ICD-10: How to Avoid These 5 Costly Problems

Betsy Nicoletti, MS


March 25, 2015

In This Article

The Landscape Will Change Soon

The US healthcare community is moving to ICD-10 in October 2015. There will be 70,000 choices of diagnosis codes alone, instead of a mere 16,000 choices currently available to describe a condition, illness, injury, or symptom. Coders are delighted. Physicians, not so much. But despite the notice and preparation, there are things that could go amiss.

To understand what could go wrong and prevent those things from happening, it's important to realize that coding in a physician office is very often done by a physician, nurse practitioner, or physician assistant and not by a coder. In the hospital, professional coders touch all claims. In a physician office, many services are provided, documented, and coded by a clinician, not by a professional coder. Larger organizations and bigger practices may have coders, but that is not universal.

The physician, nurse, or physician assistant who is treating the patient selects the codes within the electronic health record (EHR). These professionals are already feeling burdened by the complexity of documenting via an EHR, and now the diagnosis coding options have more than quadrupled! What could possibly go wrong and cause delays and problems for your office? Read on.

Unspecified Codes Cause a Slowdown

Hospital coders, lab technicians, and office staff send questions to physicians and other clinicians about diagnosis codes. The lab notices that a test ordered doesn't have a covered indication and wonders whether there's another diagnosis that the physician can add to the order form. Hospital coders have questions for physicians about many diagnosis codes that affect payment for the hospital: What type of congestive heart failure does the patient have? Could you be more specific about the pneumonia? Please describe ulcer in the stage of the ulcer in more detail. The hospital's payment varies on the basis of what the doctor describes as the diagnosis. In the office, coders ask healthcare professionals for a more specific diagnosis or to link a test with a certain diagnosis.

These queries will only increase with the additional diagnosis codes, unless coders and providers make a concerted effort now. Drive out unspecified diagnosis codes in ICD-9. These are codes that are listed as not otherwise specified (NOS), many of which end in .9. If you make an effort to stop using them in your current system, there will be fewer queries with the implementation of ICD-10.

Run a list of your most frequently used diagnosis codes and identify these unspecified codes. Look at the descriptions of them in your EHR. In some systems, the descriptions have been changed by the staff. For example, 682.9 may be described as cellulitis and used for cellulitis in all locations on the body. However, 682.9 is actually cellulitis – unspecified location. There are more specific diagnosis codes based on location for cellulitis.

Fix those errors now. Physicians who work in the hospital should note what type of questions come from the inpatient coding staff and immediately add specificity to the documentation for those conditions.


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