ICD-10: Take the guesswork out of code changes

Q. What intake processes will be affected with ICD-10 implementation?
Monday, April 23, 2012

A. Intake will become the critical link for claims accuracy. The risk of keying ICD codes incorrectly during intake will most likely increase with this changeover unless personnel have tools to improve efficiency and precision.

An essential part of claims submission involves having a comprehensive understanding of the relationship between ICD codes and HCPCS codes and how to correctly apply them. ICD-10-CM is more clinical in nature than ICD-9. For example, a single code in the ICD-10 format can report a disease and its current manifestation (i.e. Type 2 diabetes with diabetic retinopathy). Assigning the wrong code can result in a denial. 

There are two key things HME providers should do to ensure intake works properly. First, intake coordinators need ongoing communication and training. Training is not only for internal staff, but will need to extend to referral sources and other healthcare personnel involved with patients. Second, businesses should automate. Not only does it streamline workflow, it reinforces training.

Keep in mind, ICD-10 codes will not match ICD-9 codes in structure or length. The best way to address this is through automation of General Equivalence Mappings (GEMs) of codes for new and existing patients. This takes much of the guesswork and workflow interruption out of the process. In addition, updating LCDs and NCDs and tying them directly to inventory items provides reference information alongside each product to easily interpret what products should be applied based on the diagnosis. Consider refresher courses for your intake personnel.

Gregg Timmons is president and CEO of MedAct Software. Reach him at gtimmons@medactsoftware.com or 800-326-0314.