12 ways to mitigate the impact of expanded ICD-10 codes

Healthcare providers will soon have thousands of new codes to contest with, as CMS and the CDC will add 1,900 diagnosis codes and 3,651 hospital inpatient procedure codes to the ICD-10 coding system for fiscal year 2017.

According to the American Hospital Association, the new codes are being added now because there was a freeze on updates to ICD-10 codes before the Oct. 1, 2015, implementation date. The expanded codes take effect Oct. 1, 2016.

In light of this, Nearterm, a healthcare company providing revenue cycle management and financial management services, offered suggestions on what hospitals can do to mitigate the impact of these new codes.

Below are the company's suggestions.

1. Create a plan of action to uncover and address shortfalls and unpreparedness in all RCM functional areas.

2. Ensure coders and clinical documentation improvement specialists are trained on the new/revised codes and how they may impact business.

3. Update CDI and coding policies to include directives on the new codes if applicable.

4. Follow up weekly with coders and CDI specialists to discuss specific code sets/procedures.

5. Designate a point person to regularly check coding for quality.

6. Physicians must make sure all documentation remains at a high level of specificity.

7. For high impact surgeries and diagnoses, complete a 5-to 10-chart/provider documentation review to ensure the documentation supports the highest level of specificity.

8. Include the physicians and practitioners in the audit results and provide them with education on how to properly document the severity of their patients' illnesses.

9. Billers should also become familiar with expanded ICD-10 code sets for the specialty for which they bill.

10. Effective Oct. 1, 2016, Medicare will no longer accept unspecified codes for Part B. Therefore, Nearterm said hospitals should have a plan of action to prevent these accounts from being billed before a second level coding review can be done.

11. On the outpatient hospital side, Nearterm said queries may have to be sent back to the ordering provider requesting specificity either before the patient is seen (at registration) or at the time of coding for final billing.

12. Ensure vendors are ready for the expanded codes.


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