Common ICD-10 Coding Errors that Medical Practices Should Take Care to Avoid

Common ICD-10 Coding Errors that Medical Practices Should Take Care to Avoid

Healthcare providers must be aware about coding deficiencies and review the accuracy of their ICD-10 coding procedures for continual improvement.

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The grace period for ICD-10 coding ended on October 1, 2016. Healthcare entities had been warned about the expiry of this deadline and that CMS will no longer be flexible regarding specificity in diagnostic coding.

However, experience over the past year has

shown that there are some areas where medical coders tend to make mistakes. Whether they are submitting codes to Medicare or commercial payers, medical practices need to be vigilant to avoid such errors. Let’s take a look at the most repeated ICD-10 coding mistakes: 

Specificity in documentation detail, such as the use of the seventh character for trauma and fracture codes: In ICD-10, the first six digits of the code describe the type and nature of the fracture while the seventh digit reflects the type of encounter (initial, subsequent, or sequela). All fractures require an encounter code (7th digit) when coding a fracture along with the description (first 6 digits). Coders generally have a problem getting the encounters right when using the injury codes.



Errors arising from use of procedure codes to determine diagnostic-related group (DRG) codes: Some procedures which were reported with a single code in ICD-9 need two codes in ICD-10. Grouper logic for ICD-10 features several procedure codes that result in a different DRG when reported alone and when reported along with another procedure code.



New details when coding strokes: In ICD-9, important details about the stroke type or cause were left out in coding stroke in a long-care setting. In the transition to ICD-10, surveys found that many coders were unaware of the additional coding rules in regard to the specificity of sequela as well as the required level of specificity.



Uncertainty around using respiratory failure as a principal diagnosis: In ICD-10, a code from subcategory J96.0 Acute respiratory failure, or subcategory J96.2 Acute and chronic respiratory failure, may be assigned as a principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital and depending on the circumstances of the admission.

Chapter-specific coding guidelines for obstetrics, poisoning, HIV, and newborn that provide sequencing direction take precedence.



Confusion around sepsis coding: Sepsis coding has always been challenging due to changing terminology, new definitions, and guideline updates. In ICD-10, sepsis coding is even more complex as multiple codes are needed to fully capture the diagnosis.

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Two

additional

errors

that

the

American

Health

Information

Management

Association (AHIMA) identifies are: 

Lack of specificity regarding devices, components and grafting materials during medical procedures.



Mistakes around whether dye was used during procedures with guidance tools, such as fluoroscopy or ultrasound.

The AHIMA report also mentions several areas where coders experience the most difficulty: V00-Y99 - external causes of morbidity; R00-R99 - symptoms, signs and abnormal clinical and laboratory findings; S00-T88 - injury, poisoning and certain other consequences of external causes; Q00-Q99 - congenital malformations, deformations and chromosomal abnormalities, and D50-D89 - diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism.

AHIMA also noted that healthcare entities submitted accurate codes for: endocrine, nutritional and metabolic diseases (E00-E89); diseases of the genitourinary system (N00N99);

diseases

of

the

circulatory

system

(100-199);

mental,

behavioral

and

neurodevelopmental disorders (F01-F99), and diseases of the eye and adnexa (H00-H59).

CMS has released the 2017 ICD-10-CM files on the ICD-10-CM updates for FY 2017. These 2017 ICD-10-CM codes are to be used for discharges starting October 1, 2016 through September 30, 2017 and for patient encounters occurring from October 1, 2016 through September 30, 2017.

For healthcare entities, more codes and increasing complexity means not only training for the new codes, but also reviewing existing ICD-10 codes that are prone to errors. Opting for outsourced medical billing and coding is a feasible option to minimize errors, and ensure accurate claims submission. Established medical coding companies have regular training programs in place to ensure that their coding team is current on coding procedures and changes to help providers deal with existing and forthcoming challenges and increase revenue.

www.outsourcestrategies.com

Phone: 1-800-670-2809