![]() In our system, that varies from doctor to doctor and from one hospitalist group to another. Why is payment for procedures a big deal for hospitalists? After all, survey data indicate that the number of hospitalists still doing procedures has dropped quite a bit in the past 10 years. But in the meantime, hospitals are waiting for large bills to be paid. The CMS has tried to move quickly to fix the errors. Here’s one unanticipated surprise: Since the ICD-10 conversion, payment for some procedures (catheter thrombectomy of carotid arteries, for example) has been denied due to errors in the way payment policies were set in electronic payment systems. As we treat these conditions, we can help by providing as complete documentation as possible. Ones that come to mind include heart failure, complications of diabetes (retinopathy, nephropathy and neuropathy) and malnutrition. More specificity also seems to be required for certain conditions that hospitalists deal with frequently. Crohn’s disease- particularly the involvement of small or large bowels, or both-is another condition in which coders and clinical documentation specialists keep coming back to us, asking us to be more specific. If the malignancy involves both lungs, you need to clarify that. Lung cancer is a good example: There are left- or right-sided lung, or bronchial cancers. In most clinical scenarios, you can easily determine laterality and readily figure out what documentation is required.īut there are certain situations in which requiring laterality may not seem obvious. Since the ICD-10 go-live, for instance, the highest number of denials has been due to laterality specificity (left or right). ![]() And some specificity has been critical for helping hospitals avoid payment denials. (That never stopped.) Hospitalists frequently receive queries from coders asking to clarify diagnoses, and physicians know they can help by answering those queries quickly to avoid billing delays.Īlthough not every code has to be specific, more specificity means a better description of a clinical condition and less likelihood of receiving a query from hospital coders and clinical documentation specialists. Obviously, it will take time for all of us to get accustomed to this new system, but many in the coding world worry that productivity may never return to pre-ICD-10 benchmarks.įor us, we are bouncing back slowly from the drop we saw in coder productivity, and we continue to educate clinicians about documentation. The PCS coding system is complex and requires a significant amount of training. This has been particularly true with the ICD-10 PCS (procedural coding system), which has not been used in any other country and was rolled out here for the first time last October. The biggest hit that I have seen has been on coder productivity. Let’s take a look at these issues before the next batch of ICD-10 codes arrives later this year.Ī smooth transition doesn’t mean that there was no negative impact at all. The CMS is rejecting only 1.9% of claims, which is actually lower than the pre-ICD-10 baseline.īut the advent of ICD-10 did include some disruptions and unanticipated surprises. To them, the term “encephalopathy” inherently states the level of consciousness, and having to explain further seems redundant. This is somewhat foreign to how hospitalists think. For example, under ICD-10, doctors need to document hepatic encephalopathy whether or not it coexists with coma. In my health care system, we have not had a tremendous amount of pushback from physicians, even though the new coding system may not reflect how doctors think about or process diseases. ![]() That is actually lower than the pre-ICD-10 baseline of 2%, and private payers and claim processing companies have reported similar figures. The Centers for Medicare and Medicaid Services (CMS) continue to process an average of 4.6 million claims a day, with only 1.9% of those claims rejected. There have been no major financial disasters, nor am I aware of any practices that have thrown up their hands and gone out of business. converted to the new classification system and, so far, the transition has been relatively smooth. Published in the June 2016 issue of Today’s Hospitalist.
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