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To Code Or Not To Code? That Is The ICD Question. Why Small Agencies Can Benefit From Outsourcing

Today, many agencies with a small Medicare footprint minimize the importance of proper coding. So, for the purposes of this posting, we would like to consider why the size of your Medicare census is irrelevant to how you code. Let’s look at the financial and clinical implications for your coding.

What’s In A Code?

Well, for those of you in the industry that remember ICD 9 coding, it seems pretty simple compared to today. Many times, nurses completed their own coding and everyone had access to the big ICD 9 coding manual. The specificity that was required back then did not force agencies to have certified coders on staff. Although it was best practice to assure accuracy and reimbursement, many agencies did not invest in certified coders. Then, enter ICD 10 coding.

Now, coding becomes much more intricate. And, not providing proper specificity started showing in the money agencies received. It was generally easy to distinguish between those agencies who used certified coders and those who didn’t. That rings true today. Not only do we have codes up to 7 digits long, they now fit in a more convoluted maze of the current Oasis and PDGM. Having been in this business decades and working with agencies throughout the United States, we often see difference of $300-$100 per 60 day episode in those agencies that do not have coding completed by those certified in coding and Oasis.

Why Does It Matter Clinically?

Well, the whole point is to have the clinician dig deeper into a care plan that matches the complexity of the patients. Patients who have heart failure shouldn’t have the exact same care plan. Symptoms that are predominate for some will be different for another. You clinicians need to use the ICD 10 code to develop the care plan that makes sense for each patient. Consider working with your clinical leaders to spearhead initiatives that promote patient specific care planning within your agency.

Accuracy of coding is also crucial when looking at auditing both internally and by CMS. Without certified coders, the ICD code is often chosen is inaccurate or doesn’t have the documentation to back it up. Often times, the uncertified coder doesn’t even realize the liability of the wrong codes when potentially upcoding. This leads to CMS determining things like case mix creep and cutting reimbursement to offset what they consider to be inaccurate. Either way, the clinical picture is damaged by the wrong code.

Let Kenyon Homecare Consulting Check Your Coding:

At Kenyon Homecare Consulting, we provide a broad spectrum of consulting services as well as coding and Oasis review by those certified in Oasis and ICD 10 coding. We also provide 5 free recodes out the for agencies who want to see how their current coding system is doing. We will do a side-by-side comparison that will either show your agency you are on the right track or cue you in to potential revenue losses and documentation issues if they exist. Call us at 206-721-5091 or contact us online to let us do 5 free recodes for you.

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