Gastroenterology Coding Alert

Asking just 2 questions can help you get the most specific code

Reporting your diagnoses to the highest level of specificity that the gastroenterologist's documentation will support is a surefire way to prevent denials based on incomplete diagnosis codes.

Times Have Changed

-A lot of us didn't pay attention to ICD-9 coding in the past because Medicare was the only carrier that cared if you used the correct codes,- says Victoria Jackson, owner of Omni Management, which provides practice management services for 15 medical offices in the Los Angeles area. Now, all insurance companies are looking for ICD-9 codes, and coders must be more vigilant about the diagnoses they assign.

Take Time Out for ICD-9 Accuracy
 
You should always report the ICD-9 code that provides the highest degree of accuracy for the condition the gastroenterologist is treating.
 
-That -highest degree- means that you should assign the most precise ICD-9 code that most fully explains the narrative description of the symptom or diagnosis,- says JoAnn Baker, CCS, CPC-H, CPC, CHCC, a coding education specialist in East Orange, N.J.
 
Strategy for success: To ensure you use the most accurate ICD-9 code every time, Margaret Lamb, RHIT, CPC, coding expert in Great Falls, Mont., suggests asking two questions before sending out a claim:
 
1. Do I have a complete code?
 
2. Do I have the most specific complete code?
 
Rely on your ICD-9 manual's instructions to ensure you-re listing complete ICD-9 codes. If you see a check mark with a -4th- or -5th- next to a code, ICD-9 is telling you that the code requires a fourth or fifth digit. Anything less would result in an incomplete claim.
 
For example: If you find the tabular listing for abdominal pain (789.0), you-ll see a box with a checkmark  printed to the left of the code. This box indicates that a complete ICD-9 code for an abdominal pain diagnosis must be five digits.
 
Why? You need five digits to reflect the subclassification, such as right upper quadrant.
 
Key idea: If the ICD-9 code you submit is not as specific as carrier rules require, the carrier may reject the claim for lack of medical necessity and/or a truncated code, Lamb says.

Use Care When Selecting Symptoms
 
When working with diagnosis coding, you must remain up-to-date with your codes and read through a code listing entirely, or you may find yourself forgetting a fourth or fifth digit.
 
This past October, ICD-9 added many new codes, some of which were the result of expanding four digits to five digits, allowing you to specify conditions that you previously couldn-t.
 
Good news: The increased detail of the codes will help you to prove medical necessity for a procedure that a carrier could assume was merely cosmetic, says McCoy Rockefeller, CPC, coding specialist with the Medical College of Georgia in Atlanta. By staying current on your codes, you-ll be able to code more accurately, increase your chances of proving medical necessity and decrease your chance of a denial.
 
Pay Attention to Claims With 3-Digit Codes 
 
Before sending out a claim with a three-digit diagnosis code, you should double-check it, Jackson says. Three-digit diagnosis codes raise payers- eyebrows, she says, because there are very few ICD-9 codes that don't require at least four digits. Payers realize this fact and examine ICD-9 codes to ensure they-re appropriately specific. That means a three-digit code won't make the grade if the carrier requires a four- or five-digit code.

Save Time With Specificity
 
With the number of codes growing every year (and the prospect of a much-more-specific ICD-10 in the future), you must keep your superbill updated, Lamb says. She says that many offices have quite a few truncated codes on their bills, causing coders and billers to go back to the chart or the physician to find out what the fourth or fifth digit should be.
 
Tip: Add a dash after a code and space to write to allow the physician to add the information in a more specific form, she says.