Don’t Deny the Denials

The recent delay in the ICD-10 code system has given us additional time to learn this code set. In the June 2014 Journal of AHIMA there is an article titled Don’t Deny the Denials. This article addressed ways to be better prepared for the implementation of ICD-10-CM/PCS.

In this article by Lisa A. Eramo it says “Many are looking for creative strategies to mitigate anticipated decreases in coder productivity that will come with the switch. Some are ramping up education, others hiring additional staff members or implementing computer-assisted coding.” Each of these areas will help us to avoid decreases in coder productivity.

The article also says “A strong denial management strategy may be one of the most efficient and effective solutions for minimizing the impact of productivity loss.” The remainder of this article discusses how to implement a denial management program and the different types of denials. The article goes on to discuss different types of denials and the solutions for avoiding them.

Technical Denials
This type of denial has to do with the processing of the claim. Any errors in the information provided on the claim form can lead to a denial. The article gives the solution to avoiding this type of denial by stating “The best way to mitigate technical denials is to ensure that accurately coded test claims are vetted through a formal end-to-end testing process.”

Logic-based denials
This denial occurs when the ICD-10-PCS or CPT codes don’t match the corresponding ICD-10-CM code. The author gives an example by stating “For example, carpal tunnel syndrome now specifies left or right. The diagnosis code should match any corresponding procedure code.” When these two codes don’t match a denial can occur. The solution is “Hospitals may be able to rely on claims scrubbers to catch these types of errors. However, physician practices with less sophisticated software may have a more difficult time. Coders will need to pay close attention to diagnoses that specify laterality to avoid denials.”

Denials for unspecified codes
In the ICD-10 code system there are more specific codes than those currently available in the ICD-9 code system. Because of this, payers will be more likely to deny any unspecified codes that are reported. The article lists the following solution: “Identify your current unspecified rate today in ICD-9-CM and track it.” You should have a goal to keep that rate from increasing after ICD-10 is implemented.

Denials for invalid codes
This type of denial also has to do with the increased specificity of the code in ICD-10. A code is invalid if the coder doesn’t assign the correct number of characters. This type of error may occur because the unfamiliarity with the ICD-10 code system. The article says “The best way to mitigate these errors is to ensure that coders receive proper training.” With the additional time to prepare for the implementation of ICD-10 medical coders should receive the necessary training to avoid this type of denial.

The last part of the article provides some tips for a strong denial management program. Read the full article to learn about and implement these tips.

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