So, reimbursement is directly tied to coding specificity now more than ever. The problem is that knowing exactly which ICD-10 code to use when treating a patient that’s been "struck by a dolphin (W56.02XA)" can be difficult, especially using a paper-based system. In fact, the transition to ICD-10 in October 2015 drove many groups to move to mobile charge capture systems like pMD, as they felt there were just too many codes to keep up with on paper. But what do this year’s changes mean? What else can groups do to make sure they are being as comprehensive and specific as possible with their coding?
At pMD we’ve been focused on providing tools to help our practices comply with the new, stricter coding guidelines. Here are some of the ways that we’re helping users of our mobile charge capture software:
The number one tool that pMD offers to help providers with their diagnosis coding is a dynamic, smart code search functionality that makes it fast and easy to find what they’re looking for. Flipping through a code book to search for specific codes is tedious and can increase charge capture lag. More often than not, the provider knows exactly what diagnosis they are treating the patient for and will happily select the most specific code if it’s intuitive and easy to find. In pMD, diagnosis codes are searchable by both a custom “nickname” and the long description, so providers searching for DVT and Deep Vein Thrombosis will both be able to quickly find what they’re looking for.
pMD charge capture also offers reporting capabilities to view the group’s usage of diagnosis codes by frequency and by provider. This report can help analyze group-level and provider-level trends as it relates to codes that are no longer considered specific enough. Many of our practices have used this report to identify members of their team that might require additional diagnosis coding education.
In addition to selecting the most specific code warranted based on the documentation, certain diagnosis codes also require an additional or supplemental code be included on the claim when applicable. In some cases two or more codes may be required to fully describe a condition. For example, if billing a charge for a patient that has Type 1 or 2 Diabetes with CKD (E10.22 or E11.22), you are also expected to include the diagnosis code for the CKD stage (N18.1-N18.6).
It can be hard for providers to identify which codes actually require additional information, and even when they do know, it’s easy to forget to apply both codes to a charge. Based on the diagnosis entered on a visit, pMD can prompt the provider to select another corresponding diagnosis code. This ensures greater accuracy on charges, particularly for specific diagnosis codes that require additional information for billing.
Arming yourself with the tools you need to comply with CMS’s stricter ICD-10 coding guidelines may not be able to help you avoid getting struck by marine mammals (W56.32XA), but it can help you avoid claims denials.