ICD-9 coding requires careful consideration.
The International Classification of Diseases Revision 9 (usually abbreviated as ICD-9) was designed to standardize billing in the health care industry. While the coding system has had some small success at preventing billing fraud and waste, it has also added a layer of complexity to medical claims processing. With the right tips, a medical coding specialist can eliminate many of the errors that lead to delayed processing or the inability to process a claim.
Understanding Diagnosis
In a casual scan of the medical record, it could be easy to confuse medical history and diagnosis. Make sure that you check the context of the diagnosis to determine if it is a supporting diagnosis, or simply a part of medical history. In addition, when multiple diagnoses are listed, make sure that you prioritize them by medical relevance. Failing to meet these conditions can lead to being underpaid, or creating undocumented diagnoses that will not be paid.
Using Standardized Abbreviations
Be wary of using abbreviations that are not on a facility specific list. In many disciplines, such as ophthalmics, there are multiple abbreviations in which the same set of letters can stand for drastically varying conditions. NV, for example, could stand for Neovascularization or Near Vision, depending on context. This confusion can create diagnoses without supporting documentation, leading to billing errors that result in refused payment for services or goods.
Being Mindful of Time
Be alert to the time and date on a given medical encounter. When a patient receives services that cover the period including midnight, physicians or nurses sometimes neglect to create a new date of service. Also make sure to submit only a single charge for a 24-hour period when multiple physicians are involved in treatment for that period.
Overlooking these can lead to missing a charge or submitting multiple billings. Multiple billings will result in claims rejection.
Providing Proper Documentation
For a patient encounter, multiple diagnoses are often cited for a single visit. Make sure that the patient's condition and the relevant care is taken into account when selecting your billing codes. If a condition is stable for that billing period, or does not require treatment, then you will not be able to document sufficient reason to justify billing. If you have a medical code that is processed, then you should cite all relevant information to support the diagnosis.
Submitting Claims Promptly
All medical insurers have strict limits on when they will accept submission of claims. For most, the time period is as short as a month or two. While Medicare extends this to as much as six months, this limit does not allow for many billing mistakes or resubmissions. Failure to submit claims in a timely fashion is one of the most costly mistakes a biller can make and constitutes the greatest loss for most clinics.
