One of the many challenges facing Eyecare professionals concerning ICD-10 coding is whether to dual-code their encounters or not. In other words, whether it is one day, one week or a month, should the clinic code both ICD-9 and ICD-10 codes for a period before the Oct 1 2014 implementation date?
There are several good reason to do this. The main reason is to practice finding and reporting the new codes. The second reason is to determine if there are problems with either the terminology or ICD-9 to ICD-10 crosswalk. Another reason is based on documentation and whether the providers are providing the level of detail necessary to report the most accurate ICD-10 code.
At the very minimum, a comprehensive documentation-audit should be performed six to three months before the implementation date. This should be organized as follows:
The clinic performs a comprehensive review of all their current ICD-9 codes (fee ticket/cheat sheet/top 50 ICD-9 codes) for specificity and guidelines. Common examples include reporting one code when two are required (e.g., diabetic manifestations, ophthalmic hypertension) and not reporting late effects and E codes for injuries.
All ICD-10 codes relevant to Eyecare should be reviewed by both clinical and the coding and billing staff. Decisions should be made on what level of specificity will be required by the providers per the documentation. Allowing wide variance in documentation standards and reporting specificity is not recommended. The carriers will be auditing for ICD-10 compliance and if the documentation does not reflect what is reporting this will be considered a compliance violation.
Once the clinic agrees on standards, then the providers should implement the new requirements (e.g., documenting right and left for every eye condition, using the term “with hypoglycemia” for diabetic patients).
Audit the documentation for completeness and convert the codes to ICD-1o. This could be dozens or hundreds of codes.
The clinic must decide how codes are selected: lookup program, cheat sheet, fee ticket, abstracted from actual notes by a coder or written on the fee ticket by the provider.
The clinic should determine if they will be using a Legend/Cheat Sheet approach to coding ICD-10. This approach will require both training and practice to reduce the possibility of errors.
While dual-coding for an extended period may not be economically feasible for many clinics, a spot audit of 100 encounters or several days–spaced out over a few months is a wise strategy to determine any gaps or confusion in reporting the new ICD-10 codes.
The EyeCodingForum provides comprehensive training (online, recorded), consulting services, and an ICD-9 to ICD-10 conversion service that goes far beyond GEM one-to-one mapping (crosswalk) of codes. There are numerous “Gotcha’s” and exceptions. Those exceptions, though few will make the difference between a clean claim every time, and many hours wasted on follow-up and lost revenue due to improper ICD-10 coding.
Jeffrey Restuccio, CPC, CPC-H
Eyecare coding consultant