Test your knowledge of ICD-10 coding and documentation requirements for five diagnoses you're likely to encounter in family medicine.
Fam Pract Manag. 2015 Sep-Oct;22(5):15-21.
Author disclosure: no relevant financial affiliations disclosed.
The time has come. Are you ready for the Oct. 1 transition to ICD-10 diagnosis coding? If you are not sure, you are not alone. Many elements of this transition have depended on your software vendors, clearinghouses, payers, and staff, but there is one thing you can control: your documentation of the information necessary to support the diagnosis codes you choose to bill. Your documentation probably does not need a major overhaul, but you will need to be more specific and detailed in certain areas. In this article, we will look at the documentation elements required to support ICD-10 code selection, focusing on five common conditions in family medicine. Quizzes will test your knowledge throughout the article.
First, why should you care?
The increased specificity required in your documentation and coding under ICD-10 may seem unnecessarily burdensome. However, diagnosis coding has a wider impact than you might immediately recognize.
Question: In which of the following ways does diagnosis coding affect physician practices and patient care?
Diagnosis codes support the medical necessity of services provided.
Diagnosis codes support claims payment.
Diagnosis data is increasingly used to evaluate cost and quality of care.
Diagnosis data is used to influence public health policy.
All of the above.
Answer: The diagnosis codes reported on physician claims must be supported not only to facilitate payment but also because they become the data upon which decisions beyond claims payment are made. The correct answer to the above question, then, is E, all of the above.
Documentation that supports specific diagnosis coding also may alleviate burdensome medical record requests from third parties. Take for instance the following statement a physician forwarded to me from a claims administrator regarding medical record requests to support risk adjustment: “ICD-9-CM (or its successor ICD-10-CM) diagnosis codes determine a patient's risk score. The more diagnosis detail submitted with claims and encounters, the less likelihood that [insurer name redacted] will need to request and audit medical records.” In other words, if your documentation supports the level of service coded and the selected diagnosis codes specifically identify the nature of your patient's condition, you are less likely to receive a request for your medical record. If a request is made, your documentation will support both the service provided and why it was provided.
DOCUMENTATION ELEMENTS FOR COMMON DIAGNOSES
This article contains seven tables outlining the documentation elements for common diagnoses. All seven tables are available for download as a single resource.
What to report
Before we review common diagnoses, it is important to know when codes should and should not be reported for a con
1. National Ambulatory Medical Care Survey, 2009. Hyattsville, MD: National Center for Health Statistics; 2011.
2. National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: National Heart, Lung, and Blood Institute; 2007.
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