The ICD-10-CM Medical Billing Challenge and HSMN’s Coding Answer

HSMN has worked for over 25 years in consulting on all of the iterations of ICD-CM coding for both Diagnostics and Procedures., 12/19/2012 – HSMN has worked for over 25 years in consulting on all of the iterations of ICD-CM coding for both Diagnostics and Procedures. We believe that the greatest challenge will be in coding ICD-10-PCS procedures. We know that from our experience of working with physicians/surgeons over these many years. We believe that in order to code ICD-10-procedures accurately, the Coder must first understand the clinical intent of the procedure being performed in order to first identify the “Root Operation”.

In our many years of experience in working with surgeons in every possible setting, the communication of the order sets a chain of events that will determine reimbursement. Should the order differ from the actual procedure, then the authorization will be voided and no reimbursement. HSMN provides a new program from order to final claim that includes working with the medical coding and medical billing staff in order to create a Continuum in the ICD -10 world of procedure and diagnostic coding. Our program is called “Getting to know you and what you do”. It is a program that develops both communication patterns and a common language embedded in the clinical documentation to allow both the surgeons and the Coders to have a correct claim.

How does it work? We start with a basic premise that Coders are not Clinicians and Clinicians don’t always document to the specificity needed in the ICD-10-CM world. Therefore, the Coder who knows anatomy, physiology and clinical language will act as a consultant to the physician, while the physicians will coach the Coders are the procedures they are doing. The will emphasize the underlying root operation, reasons for doing it and the potential complications and additions that might take place. So this satisfies “what we do” and “why we do it”. The Coder in turn works with the physicians to explain what needs to be documented to satisfy ICD-10-procedure requirements.

The “Getting to know you and what you do Program” is one that HSMN has modified over the years in order to achieve a symmetry and continuity and clear communication between Coder and Physician. HSMN has worked in hospitals of all sizes, surgical centers and other settings to help clients make sure that they are receiving the appropriate reimbursement based upon the resource use.

We have put into place “Assessment Teams” to see how organizations are doing with ICD-9 so that the transition to ICD-10 is a bit easier. But there is no easy way to master ICD-10 except to create “Team” and “Partnerships” of well-trained Coders (who will need didactic updates to their knowledge base) and physicians who will need to have current cases deconstructed or parsed to allow them to see what they are doing now versus the specificity they will have to use for ICD-10. Once the Teams are formed, a well-targeted training program has to be in place so that current work does not slow down and it also provides the opportunity for the Deconstruction Methodology that physicians find so useful in discussing cases. HSMN sees ICD-10 as an opportunity to bring physicians and Coders together working in ways that have not been typical.

Please call us 866-908-4226 so that we can discuss an Assessment and putting in place a Program that will launch your organization successfully into the ICD-10 World.



 December 2012