Research shows that pediatricians are at higher risk than other physician groups for financial loss as they transition to ICD-10. Here, 8 areas you can focus on now.
A study conducted by the University of Illinois at Chicago (UIC) last year indicates that pediatricians are at a higher risk of 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.
Well-child exam expansion. ICD-10-CM distinguishes between “with abnormal findings” and “without abnormal findings.” Be sure to document the specific abnormal finding, when present. The distinction between “with” and “without” abnormal findings could benefit pediatric practices because it may bolster support for providers to be able to separately bill for an E&M code.
Documentation of “asthma” will no longer be sufficient. Pediatricians must specify the type of asthma as well as whether the asthma is uncomplicated, with exacerbation, or with status asthmaticus. An additional code is necessary to denote the cause.
Documentation of “otitis media” will also not be sufficient. In ICD-10, pediatricians must specify the type, severity, and laterality (ie, left, right, or bilateral). Additional codes need to be assigned for the presence of any associated perforated tympanic membrane as well as environmental factors such as tobacco use.
Codes for diabetes have greatly expanded. They now include the type of diabetes and body systems affected along with complications documenting the use of insulin.
Pediatricians must document acuity as well as the causal organism for bronchitis. If the cause of the bronchitis is unknown, it may be acceptable to use an unspecified code. Don’t change clinical decision making simply to obtain greater specificity.
Document the specific type of newborn feeding problem. Unlike ICD-9-CM, ICD-10-CM includes separate codes for each specific problem so there is an increase in the number code options. Review this section closely.
In ICD-10-CM, codes for injuries are organized by anatomical site. Pediatricians must document the site of the injury, episode of care (ie, initial, subsequent, or sequela), and external cause.
Underdosing is a new concept in ICD-10-CM. This new code captures instances in which a patient takes less medication than was prescribed. Pediatricians must specify whether the underdosing is intentional or unintentional and the reason (ie, financial hardship, disability, etc).
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.More information 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 firstname.lastname@example.org.