An ICD Code By Any Other Name Is Not The Same

June 29, 2021

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The basis of an ICD 10 diagnosis code is disease tracking. Categorizing a diagnosis by a numbered system used universally allows numbers of a particular diagnosis to be tracked. This makes a lot of sense in terms of studying prevalence and potential environmental factors that may be linked to a diagnosis. Now, our system of ICD 10 involves payment and this is where our world of healthcare has had to be more particular than ever regarding the proper diagnosis code. Now comes the reason getting it right is more important than ever.

What's In An ICD 10 Code?

You may think this is a silly question, but it's not. The majority of people, even clinicians see the code only as a reimbursement tool. It certainly is, but it is more. If you polled all of your professional clinical staff as to why a diagnosis code exists, how many of them would say if is just there for reimbursement? I bet it is more than you think. The reality is that your diagnosis code should be firmly a part of the care plan used by the staff. Often the specificity of the code can lead to different interventions by clinical staff if generalities are taken off the plate. For example, when your clinical staff sees heart failure, do they look for the symptoms normally associated with left-sided failure like dyspnea on exertion, crackles in the lungs, and fatigue? What about those with right-sided failure that would experience different symptoms such as weakness, ascites, and weight gain? Left-sided failure is more common and it is often automatically what is treated in the nursing care plan. Now, while we acknowledge that there will be some overlap in intervention regardless which side is affected, being able to assess and recognize the differences are extremely important for teaching the patient and recognizing an exacerbation early.
Yes, now we will talk about the money. Having the wrong code can hurt you monetarily. It is critical to capture the code that best represents the level of specificity you are able to prove. ICD 10 coding has to be completed by certified coders who understand the intricacy of the code. They must be well-versed and keep themselves up-to-date on changes to coding rules. Nurses completing clinical care should not be responsible for coding as well. There is no way for the nurse to be a professional nurse and also be a GOOD full time clinical coder at the same time. Often we see those nurses who get certified either go full time into coding or they end up doing so much hands on care that it becomes too difficult to effectively and efficiently code. If nurses are not properly trained, then ICD 10 codes are just put in and nurses tend to pick non-specific codes. Nurses have enough to do in the homes today and the time on coding is not cost-effective.
ICD 10 coding requires clinical accuracy. This is so important for compliance. You do not want variations of a diagnosis code used because it give more reimbursement. If you are audited, then you are at risk of money being pulled back as well as a full blown audit of your organization which could put your agency at real risk if there is a pattern in the practice of upcoding. The most important thing is to have the proper documentation and find the corroboration from the MD to support what you have listed on the 485.

Let Kenyon Homecare Consulting Help Be Your Coding Experts:

At Kenyon Homecare Consulting , we have different levels of coding, documentation support, and education to help your agency maximize accuracy, reimbursement, and compliance. We can review Oasis, complete remote or in-person education, care plan review, and ICD 10 coding from our certified coding experts. Call us today at 206-721-5091 or contact us online to see how we can help you reach your coding and documentation goals.

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