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    ICD-10 ‘grace period’ ending soon, but don’t panic

    Letting go of ICD-9, avoiding/eliminating unspecified codes can help you prevent denials


    Action: There are two steps we recommend for practices as they continue to refine their diagnosis coding and avoid general denials where possible. First, we recommend letting go of ICD-9. Many practices continue to use old forms, crosswalks, cheat sheets, EHR crutches, and other tools that require looking first for diagnosis codes in the old ICD-9-CM system. It is time to let go and move on (unless you have an EHR that cannot keep up). Shortlists with verbiage that you customize in either paper, cheat sheets, or within an EHR need to be updated to ICD-10 direct codes.

    Read - MIPS: A first look at how it will affect your practice

    Updating these forms to ICD-10 or for those who have already eliminated ICD-9, updating these forms for 2016 will need to include the second step, which is to remove any “general” unspecified codes that do not make clinical sense. One obvious example we have run across is C67.9 (Malignant Neoplasm of the Bladder, site unspecified). Basically, if you know that a tumor is malignant, you should know where it is. Another example is R31.9 (Hematuria, unspecified). Our argument is similar; if you find hematuria, you should know at least if it is gross or microscopic.  You should not eliminate unspecified codes that make clinical sense such as N52.9 [Male erectile dysfunction, unspecified], as these codes will still be used for cases in which there is no need to further diagnosis or for which you can prescribe treatment without a more definitive diagnosis.

    By eliminating unspecified shortcut codes, you will help remind yourself and your colleagues to be more specific. If you can remove other codes that are infrequently used and replace each code with a more specific diagnosis, do it.

    Watch for changing codes

    The Centers for Disease Control and Prevention and Medicare announced changes for ICD-10 codes for 2017 ICD-10-CM. Remember that ICD coding both for versions 9 and 10 have been frozen for 4 years. The freeze has ended. They have announced that 2017 ICD-10-CM will contain 1,943 new codes, 422 revised codes, and 305 deleted codes. Luckily, the majority of the changes do not affect urology directly.

    In all, we identified 121 changes to codes that would likely affect urology. (Note: We did not count code changes for any chronic diseases that were not typically urologist treated.) Sixty-four of the changed codes were made to the code family of T83 (Complications of genitourinary prosthetic devices, implants and grafts) and T85 (Complications of other internal prosthetic devices, implants and grafts) (added to the list based on the use of InterStim by urologists around the country). Both the full list of proposed changes and those changes identified as affecting urology are posted on AUAcodingtoday.com to assist in preparation for this change.

    Action: Begin the process of updating your 2016 ICD-10 file to the 2017 ICD-10 file. Make sure that your practice management system and EHR will have the updated files ready for use by Oct. 1, 2016. Depending on your practice, some of the additions and changes may have limited impact.. However, there are a few new codes that many will find helpful in removing unspecified codes from your short list of ICD-10 codes.

    Last but not least, in the fee-for-service world, is the fact that the grace period included Medicare’s promise to ignore ICD-10 mistakes from an audit perspective. The reverse of this, of course, is that Medicare and other payers now have the go-ahead to evaluate non-specific codes and general family codes suspected of being incorrect by reviewing the Medical record. We see this as being executed in both pre- and post-payment reviews.

    We have mentioned previously that documentation of service and clinical findings must stand on their own during medical necessity review. A move to increase accuracy will likely result in a few more medical record requests.

    Read: PQRS success challenging but doable for urologists

    Action: Continue to improve your documentation and data capture, with an eye toward the most specific diagnosis available. Documentation improvement and coding education should remain on every office to-do list year after year. You may need to educate and audit some of providers in a preventive step to help increase compliance and lower risk from audit take-backs.

    Next: Don't forget MIPS

    Ray Painter, MD
    Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver, and is also publisher of Urology Coding and ...
    Mark Painter
    Mark Painter is CEO of PRS Urology SC in Denver.


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