Avoid denials for unspecified codes

ICD10 Grace Period Ending October 1, 2016

Hard to believe that it has been almost a year since ICD10 was implemented.  Have to admit that from our point of view the implementation went fairly smoothly with just a few bumps.  But we were warned that Medicare and other commercial carriers were going to allow a grace period of one year for non-specific ICD10 codes.  After one year claims with unspecified ICD10 codes will be denied.

That one year grace period ends October 1st.  We have actually already seen a few denials for unspecified codes but we are expecting that number to rise after October 1st.  We have been reminding our providers to be as specific as possible when coding.  Providers that are using the unspecified codes as primary diagnoses will probably see many denials one the grace period ends.

There are things that can still be done to prevent this.  If a provider is still using a superbill make sure the codes on the superbill allow them to indicate the specifics.  For example, if a patient has a sprained ankle make sure the provider can indicate if it is the right or left ankle.  Also, is this the first visit for the sprain, or is this a subsequent visit?  Is it a subluxation or a dislocation?  All of this information is required in order to use a non specific ICD10 code.

Most EHR systems help with this issue by giving the options when the provider is documenting the visit.  If the provider is using an EHR program, make sure it allows for them to pick the specific code when documenting.

Educate your providers.  Let them know that if they don’t use specific codes or provide the information so that specific codes can be assigned they will disrupt the cash flow.  Many times the provider is still unaware that it is important to indicate right or left, or other specific information needed to select the correct ICD10.

The biggest thing is don’t wait.  Take a look at the situation now and try to prevent the denials.  Check the billing currently going out to see if unspecified codes are being used.  Identify the areas that need to be improved and implement systems to fix them now before the denials start to come.  This will prevent the disruption to the provider’s cash flow.