• linkedin
  • Increase Font
  • Sharebar

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

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


    Don’t forget MIPS

    In addition to the fee-for-service world, you should also begin thinking about the future under the Merit-Based Incentive Payment System (MIPS) and value-based care. Last year, in preparation for ICD-10, we encouraged you to focus your efforts on urology diagnosis. During the move to ICD-10, it was important and remains important to continue cash flow, and urology-specific diagnosis coding is still a primary driver in reimbursement.

    Have you read: Is modifier –22 an option for multiple stones?

    However, as we move to value-based medicine, it is important to include those underlying diseases that may increase resource consumption across the spectrum. Understand that population health, coordinated care, and cost reduction are going to be a focus of health care system changes for years to come. The Medicare value-based payment modifier and eventually MIPS, as well as other private payer initiatives to change the overall cost of health care look beyond urology, but do not look beyond urologists and the possible contribution they can make to general health problems.

    While not fair and often generally incorrect, penalties for value-based services that tend to impact future payments have already begun. Diagnosis coding that tells the entire patient’s story relative to health is an important measure for most payers in the current and future markets.

    Action: Focus on collecting patient information on important population health diagnosis codes. Specifically, chronic kidney disease, hypertension, heart disease/failure, chronic obstructive pulmonary disease, osteoporosis, rheumatoid arthritis, cancer, body mass index-obesity, and diabetes, which are the current focus of Physician Quality Reporting System measures, should be made top priorities. Education of physicians and non-physician providers and amendments to patient data collection tools can ease the pain of increased data requirements. It is not too early to start working on these long-term goals, as the future as always is closer than you think.

    Generally, ICD-10-CM coding is going to expand. Remember, diagnosis coding tells the story of what is currently problematic for a patient. CPT tells the story of what the urology practice has done to address those problems. If you do not tell the whole story from a problem standpoint with accurate codes, payment for the actions you have taken will decrease or at the very least will be delayed. A systematic approach, education, system changes, and increased communication taken in daily actions are best practices and should be a part of yours.

    More from Urology Times:

    What urologists need to know about APMs

    IRAs: How to make an early withdrawal

    MIPS: How you will be measured going forward


    The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.

    Subscribe to Urology Times to get monthly news from the leading news source for urologists.

    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.


    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • No comments available