Capture ICD-10 Specificity with Expert Medical Coding Services

Capture ICD-10 Specificity with Expert Medical Coding Services Physicians can maintain practice health with consistent, complete and accurate clinical documentation and the

support of an experienced medical coding company for error-free claim submission.

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Whether ICD-9 or ICD-10 coding, you would know that capturing specificity is crucial for payment. Nevertheless, with ICD-10, specificity requirements when reporting diagnoses are even more stringent. In fact, recent reports indicate that private insurance companies have started demanding greater specificity in claims. In this scenario, professional medical coding services can prove invaluable for accurate claim submission with diagnostic codes incorporating the required level of detail.

What ICD-10 Specificity Means ICD-10-CM differs from ICD-9-CM in organization, structure, code composition, and level of detail or specificity. While ICD-9 codes consist of 3-5 characters, ICD-10 codes have 3-7 characters, with the seventh digit extensions standing for visit encounter or sequelae for injuries and external causes. Here are examples of the higher level of specificity and clinical detail that ICD-10 codes offer: 

Combination codes for conditions and common symptoms or manifestations. A single code can be used to classify two diagnoses, a diagnosis with an associated sign or symptom, or a diagnosis with an associated complication. Fewer cases requiring more

than

one

code

reduce

sequencing

problems.

For

example:

I25.110,

Atherosclerotic heart disease of native coronary artery with unstable angina pectoris. 

Combination codes for poisonings and external causes, for instance: T39.011A, Poisoning by aspirin, accidental (unintentional), initial encounter.



Added laterality - right vs. left, for example: C50.511, Malignant neoplasm of lowerouter quadrant of right female breast).



Precise codes to represent specific anatomy and physiology.



Added extensions for episode of care: A = Initial encounter, D= Subsequent encounter, and S = Sequelae (complications that arise as a direct result of a condition).



Expanded

codes

(injury,

diabetes,

alcohol/substance

abuse,

postoperative

complications). 

Inclusion of trimester in obstetrics codes and elimination of fifth digits for episode of care.



Greater detail relevant to ambulatory and managed care encounters, that is, more information showing use of provider services by health plan enrollees.

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

Changes in timeframes specified in certain codes – for instance: in ICD-9-CM, the initial time frame for acute myocardial infarction (AMI) treatment is within eight weeks of onset, while in ICD-10-CM, the initial time frame for acute treatment is within four weeks of onset.



External cause codes are no longer a supplementary classification – The codes in the Supplemental Classification of External Causes of Injury and Poisoning of ICD-10 are alphanumeric and start with the letter “E.” These codes allow the classification of environmental events, circumstances, and conditions as the cause of injury and other adverse effects, and are to be used in addition to codes that report the actual injury. For example: E813.1 Motor vehicle traffic accident involving collision with other vehicle injuring passenger in motor vehicle other than motorcycle.

Avoid Denials - Code to the Highest Level of Specificity The Centers for Medicare and Medicaid Services (CMS) has stated that it will accept and process claims that are submitted in the correct ICD-10 family of codes until October 1, 2016. However, a report in Healthcare IT news indicates that some commercial health insurance companies are not prepared to wait till then and have started demanding greater specificity.

Physicians can maintain practice health with consistent, complete and accurate clinical documentation and the support of an experienced medical coding company. AAPCcertified coders in a reliable company would have a clear understanding of clinical concepts for comprehensive coding of conditions as well as insight on chronic and acute conditions for accurate ICD-10 coding with the required degree of specificity. Expert medical coders can prevent conflicts in the crossover from ICD-9 and ICD-10 and ensure that modifiers are properly used. This will assure claim submission compliance to maximize reimbursement and minimize denials and risk of fraud.

www.outsourcestrategies.com

1-800-670-2809