How to Guarantee Clean Claims With ICD-10

IMPROVE YOUR DOCUMENTATION AND READ THE ICD-10 GUIDELINES.  That really is the key to surviving the transition from ICD-9 to ICD-10.  This process does not involve learning a new way to actually code – you follow the same steps as you would with ICD-9.  First, look up the diagnosis alphabetically and then verify the code in the tabular section.  The difference is in the new and/or expanded ICD-10 guidelines along with the notes each section provides.

Reading and understanding the guidelines will help you understand what is needed in your documentation so the correct code(s) can be assigned to your claims.  The Alabama Association of Health Information Management offers detailed ICD-9 and ICD-10 Chapter Guideline Comparisons and if you are looking for specialty specific tip sheets, Steve Sisko (@ShimCode) has over sixty downloads including a “Create Your Own Template”.

Many ICD-10 codes include a note stating “Use additional…” or the new “Excludes 1 and Excludes 2” notes.  This is the part of the coding process where many providers (or their coding staff) will have issues – what details do you have documented in the note?  For example, if you frequently used the ICD-9 code 729.5 – Pain in Limb you need to include specifics such as right/left upper/lower arm/leg.  When those details aren’t documented, you can be sure problems will begin to creep up.


If you are using an EMR and claims are generated and submitted automatically, you or your billing staff will begin to notice more clearinghouse rejections for “Invalid ICD-10 code (or combination)”.  Many of the online ICD-9 to ICD-10 code converters or EMR programs I have seen only lead you to the right family of codes.  Any additional notes, guidelines or codes required in addition to the main code you chose are not factored in, and many programs do not have the capability of alerting you of these critical details.

There are a number of ICD-10 codes which require an additional code to identify alcohol abuse and dependence, exposure to environmental tobacco smoke and/or history of tobacco use or dependence for example. If you aren’t familiar with the actual book and have not read the guidelines, you won’t know to include this when you finalize your EMR entry or write a code on the bottom of your superbill.

Most facilities and hospitals require physicians to fully document every detail and if they don’t, the HIM department coders will query you when information is missing.  If you do not have a certified coder in your office, your staff may not know when to question you and may unintentionally assign the wrong code.  This only leads to denied claims and a gradual decrease in cash flow to your practice. Add this to the usual list of issues related to denials and rejections and you can see why experts have suggested keeping a three month cash reserve on hand for ICD-10.

bottleneckI often suggest comparing one of your Admission notes from the hospital to a New Patient progress note.  Or a hospital Operative Report (your own or another surgeons) to the entry you have when procedures are performed in the office.  Do you provide the same detailed information for your office patient notes?

If you do – Kudos!  Your practice should not experience too many additional issues although you should still become familiar with the ICD-10 Official Guidelines.  If you feel there is room for improvement, you and your staff should set aside time NOW and check out the Provider Resources page.  There are many links to help everyone involved in the coding and billing process as well as links on how you can improve your documentation.

The best advice I can give is to track your claims religiously from this point on.  If you submit electronic Medicare claims and they aren’t rejected initially at the clearinghouse level, expect that remittance advice within 2 weeks and verify every detail.

Also, don’t let weeks or months go by without tracking your Accounts Receivable report.  If you start to notice the higher numbers creeping towards the 31-60 and 61-90 columns, changes are needed IMMEDIATELY.  Those outstanding claims need to be worked before they end up as denied for timely filing.

There are many consultants, billing services and other professionals who have prepared for ICD-10 and are also experienced in improving and/or managing the revenue cycle of a medical practice. It may be worth it to consider taking advantage of their experience and expertise so you can continue focusing on providing quality care to your patients.

Heidi Bio Pic

About Heidi Kollmorgen

My passion and interest involves anything related to medical billing, coding and health information management. I love to share what I learn and educate others so you have definitely come to the right place! ICD-10-CM is set to become mandatory beginning October 1, 2015. As an AHIMA ICD-10-CM Trainer also carrying the title of CCS-P (Certified Coding Specialist - Physician Based) you can be assured that quality care of your patients is the ultimate goal of my work as a consultant. HD Medical Solutions is dedicated to providing you with all your Revenue Cycle Management needs.
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