Wiki reimbursement with ICD-10 codes

[gmlittle]

Trying to find a way to explain to our doctors why it is so important to not use the unspecified codes when we start using ICD-10, so any help would be appreciated..

If the ICD-10 code does not determine what we get paid, and that it is the E/M code, why can't we bill with the unspecified code?

Thanks so much,

 

[mitchellde]

The ICD-10 Cm codes will determine whether or not you have the severity of illness necessary to meet the requirements of the level being billed. Because this is the patient's diagnosis and there are many very specific codes it is important to capture the most specific diagnosis. There are some acceptable unspecified codes but not many. There is a new ICD-10 Cm guideline for 2014 regarding unspecified codes. Basically if the provider does not have or cannot obtain the information to make the more specific diagnosis then the unspoecified is acceptable. But if it is reasonable to expect that the provide could or should have access to the information to be able to render a specific diagnosis, then unspecified will not be the best dx code that can be assigned.

 

[gmlittle]

Thanks for the information. by chance do you have the link to CMS that shows the guidelines for unspecified codes?

 

[mitchellde]

Thanks for the information. by chance do you have the link to CMS that shows the guidelines for unspecified codes?

This is not a CMS guideline it is an ICD-10 CM guideline added for 2014. Located in the front of the 2014 code book number 18 under general guidelines or download from the CDC data warehouse for ICD 10 CM