How can you put the coding system to best use in your practice and even squeak out some added value from the time you have spent preparing for the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10)?
ACCURACY IN CODING
As the saying goes, you reap what you sow. By being meticulous in coding every service, many of your practice’s billing processes will be streamlined and more efficient. With every lapse in coding, your staff will have to revisit the claim, try to understand your chart notes, and most likely involve you again in the conversation of how to code a service that occurred days ago.
Even if you use “claim scrubber” software before your claims go out, learning and understanding different payer coding rules will enhance the billing process. By coding accurately according to known payer rules for tests and procedures, you will prevent rejections, thus saving your staff time and work. Every rejection requires at least double the work of an initial claim. The former entails research, revision (if possible), the placement of an appeal within a tight deadline, and then follow-up on the results.
ICD-10 increases complexity. For example, you now often code for laterality. Codes that you and your staff knew by heart in ICD-9 are no longer recognizable in ICD-10. All of this slows down the coding and billing process, and you have to make up for that somehow in the near term. Being accurate and coding every service are key.
OPPORTUNITIES TO SPOT MISSING REVENUE
Added granularity in ICD-10 can serve to double-check coding accuracy. For codes that have laterality, linking the ICD-10 code with laterality to the right/left/eyelid modifiers on the tests and procedures that require laterality can help ensure that all claims are being sent out appropriately. Did every IOL power calculation get billed for every cataract surgery? Run a report to check that the ICD-10 code for cataract with laterality lines up with the associated code for A-scan 75219-left/right or optical coherence tomography scanning 92136-left/right and that the cataract surgery right/left after the surgery is performed. Doing so could identify missing revenue.
The American Academy of Ophthalmology’s IRIS Registry can help with the analysis of disease severity, outcomes, and resource use via coding as well as actual data extracted from charts. It should enhance ophthalmologists’ care of patients. Coding within the IRIS Registry is already used for various quality measures. It can become even more specific and helpful with some of the new ICD-10 families of codes.
Cynthia Mattox, MD
• associate professor and vice chair, Department of Ophthalmology, Tufts University School of Medicine, New England Eye Center, Boston