Want to improve the diagnosis coding in your eye care practice and reduce denials? Harness the power of your EHR software by designing documentation templates that prompt clinicians to provide the information necessary for correct coding.
ICD-10 2019, for example, has added new specificity for several codes, including blepharitis. For your practice to code these series correctly, your ophthalmologists, optometrists, and other clinicians must remember to document laterality and in some cases, the upper, lower, or upper and lower eyelids as well. Has your coding and RCM team designed the documentation templates to help clinicians remember? If not, follow this three-step process to create templates that support your practice’s CDI efforts:
Use your practice management system’s reporting abilities to make a plan.
One of the best things you can do is to run a PM report that shows you how often your practice uses ICD-10 code series now. That way, when revising your templates, you can narrow your efforts to series that actually impact your practice.
Don’t make ‘unspecified laterality’ an option in your templates—even though it’s often an option in ICD-10.
There’s often a good reason to use a code that contains the word “unspecified” in the descriptor, but not when it comes to laterality. No matter the status of diagnostic testing, doctors know which eye has the problem—even at the first encounter. If providers don’t document right eye, left eye, or both eyes, and the claims goes out with an “unspecified” ICD-10 code, the payer will almost certainly deny it.
To prevent clinicians from accidentally choosing unspecified laterality codes, some practices ask their EHR vendor to remove them from the ICD-10 pull-down options.
Carefully monitor denial patterns.
You should always be tracking denials and looking out for patterns that indicate systemic problems, but you should be paying extra attention during the fourth quarter of every year as ICD-10 changes take effect. Denial patterns can signal that you should tweak your templates a bit more to help your clinicians get it right.