Pediatric Coding Alert

Plus: Here’s when you can report ‘abnormal findings’ during well child visit.

If your vision of the ICD-10 transition involved pediatricians scratching their heads and billers facing stacks of denials, you’ve hopefully found that these predictions of worst-case scenarios were overblown.

An October 13 Forbes article underscored how smoothly the transition has gone, noting that both Humana and UnitedHealth Group have reported very few errors due to the new diagnosis coding system. In addition, CMS released some stats about the new diagnosis coding system on Oct. 29, and those numbers are quite positive, with 90 percent of Medicare and Medicaid claims accepted between Oct. 1 and Oct. 27.

Many naysayers pointed to this information as evidence of the fact that insurers have the easy side of the deal, whereas medical coders and billers are toiling in the stress of the adjustment. To that end, Pediatric Coding Alert polled five coders to get the full story on how the transition has gone since ICD-10 implementation took place on Oct. 1. Read on for the results.

Most Find Smooth Sailing—With A Few Glitches

Dawn Hartge of Annapolis Pediatrics, has found a positive transition so far, but has faced a few questions along the way. “For example, what is considered ‘abnormal’ with a physical exam?” she asked. “Does it have to be an active problem or can it be a chronic issue to qualify for Z00.121 (Encounter for routine child health examination with abnormal findings)?”

To answer Hartge’s question, Pediatric Coding Alert researched a Sept. 29 American Academy of Pediatrics’ article entitled “FAQ for Coding Encounters in ICD-10,” which indicated that no official guidance has been issued yet by payers on this subject. However, the AAP says that its Coding for Pediatrics manual advises that even minor findings would qualify for Z00.121, and goes on to explain that most likely, “any abnormality that is present at the time of the routine examination may lead to reporting Z00.121 and a secondary code to describe the finding. This may include, but not limited to an acute injury, an acute illness, an incidental or trivial finding that is diagnosed in the patient’s chart, an abnormal screen, an abnormal exam finding (eg, scoliosis), a newly diagnosed chronic condition, or a chronic condition that had to be addressed (excluding medication refill) due to it being uncontrolled or new issues arising.”

Resource: To read the AAP’s FAQs, visit www.aap.org/en-us/Documents/coding_faq_coding_encounters_icd_10.pdf.

Robert Perez of Kingsbrook Jewish Medical Center in Brooklyn, NY, reported an easy transition to ICD-10, and also discovered that his payer had implemented some diagnosis coding edits. “The insurance company already denied the ICD-9 codes for a claim with an Oct. 1, 2015 date of service,” he said. “I have been successful in finding diagnosis codes so far using two helpful programs from Codify and the AAPC website.” He also considers it a good sign that he hasn’t gotten an influx of calls to help other hospital departments with their diagnosis codes, although the admitting and surgery departments have requested help with authorizations.

Vinod Gidwani, founder of Currence Physician Solutions in Skokie, Ill., notes that the transition has gone quite smoothly. “Frankly, the ICD-10 so far, as far as submitting claims and getting the claims accepted the experience, has been great!” he reports. “We are still in the process of analyzing payments. This whole ICD-10 reminds me of Y2K transition, all the hoopla but really ‘much ado about nothing!’”

Gina Faulkner, medical business office manager in Hot Springs, Ark., said that her claims have fortunately been processing smoothly so far, although some problems have come up when ordering tests. “The issues that seem to raise the most questions from my end is there seems to be a lot of confusion on which to choose for the codes ending with the seventh digit denoting the timing of encounters. Either it is misunderstood which one to choose or when scheduling tests etc. Facility schedulers don’t ‘like’ the codes ending with letters. I have been scheduling X-rays and been told ‘we can’t find those codes, just tell us what’s wrong, we don’t need to know when they’ve seen you.’ This makes for lack of continuity.”

Donelle Holle, RN, practice administrator for Fort Wayne Pediatrics and a pediatric healthcare, coding and reimbursement consultant, says she is getting payments, but has also seen some denials. Some of those may have been due to her carrier “really not being I-10 friendly yet,” but she adds that most carriers were more prepared than practices had expected, and payments have been appropriate thus far. “I did just today hear one managed care group denied a Z23 (Encounter for immunization) on a vaccine.  I have advised to just refile it to see if they were just not ready. We’ll see.”

One Insurer Makes ‘Mass Adjustment’

After Holle reported that she was seeing instances of Z23 (Encounter for immunization) being denied in error, Pediatric Coding Alert investigated further and discovered that at least one payer—NGS Medicare—announced on Oct. 21 that it had “identified a claims processing issue” that impacted reimbursement for this diagnosis code. Although most pediatricians don’t bill Medicare, this computer glitch may be in the software of multiple insurers.

“Claims for the following immunization and administration procedure codes incorrectly denied due to an incorrect diagnosis code,” NGS said in an Oct. 21 email blast to providers. The list of codes is as follows: G0008, G0010, G0009, 90630, 90669, 90670, 90686, 90732, 90739, 90740, 90743, 90744, 90746, and 90747.

The system error “impacted providers who submitted claims for these services in which they reported ICD-10-CM diagnosis code Z23,” NGS said. “A mass adjustment will be made to claims that denied in error; adjustments will be completed soon. It is unnecessary to resubmit the claim or to request an appeal. No provider action is needed.”