-Joint-Announcement.pdf) 

“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 webbservices.lori@gmail.com or you can also find current coding information on her blog site: http://lori-lynnescodingcoachblog.blogspot.com/.