Kenyon HomeCare ConsultingICD 10 Coding: Understand How Coding And Documentation Can Keep Your Agency Out Of Hot Water At Audit Time! - Kenyon HomeCare Consulting (206) 721-5091

Kenyon Connects

ICD 10 Coding: Understand How Coding And Documentation Can Keep Your Agency Out Of Hot Water At Audit Time!

ICD 10 CodingSometimes, home health agencies don’t give ICD-10 coding much thought. Maybe you are a home care that provides mainly Medicaid services, so you don’t focus on Medicare specifics. Either way, we are coming up on big changes to payment reform. It is important on both a compliance and financial standpoint to get it right to thrive in a PDGM world. Let’s look at why you should code confidently and not dismiss its role in the auditing process.

Are You “Just Being Safe”?

Often times, agencies will avoid code specificity for multiple reasons. It can be a lack of knowledge, lack of supporting documentation, or fear of the dreaded “upcoding”. Let’s address each of these and what needs changed.

  • Lack Of Knowledge: Who is your coder? Many smaller agencies have office staff or the nurses coding. Nurses have so many responsibilities. It is unrealistic to think that the nurses can spend the time to properly code along with everything else. An office manager who also works to code isn’t a good option either. There is no question a certified coder needs to do your codes.
  • Lack Of Supporting Documentation: In the previous bullet point, think about whether or not your nurses or office staff would be able to take the time and follow through to hunt down extra documents. The answer is no. Those individuals already have other specific job roles. What takes precedence for them? The difference in hunting down the documentation could mean the difference in hundreds to a thousand dollars an episode.
  • Fear Of “Upcoding”: Many agencies fear code specificity for fear of “upcoding” or getting in trouble for picking a code with higher reimbursement. This does an injustice for your agency. If you have the documentation, there is no upcoding. As Medicare uses the data derived from agencies to determine ongoing reimbursement rules, you must show the level of care by the diagnosis you address.

How Does ICD 10 Coding Affect Me At Audit?

If CMS sees ongoing uses of non-specific codes, it may trigger audit. It could be that there is an ongoing number of therapy visits attached to a certain non-specific diagnosis that doesn’t support it. As an agency, you don’t want to trigger an audit. Maybe you didn’t trigger one, but an audit demonstration hits your state. Ultimately, use of non-specific codes is often unsupported by face to face documentation and can immediately have your episode denied. Without certified coders, you don’t really know if your charts have the documentation needed to even get past the first part of your audit.

Let Us Help!

At Kenyon Homecare Consulting we have ICD-10 coding available along with billing programs if you need the assistance. If you are unsure, then let us do a free side-by-side code demonstration and see what the potential difference in revenue and compliance is for your agency. Call us today at 206-721-5091 or contact us online to see if our coding program is the solution for your agency moving forward.

Category: ICD Coding

Leave a Reply

Your email address will not be published. Required fields are marked *