With the introduction of ICD-10 in October 2015, there has been a great deal of transition With the introduction of ICD-10 in October 2015, there has been a great deal of transition in the healthcare industry throughout 2016. According to a recent study, only 63% of ICD-10 coding is accurate. Now that the grace period has ended, physicians are no longer protected from being audited for not including the specificity of the diagnosis and can now be penalized for mistakes (source). This leaves healthcare organizations at risk for having claims denied or not receiving a full reimbursement due to ICD-10 coding mistakes.
It is crucial for any healthcare organization to become familiar with the changes ICD-10 brings. Here are 2 ways you can prevent coding errors when submitting ICD-10 claims:
1. Get Specific
ICD-10 comes with at least 55,000 more codes than ICD-9. This means that healthcare providers must document and code in a much more detailed manner with ICD-10. In order to avoid getting penalized, physicians must focus on site specificity and laterality of the diagnosis. Site specificity refers to the particular region of the diagnosis (IE: documenting the specific joint effected by osteoporosis). Laterality means identifying which particular joint where the condition is contained. An example would be identifying the right elbow instead of just the elbow.
2. Ensure All Codes Are Documented
Another common mistake when billing is not specifying the procedure, diagnosis, or even occurrence code. This can lead to a loss of reimbursement and can undercut your organization’s long-term profitability.
Now that we are past the grace period for transitioning to ICD-10, it is imperative that you are prepared to handle the changes that ICD-10 brings.