The pMD Blog

Welcome to the
pMD Blog...

where we cover interesting and relevant news, insights, events, and more related to the health care industry and pMD. Most importantly, this blog is a fun, engaging way to learn about developments in an ever-changing field that is heavily influenced by technology.

Weekly Byte: ICD-10 Specificity is the Name of the Reimbursement Game
Last month, my colleague Lindsay shared some information on the end of CMS’s one year ICD-10 grace period. To recap, as of 10/1/16 CMS will no longer accept unspecified ICD-10 codes on Medicare fee-for-service (FFS) claims when a specific one is warranted by the medical record. CMS also removed 305 existing ICD-10 codes and added 1,900 new codes.

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:

Smart Search
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.

Education
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.

Automation
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.
ACA ACI Advancing Care Information AHCA AHRQ AI Alternative Payment Model Android Apple Artificial Intelligence BCRA Best Places to Work Big Data BPCI BPTW Bundled Payments Care Communities care coordination CDC Charge Capture Charge Capture App Charge Capture Software Charge Capture Solution Charge Capture Statistics Charge Lag CHIP CIO Clinical Communication Clinical Data Registry CMS Conferences custom reports Customer Interaction cybersecurity Developer DHHS dotmed EHR Electronic Charge Capture epidemic FDA Flu fundamentals Goals Health Care Health Care Technology Health Care Web Health Information Exchange Healthcare HIE HIPAA HIPAA-Compliant Hospital Census Hospital Communication IA ICD-10 ICD-11 Improvement Activities Inc Magazine interoperability iOS iOS 8 iOS7 iPad iPhone iPhone 6 MACRA Medical Billing Medical Software Medicare Mentorship messaging MGMA MIPS MIPS Registry mobile Mobile App Mobile Charge Capture Mobile EHR Mobile Health Mobile Messaging Mobile security Mobile Technology Modern Healthcare Native App news NIH OCM Oncology Care Model Patient Patient Care Patient Generated Health Data Patient Handoff Software Patient Information Patient Visits Patient-Centric pmd pMD Team population health Population Health Management PQRS QCDR Quality Scoring Recruiting Reimbursement reports Residents Responsibility Secure Data Secure Messaging Secure Messaging Video Secure Text Messaging SF Biz Times success support TCM Teamwork technology telehealth Text Messaging texting Upgrades VA Value-based care Wearable Device Web App