The switch to ICD-10 will trigger a monumental shift in the way medical practitioners code patient diagnoses. In addition to an entirely new coding structure—ICD-10 codes contain up to seven characters, whereas ICD-9 codes max out at five—ICD-10 incorporates much more advanced anatomical terminology. Furthermore, in addition to coding for patients’ conditions, you often will need to submit supplemental codes to describe how and where certain injuries occurred as well as their degree of severity.
The result is increased specificity in coding, but all that slick, souped-up data comes at a cost—time. And as a rehab therapist, you don’t have a lot of that to spare. So rather than trying to manage the transition—and master a code set with five times more codes than the library you’re used to—all by yourself, you might want to consider calling in some backup in the form of an ICD-10 coder.
Medical coders are trained to review clinical documents and patient records and assign numeric codes for each diagnosis and procedure. So basically, when you have a coder, he or she will take your patient notes and translate them into the correct codes. Those codes help paint a clear picture of a patient’s condition and treatment, thus justifying reimbursement from payers.
Unlike large-scale medical organizations (such as hospitals), most small practices do not have dedicated coders, and with ICD-9—which features only about 13,000 codes to ICD-10’s 68,000—that might work just fine. But beginning October 1, 2015, if your practice fails to record and submit the proper ICD-10 codes, you won’t get paid. That’s a lot of pressure to deal with on your own—and that’s where a pro coder can help. Now, your gut reaction is probably, “There’s no way I can afford to hire a dedicated coder.” But considering the potential revenue loss your practice could suffer if you do not code correctly, the investment might be well worth it.
As this report explains, “The medical coders’ role in assuring that all information is accurate and complete is crucial to the economic well-being of the hospital since their entries determine the amount of reimbursement for patients covered by Medicaid, Medicare and other insurance programs. Coder efficiency in timely processing of coded bills maintains the flow of income into the institution.”
To code effectively, such professionals must demonstrate mastery in specific code sets and the ability to translate specific documentation into codes. For that reason, coders competent in ICD-10 are already in high demand among large institutions that currently retain on-staff medical coders. But as I mentioned above, ICD-10 could prompt smaller clinics to invest in trained coders as well—which in turn would drive up the demand even more. So, if hiring a coder to optimize your clinic’s ICD-10 coding and ensure reimbursements sounds like an attractive option to you, you’ll want to start looking for one sooner rather than later. Remember, you don’t necessarily have to add a full-time, in-house coder to your payroll; if you’d rather outsource to a third-party company (which is typically a much less expensive option), there are plenty of good ones out there. Check out the list at the bottom of this article for some suggestions.
And if bringing a coder on board simply isn’t in the cards—or the budget—for your practice, I would highly recommend sending your clinic’s current coding hat-wearer to an ICD-10 training course or two.
How is your practice planning to handle the switch to ICD-10? Would you consider hiring a medical coder? Share your thoughts in the comment section below.