10 Things Rheumatologists Should Know About ICD-10

Nov 18, 2015

Rheumatologists and staff should communicate about coding, says ACR’s Melesia Tillman who offers an ICD-10 recap post ACR/ARHP 2015.

After years of talk and preparation, the new ICD-10 coding system for billing replaced its predecessor, ICD-9, on Oct. 1. At the 2015 ACR/ARHP meeting in San Francisco earlier this month, coding expert Melesia Tillman CPC, CPC-I, CRHC, CHA, gave an ICD-10 coding course for rheumatology practices to cover changes and offer tips to ensure claims reimbursement. In an interview with Rheumatology Network, Tillman, a coding and reimbursement specialist with the American College of Rheumatology, shared 10 ICD-10 tips for rheumatology practices.[[{"type":"media","view_mode":"media_crop","fid":"43473","attributes":{"alt":"©MartialRed/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_9714033030904","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4740","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":" ","typeof":"foaf:Image"}}]]

1)  Make sure that documentation matches the ICD-10 code. “They are looking at providers’ documentation. You have to make sure the documentation matches the diagnosis,” Tillman said.

​​2)  If a claim is rejected, check the insurance carrier’s medical policy to make sure it’s covered. “It will be denied if it doesn’t meet medical necessity,” she said.

3)  If there’s a rheumatoid arthritis diagnosis covered under ICD-9, it should be cross-walked to ICD-10. More than 200 codes moved from ICD-9 to ICD-10, said Tillman, so if it was covered before, it should be covered now.

4)  Avoid unspecified codes unless there’s no appropriate code to use. Some codes cross-walked to ICD-10 aren’t pointing to the correct code, but rather to an unspecified code leading to claim denial. “We were told that unspecified codes are used for surveys and research. There are some times where there’s no code,” she said. New codes won’t be added until 2017, as the 2016 cut-off for submitting proposed codes passed.

5)  Physicians and staff should communicate about coding. Talk frequently to make sure doctors and staff are on the same page. Tillman suggests meeting once monthly to discuss claims rejections, and ensure that claims are getting paid. 

6)  Keep an eye on accounts receivables. “This is a big computer change. Anything can go wrong,” Tillman said. Confirm you’re getting your contracted rate and look closely at high dollar claims like infusions to make sure you’re getting reimbursed.

7)  Consider using a scribe to document during medical visits, to ensure that documentation matches the ICD-10 codes. “That’s another option if physicians feel they’re overburdened with documentation or missing documentation,” said Tillman. The scribe doesn’t provide medical care or coding, just documentation.

8)  Don’t down-code to stay under the radar for audits. “Bill for what you do, just document what you do,” she said.

9)  When sending requested documentation to the insurance company, do it right the first time. “When someone asks you for medical records, that’s an audit,” Tillman said. “Some payors only give you one chance to send in medical records for an appeal. Send in everything needed the first time. You might only get one chance.”

10)  Get training. Even if you use electronic medical records, “everyone should have an ICD-10-CM book. It saves a lot of trouble when getting weird denials. They’ll see the coding guidelines that don’t show up on the EMRs,” Tillman said. ICD-10 training is available through the American College of Rheumatology, the American Academy of Professional Coders (AAPC) and American Health Information Management Association (AHIMA). I addition to training and the ICD-10-CM book, the ACR recommends downloading its Rheumatology ICD-10 Crosswalk which lists the top commonly used diagnosis codes in rheumatology.

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