Medical Billing Forum

Billing => Billing => Topic started by: bt_elite00 on September 08, 2016, 02:28:12 PM

Title: ICD-10 Specified Codes
Post by: bt_elite00 on September 08, 2016, 02:28:12 PM
I know that ICD-10 codes need to be specified vs un-specified starting Oct 1, 2016. When looking over a dr.'s billing how can we as the biller know that the diagnosis codes we see are as specified as possible (to avoid denials). Is there a reference we can give the doctors? Please advise.
Title: Re: ICD-10 Specified Codes
Post by: Tameka79 on September 08, 2016, 03:51:48 PM
I think as billers, we are given the dx codes by the coders/physician, so first and foremost they should know about the rules of using the code to the highest specificity. However, what I do is if I notice the coder/provider is using unspecified codes I look at the more specific codes and ask them to be more specific by using and then I give them examples.

So let's say the dx is endometriosis (N80.9)  and that's all they put. I would ask the provider to be more specific in the location of the endometriosis if known, because the more specific codes for endometriosis are further broken down by location. I ask them to make sure that this is documented in the chart as well, not just given to me verbally.

I hope this helps.
Title: Re: ICD-10 Specified Codes
Post by: kristin on September 08, 2016, 06:56:27 PM
Really, like Tameka says, it is the provider/coder's job to code to the highest level of specificity. The reference they should be using is the ICD-10 manual, which has every code in it, if they don't have an EMR where every code is already uploaded. If you have to spend time going through each claim, trying to figure out if they could have used a more specific code, you will be there all day.

It has been almost a year since ICD-10 took effect, and if providers.coders are still using unspecified codes, when a more specific one is available, I look at that like they just don't care if their claims start to deny come Oct. 1, 2016. They were given a grace period, that they should be thankful they even this point, they need to step up and code correctly.