A study conducted by the University of Illinois at Chicago (UIC) last year indicates that pediatricians are at a higher risk for financial and data losses if they aren’t cautious about coding for ICD-10. The researchers found that about 26% of the codes commonly used by pediatricians required complex mapping that was easy to get wrong.
If documentation and coding aren’t up to par, pediatricians could risk denials and rejections. Since pediatric practices often operate on tighter margins, this puts them at higher risk for losses. According to a summary of the study, “Many pediatric practices, perhaps more than other medical fields, practice on a narrow financial margin and are often reimbursed at lower rates than other specialties, particularly by Medicaid.”
So it is critically important that pediatric practices invest the necessary time and resources into preparing for ICD-10. In particular, there are 8 areas that are very common to pediatrics that will required improvements to documentation for ICD-10. These are summarized for you in the quick slide show above.
Many of the changes facing pediatricians relate back to increased specificity around laterality, cause, severity, etc. You can start improving documentation now to include these factors. Code mapping will also be critical. Review the CMS references for pediatricians and look to the AAP for more resources. As noted in the UIC study, for more complex coding, pediatricians may be at higher risk for denials and loss of revenue. So it is worth the investment of time now to prevent this problem later.
Michelle Cavanaugh, RN, CPC, CANPC, CGIC, CPB, CMRS, is an American Health Information Management Association approved ICD-10-CM trainer, certified coder, certified professional biller, and certified medical reimbursement specialist at Kareo. E-mail Michelle at [email protected].