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Getting Paid: ICD 10 Specificity Challenges & Innovative Technology Solutions for Physicians

ICD-10 (International Classification of Diseases) is divided into two main categories:

  1. ICD-10 Clinical Modification (ICD-10 CM): captures diagnoses in every healthcare system
  2. ICD-10 Procedure Coding System (ICD-10 PCS): captures inpatient setting procedures

Medicare now requires physicians and all healthcare providers to send claims with ICD codes of highest specificity. However, since its launch in October 2015, physicians have faced several challenges with ICD-10 coding. Such challenges fall under the following four categories:

  • Documentation: Diligent noting of multilayered details in the appropriate manner is required for ICD-10 coding, which can be a challenge for physicians documenting within EMR
  • Compliance: Since ICD-10 coding expects nothing short of accurate coding, physicians are more likely find themselves facing error in coding specificity when it comes time for audits.
  • EMR/EHR: Unfortunately, EMR/EHR inadequately guides physicians to provide specific ICD-10 codes. Consequently, mobile charge technology for ICD-10 coding can be complex and problematic for many physicians.
  • Code Specification: ICD-10 requires numerous codes which need to be specified. Such may include coverage and policy alterations. Failure to code with highest possible specificity leads to claim rejection, auditing risk, and delay in payment.

Potential Fine And Fraud Allegations For Miscoding

Repercussions for improper coding cannot be overlooked. Such may come from both sides: the employer and insurance companies (including Medicare and Medicaid). In most cases, health providers are fined while other cases may take into account the inaccuracies of the coder. Therefore, taking the time to confirm diagnosis with accurate ICD-10 codes is significantly important for physicians or health care providers.

Insurance companies may decide to impose the liability documented in the Federal False Claims Act, accusing a coder for knowingly submitting a false claim for payment. Fines imposed by the employer may vary depending on employment agreement which defines financial fines and penalties.

Technology Solutions For Accurate ICD-10 Coding

The following technology-based remedies can aid as a prevention measure to finding oneself on the wrong side of ICD-10 coding practice:

  • Computer-assisted coding (CAC): A software that extracts relevant information from clinical documentation and assigns correct ICD-10 codes to the data.
  • General Equivalence Mapping (GEM): A tool to convert data from ICD-9-CM to ICD-10-CM and ICD-10-PCS and vice versa.
  • Software Enhancement: With the ability to generate specialty specific codes, softwares can keep track of most commonly used ICD-10 codes specific to each individual user.
  • Rule Engine: Softwares that prod physicians or coders to identify the clinical concepts and additional relevant info required to generate specific ICD-10 codes, similar to ICD Sherpa, a solution offered by VitalWare.
  • Artificial intelligence: Use of machine learning and natural language processing that delivers more accurate, specific and valid ICD-10 codes.

Three Features DocCharge Uses To Improve Coding Specificity And Save Time

DocCharge, a mobile physician productivity platform, tackles the challenges with ICD-10 in an easy-to-use, effective manner. The following 3 features explain how:

  1. Easy access to all 69,000-plus ICD-10 codes at the fingertips for physicians on the go while rounding out-of-office.
  2. Advance search algorithms that generate relevant codes using latest mobile technology in seconds. The software platform improves the ICD-10 specificity.
  3. Innovative CPT-ICD combo technology delivering Medicare approved ICD-10 codes for relevant CPT codes for surgery and procedures (thus avoiding denials). Solutions like the ‘HOT CPT’ concept enables physician to capture mobile charges in 5-10 minutes, saving at least 30-45 minutes per day spent using traditional model of charge capture.
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