2017 Spring Convention

Transcription

1 2017 Spring Convention ICD-10 Billing for DCs and Billing Staff Paul Andrews

2 Please scan IN at the start of class Please scan OUT at the end of class You must attend the entire session to earn your credit(s) for this class

3 International Classification of Diseases 10 th Version (ICD-10) Required with service date October 01, 2015 forward Updates effective with service date October 01, 2016

4 ICD-10 from a billers point of view What ICD-10 issues cause a claim to reject electronically? What ICD-10 issues cause a carrier to down code a CPT code? What ICD-10 issues cause a carrier to deny a service?

5 Electronic Claims Rejections The number one reason a claims rejects electronically from an ICD-10 related issue The ICD-10 reported on the claim is not the most specific code available. These errors markedly increased when the Oct 01, 2016 updates occurred. EXAMPLE M Cervical disc disorder with radiculopathy, mid-cervical region M Other cervical disc degeneration, mid-cervical region, unspecified level M Other cervical disc degeneration at C4-C5 level M Other cervical disc degeneration at C5-C6 level M Other cervical disc degeneration at C6-C7 level

6 Electronic Claims Rejections The number two reason a claims rejects electronically from an ICD-10 related issue The ICD-10 codes reported on the claim include an Excludes 1 code combination Some ICD-10 codes cannot be reported in combination with other ICD-10 codes. The codes that you cannot include in combination with the primary ICD-10 code(s) are called Excludes 1 codes. EXAMPLE M51.1 Thoracic, thoracolumbar and lumbosacral intervertebral disc disorders with radiculopathy Sciatica due to intervertebral disc disorder Excludes1 codes: M lumbar radiculitis NOS M sciatica NOS

7 Electronic Claims Rejections Another reason a claims rejects electronically from an ICD-10 related issue The ICD-10 codes reported on the claim is missing the sixth character Particularly on Sprain or Strain ICD-10 codes the lack of a sixth character or the wrong sixth character is reported EXAMPLE S33.5xxA - Sprain of ligaments of lumbar spine, initial encounter Missing six character will reject the claim A Initial encounter is the appropriate choice throughout active care not just the initial visit.

8 Carrier down coding Down coding is when a carrier replaces a CPT code that was reported on the claim with a CPT code that reflects a lower level of the same service being reported. When this occurs without a documentation review it is typically due to an insufficient number of ICD-10 codes to reflect the service being performed 98941: 3-4 region CMT reported EXAMPLE 98940: 1-2 region CMT re-code from Carrier ICD-10 codes reported did not include 3 4 anatomical regions M99.01 Segmental dysfunction cervical M99.02 Segmental dysfunction thoracic

9 ICD-10 reporting that contributes to denial of service CPT and modifier coding to report distinct procedural services from the primary procedure using the same DX pointers on the claim ABCD AB ABCD D ICD-10s reported in box 21 A. M99.01 Segmental Dysfunction Cervical B. M99.02 Segmental Dysfunction Thoracic C. M99.03 Segmental Dysfunction Lumbar D. M Myalgia

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11 Please scan OUT as you leave If you are staying in this classroom for the next session you must have your badge scanned OUT for this session and scanned IN for the next session Thank you! Mark & Paul

12 Disclaimer TOP Education & the instructors acting on behalf of TOP Education are here this weekend to educate. They are not representatives nor speak on the behalf of any Insurance Company or TOP Education, LLC. Any discussion of a specific Insurance Company is for examples purposes only. All carrier specific policy or procedure questions should be directed to that carrier