7 Things Your Back Office Should Have Done By Now To Prevent ICD-10 Denials

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The ICD-10 implementation date is here. Here’s what your back office should have done by now to prevent ICD-10 claims denials and a Q4 2015 cash crunch, says Jeffrey Restuccio, an instructor at EyeCodingForum and an AudioEducator speaker.

1. Listed the ICD-9 codes your eye care practice has reported in the last 12 months. Coders should use this practice management system-generated list to create the ICD-10 fee ticket or cheat sheet your practice will use in Q4 2014 and beyond. Expect about four times as many diagnosis codes under ICD-10 than you had for ICD-9.

2. Chosen an ICD-10 code selection tool. Will your coders use a manual or a lookup program?

3. Contacted software vendors to ensure your systems are ready for the transition. (Learn more about how to choose the best software vendor.)

4. Educated themselves about coding challenges under ICD-10. “The majority of ICD-9 codes relevant to eye care will crosswalk cleaning to ICD-10,” Restuccio says. But your practice will need to code 10-15% of diseases and conditions you currently report differently under ICD-10. It’s the codes that don’t crosswalk directly that will cause the denials, he predicts.

5. Audited documentation for every clinical provider in your practice. Provider documentation habits that caused your coders mere headaches under ICD-9 could become full-blown disasters under ICD-10. Coders should have audited your charts and they should be alerting you to documentation habits that will cause confusion, miscoding, denials, and cash flow problems under ICD-10.

6. Used LCDs and payer policies to find the ICD-10 codes that support medical necessity for the procedures your practice performs more often.

7. Checked with vision plans to learn how they want your office to handle eye exams. V72.0 “routine exam of eyes” will become two codes under ICD-10: Z01.00: Encounter for examination of eyes and vision without abnormal findings Z01.01: Encounter for examination of eyes and vision with abnormal findings. It’s unlikely that plans will consider refraction “abnormal findings,” Restuccio predicts. Instead, “abnormal findings” will likely mean “something medical like dry eye syndrome.” However, it’s important to check with the plans.

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