New ICD-10 Lab Test Codes Increase Complexity

by | Published on Feb 26, 2016 | Medical Coding

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The need for medical coding outsourcing is increasingly being felt by all kinds of healthcare practices, because of the new ICD-10 codes that seem to add further complexity to the already tricky coding process.

The ICD’s 10th edition features many new codes and details that are necessary to explain patient visits and claim insurance. The new coding system for lab tests and procedures is what hospitals and physicians around the nation have been wracking their brains around. More healthcare providers are opting to utilize medical coding services to efficiently face the challenges involved in ICD-10 medical coding.

Coders More Prepared than Physicians

Experts point out that coding specialists have been given over a year to prepare for this change, and many practices would have already provided adequate education to their coders so they’ll know what to expect. For physicians, though, the change has been quite a steep learning curve that is continuing. Physicians therefore rely on coders. As a result, coders keep going back to physicians to ensure they have all the required information regarding the lab test or any procedure performed. While this may consume a bit more of the coders’ time, physicians must be educated on being more specific with the details they provide coders.

Experts believe the reason for the increased coding is to enable doctors and researchers to have a closer and detailed observation of the trends at medical practices all through the country or in a particular medical office. According to the Centers for Medicare and Medicaid Services (CMS), the first year of claims assessment would allow a level of flexibility in assessing claims.

The new coding has also resulted in the creation of new medical procedures, as happens each year. This adds to the extensiveness.

Now let us see what physicians can do to ensure more accurate coding.

Measures for More Accurate Coding

When it comes to efficiency in coding with the aim to avoid denied claims, it always helps to have some fail-proof mechanisms in place to deal with such changes or the increased complexity that comes with newly updated codes:

  • Ensure your code selections are specific but not more specific than what you documented because that would increase the chances of you having to pay money back on an audit. At this stage, as we mentioned before, doctors can benefit from the assistance of coders who would ensure the codes are exactly based on the precise diagnosis.
  • Make sure you don’t satisfy yourself with entrusting code selection entirely to your EHR. You need to check the selections made by your EHR against the actual documentation. This is very important.
  • You need to customize the coding aspects so that your encounter forms cover all aspects required for accurate coding.
  • Private payers may have different coding policies from Medicare. This is something you must research, such as a specific code they require for a specific procedure or where they wish specific modifiers to be added. The effort helps to avoid unpaid claims.

It does get tough to ensure accurate coding, but healthcare practices have no choice since the reimbursement for their services depends on it. When the going gets tough, medical coding outsourcing to a reliable medical billing and coding company could help if the cost of maintaining and training existing coders gets too resource-intensive.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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