Nathan, Healthcare IT team By Nathan Stott, Practice Director

It’s been a full year now since ICD-10 was officially implemented as the new coding structure for diagnosing patients with the intent to get practices one step further along on the road to value-based care. While practices are now becoming comfortable with selecting ICD-10 diagnoses instead of the old ICD-9 codes, payers are now preparing to start denying claims that are not coded to the correct specificity.

So what should providers be doing to best avoid Medicare Part B claim denials moving forward?

  1. Develop Common Lists // All physicians should be using a “common list” of diagnoses that is comprised of the most commonly used diagnoses they see that already includes the highest level of specificity available for that family of codes. Many EMR programs will also let you change the description of codes to allow providers to more easily search for the code they want instead of getting lost in the semantics.
  1. Customize Templates // EMR templates should also be customized to allow for easy documentation to support the new specificity of the ICD-10 codeset. Templates for specific complaints should be used to dial in a short list of commonly needed codes for that problem.
  1. Audit for Performance // Practices should also be conducting internal and external claim audits to see what problem areas exist. Isolating the most commonly unspecified codes allows for practices to focus training on those areas and educate their providers to help them make better selections.
Value Based Care Timeline

Value-Based Care Timeline // source: cms.gov

With the end of the grace period that CMS allowed for submitting unspecified diagnosis codes paired with the continued implementation of value-based care programs over the next several years, accurate ICD-10 diagnosis coding and documentation could not be more critical.

About Nathan // After earning a degree in Business Administration from Rutgers University, Nathan has been exclusively providing consulting services within the IT and Healthcare industry. As our Practice Director, Nathan develops all of our Health IT strategies and oversees our clients’ continued success by ensuring ongoing regulatory compliance, EHR optimization, and clinical workflow efficiencies. Email > nstott@tektegrity.com