General Question for the Week of October 17, 2016

General Compliance Question of the Week

Question:

It is not always possible to avoid assigning an unspecified code but I understand that CMS now expects more specific diagnosis codes, but for FY 2017 there are so many codes to choose from. Do you have any advice for making this manageable?

Answer:

While the number and specificity of diagnosis codes can appear daunting, if everyone works together and follows the steps below, there be fewer claim denials and more accurate payment, and better quality data will be accumulated to help improve the quality of patient care.

  • Report specific diagnosis codes when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, in some instances signs or symptoms or unspecified codes are the best choice to accurately reflect the healthcare encounter.
  • Avoid unspecified ICD-10 codes whenever documentation supports a more detailed code. Check the coding on each claim to make sure that it aligns with the clinical documentation.
  • Code each healthcare encounter to the level of certainty known for that encounter.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.