The information provided here applies to Medicare coding. Be sure to check with your Medicare Administrative Contractor (MAC) for additional information and clarification on these and other items. You should also contact your local insurance carriers to determine if private insurers follow Medicare's lead on all coding matters.
New Year’s Wish for 2017 - Time for a Coder?
As I look ahead to 2017 and consider the overall theme for my work in 2016 as a consultant, the International Classification of Diseases and Related Health Problems, 10th Edition (ICD-10) is at the top of my list. The transition to ICD-10 was hyped as an enormous change in coding. In fact, ICD-10 is remarkably similar to its predecessor, ICD-9. It is simply ICD-9 on steroids with many more codes to choose from. It was not that ICD-10 is a new coding system, but rather an enhancement of the existing system. The transition uncovered a substantial lack of understanding of the ICD-9 system. The ICD-9 system is the foundation for understanding ICD-10. Without a thorough understanding and solid base for the coding process, many found themselves failing to understand ICD-10 and ultimately overwhelmed by the transition process.
The guidelines for ICD-10 state that coding is a, “joint effort between the physician and the coder.” The joint effort is critically compromised if the physician selects a code with no help or input from their coder. To this end, my New Year’s wish is for physicians to be able to stop coding, which takes a considerable amount of time and effort. Too often physicians spend an inordinate amount of time searching for codes, getting frustrated and then ultimately settling for an unspecified code. I have too often seen that the most specific and appropriate diagnostic code is not used.
ICD-10 codes have compliance concerns of which physicians are not generally aware. When an office files claims based on codes selected solely by physicians, the audits performed by my peers and I often find errors that could prove problematic for the physician. Audits are performed looking at the selection and inclusion of these diagnostic codes. This central piece of charting is generally done by physician-coders who have had little or no training in coding. This is a recipe for problems.
Turn back the job of coding to the coders. Calculate the amount of time you are spending trying to find diagnosis codes with software and on-line searches. Multiply this by your average income per-hour and do the math. You will find that there may be a strong economic argument to hire a full-time coder. Your coding will greatly improve. You can be more confident knowing you are up-to-date on new codes and other changes that ultimately impact your bottom line. Most important, you the physician will find more time in your day to focus on the things you want to focus on -- the patient.