How ICD-10 is Like Trying to Eat an Elephant in One Bite

This past week, one of our auditors, Robert Blizzard, presented to the Central Florida Physician’s Alliance in Lakeland.  There were 7 practices represented at this particular presentation.  He was asked “ICD-10 is like trying to eat an elephant in one bite.  If you were to make 3 recommendations for practices to enact right now, what would they be?  His answer was that there are 3 key areas of concern.

1. Provider Documentation; If the coding is for some reason insufficient, documentation must be specific enough that the needed information is extractable.  For that reason, it is imperative that you convince your provider that his/her documentation practices need to be reviewed in comparison to the new ICD-10 code set to be sure it is adequate.  Follow up education will be a necessity to communicate any deficiencies and implement new standards.

2. Coding; A practice’s coders are a key component in preventing denials.  They must be equipped with the necessary tools to identify and extract vital information from the documentation and query the provider before the claims are submitted for reimbursement.

3. Accounts Receivable; Monitoring LCD and NCD changes over the course of the next year will be very important.  Many tests and procedures will not be reimbursed using unspecific code selections.  ICD-10 will potentially change the landscape of meeting medical necessity for procedures based on diagnosis.