A Clear View Of The Intricacies Of Coding

Billie C. Bradford, MBA

On the surface, it seems fairly simple. Incorrect codes will result in delayed payment or outright rejection of claims by carriers. Using codes appropriately helps ensure proper payment from third-party carriers and patients.
Appropriate coding also enhances your practice’s relationship with patients. When your office codes claims accurately, patients who file their own claims will have fewer problems obtaining payment from their insurance companies. Yet many major carriers identify the first five areas listed below as the most common coding errors causing delays or inaccurate payments for doctors’ claims. With this in mind, let’s take a closer look at these common problem areas cited by the carriers.
1. Additional code to identify manifestation. At times, it is required to provide an additional diagnosis code in order to provide a complete and accurate diagnosis picture. You may need the one code to describe a condition which is the underlying cause of the manifestation you are treating, and another code for the specific manifestation itself.
An ICD-9-CM tabular notation indicates when the code cannot stand alone and is not to be listed first. Likely companion codes are shown. In the index, the notation is indicated by codes appearing in italicized brackets [xxx.x].
An example of this is when you’re reporting the diagnosis of “diabetic neuropathy” for a patient. You must list the underlying disease code (“250.6x - Diabetes with neurological manifestations”) first and then list “357.2 - Polyneuropathy in diabetes manifestation” as the second code. Remember, you should never report manifestation codes as the patient’s primary diagnosis. You can easily identify these codes since they always appear in italics in ICD-9-CM.
Be Aware Of The Exclude Notes
2. Excludes. This ICD-9-CM notation indicates that any conditions following it are to be coded elsewhere, as indicated in each case. You may find exclude notes at the beginning of a chapter or section, or immediately after any three-digit, four-digit or five-digit code. Such a note following a three-digit code would apply to all four- and five-digit codes within that category. A note following a four-digit code would apply to all five-digit codes within that subcategory.
For example, if a patient presents with marked signs of unsteady walking and incoordination, you cannot code it as “781.2 - abnormality of gait” unless your assessment (and the documentation in the patient’s record) would support a more definitive determination beyond “difficulty in walking” at this time. Without a more definitive finding, ICD-9-CM code 781.2 specifically excludes “difficulty in walking” and directs you to review code “719.7x – difficulty in walking” instead. If you later determine your patient indeed has an ataxic gait, then it would be appropriate to report ICD-9-CM code 781.2 and document it in your patient’s record.
When Specificity Comes Into Play
3. Not Elsewhere Classifiable (NEC). This is appropriate when no code is provided which would permit using a more specific code for the condition, and your patient record contains more information than ICD-9-CM allows you to provide.
4. Not Otherwise Specified (NOS). Using NOS in ICD-9-CM coding refers to a lack of sufficient detail in the patient’s record. Reporting codes in this category will frequently result in denied payments until you can submit more specific information. Be aware that frequent reporting of such nonspecific codes to avoid the burden of looking up specific codes may cause third-party payers to identify your practice’s claims reporting and chart documentation for further review.
When possible, you should not use ICD-9-CM codes containing the terms “unspecified” or “other” (these codes usually have a fourth digit of .8 or .9) if information is available that allows you to use a more specific code. For example, “abscess” lists code 682.9 in the ICD-9-CM Index, yet is followed by almost 200 listings of various types and locations of abscesses. Carriers could perceive the routine reporting of the “682.9 – abscess unspecified site” as indicating that you failed to adequately document the location or type of abscess you were treating.


misterscruff's picture

As a recent graduate from SCI Texas in the field of Medical Coding and Billing, I would have to attest and agree to the importance of coding. The difficulty of diagnosing the conditions and symptoms and translating them to universal medical codes gave me the impression that my comprehensive training was absolutely necessary, and is important in helping doctors achieve a high level of patient care.

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