One of the biggest challenges for clinicians with the transition to ICD-10 will be coding for items that they would normally include in their notes. In the new world of ICD-10, everything has a code and insurance companies won’t reimburse for anything that’s not coded.
The external causes of injuries should be a focus for clinicians and may be the most difficult to remember. Payers want more intensive information about every aspect of a patient’s visit to their medical professional.Practitioners must code injuries, onset of symptoms, external causes and treatment plans.
It’s absolutely essential that professionals in any branch of the medical profession code to prove medical necessity. In some instances, it may be necessary to rely on records from the referring physician to provide acceptable documentation.
Clinicians should always strive to code at the highest level of specificity and detail that’s possible. Practitioners can no longer code for a probable or suspected diagnosis. Payers just want to know about the facts that can be proven by tests and the clinician’s observation.
The process will be smoother and less troublesome if clinicians identify the codes they most often use and convert them to ICD-10 before the implementation deadline. There are thousands of new codes, but clinicians in private practice will typically only use a small number of those, making it easier to begin converting and using them in dual coding.
Before ICD-10, a clinician’s notes were a tool that was used to create an ongoing record of a patient’s health history. They essentially created a database of knowledge that could be referenced about the client. With the implementation of ICD-10, that same information has been reduced to specific codes that determine what clinicians will receive for reimbursements.
The clinician’s expertise with ICD-10 coding will be a determining factor for practice revenues. The GEMs will assist in those efforts to be more specific, but practitioners will want to engage in some preemptive documentation. It will help medical professionals become familiar with the new coding and facilitate the changeover in patient records.
Professional organizations have predicted a 15 percent increase in documentation requirements. Those entities indicate that 65 percent of clinician notes aren’t specific enough for the new ICD-10 coding and will result in a significant increase in documentation times. The sooner that practitioners become adept at coding with ICD-10, the less time will be required as time progresses.
Payers have always sought reasons to deny claims and place the financial responsibility elsewhere. That’s their job. As comprehensive as the new code set is, medical professionals in all fields should be aware that they may encounter substantial difficulties. Many payers are under the impression that ICD-10 has a code for every possible instance, but that just isn’t true.
The current healthcare environment is one in which the focus is on saving money and ensuring that services are actually being received. Payers are no longer content to reimburse without practitioners without providing detailed to ensure the treatment is appropriate and is actually being carried out.
To accomplish that task, practitioners now have more specific coding, along with additional coding for documenting details about the causes and circumstances surrounding the patient complaint. Notes are no longer sufficient for that purpose and a practice’s revenue stream will directly depend upon the clinician’s ability to locate the appropriate codes to provide proofs in an alphanumeric fashion instead of words contained in notes.