Billing And Coding For LARCs – Part 2 CDPHE – 2016 LARC .
Billing and Coding for LARCs – Part 2CDPHE – 2016 LARC SymposiumToni Woods, CCS, CPC,AHIMA-Approved ICD-10-CM/PCS TrainerR.T. Welter & Associates, Inc.www.RTWelter.com303.534.0388tmw@RTWelter.com
Quick Audience Survey6/16/2016www.RTWelter.com info@RTWelter.com2
LARC Cheat Sheet6/16/2016www.RTWelter.com info@RTWelter.com3
DenialsReasons for denial of payment:– Clinically based evidence Requires at least two clinical trials reveal the safety andeffectiveness of the procedure or drug.– Diagnosis Warrants medical need for that service Based on NCDs, LCDs, and best practice– Frequency Test or procedure ordered too many times in anapproved period6/16/2016www.RTWelter.com info@RTWelter.com4
Denials Scenarios:– Provider orders a pregnancytest with a diagnosis ofrheumatoid arthritis. Denied: Medical Necessity– Provider places an IUD 4xwithin a 1 year period. Denied: Frequency limitations– Provider removes skin tagsfrom a patients neck becausethe patient is self-conscious. Denied: Cosmetic procedure6/16/2016www.RTWelter.com info@RTWelter.com5
Clinical Documentation When documentation is Not “Perfect” it is – Inconsistent– Contrasting– Ambiguous– Misleading/Conflicting– Missing/LackingThere is a need for good clinical documentation –not a greater volume of documentation!!!6/16/2016www.RTWelter.com info@RTWelter.com6
Clinical Documentation Many providers remain unaware of how theirdocumentation impacts :– Coding and reimbursement– Quality reporting– Their reputation as a provider!!! New designations of “high cost” provider Plans are tiering preferred providers6/16/2016www.RTWelter.com info@RTWelter.com7
What can you do to mitigate risk? Know and understand the documentationguidelines and update yourself on changes Conduct coding and billing audits at leastannually! Identify and correct any errors as quickly aspossible Overpayments are required by law to be returnedwithin 60 days of detection Keep the lines of communication open!!!6/16/2016www.RTWelter.com info@RTWelter.com8
Audit Provider Documentation!!! Randomly select 20 Charts per provider Identifying:– Over-coding– Under-documenting– Over-documenting– Under-coding– Discrepancies– Opportunities to increase revenues (i.e. missingcharges)6/16/2016www.RTWelter.com info@RTWelter.com9
ICD-10 – So far, So Good!6/16/2016www.RTWelter.com info@RTWelter.com10
ICD-10 Struggles thus far ICD-9 codes not fully converted to ICD-10 in commonlyused templates Navigating the EMR to find appropriate ICD-10 codes(the lookup isn’t always the best tool) Lots of unspecified codes being used! Coding errors with active conditions vs. personalhistory of condition6/16/2016www.RTWelter.com info@RTWelter.com11
What ICD-10 Means to ProvidersICD-10-CM:Unspecified I don’t know!6/16/2016www.RTWelter.com info@RTWelter.com12
ICD-10-CMStructure of the book: Coding Conventions Coding Guidelines Volume II: Alphabetic Index Volume I: Tabular List*Always code directly from the tabular list andnever from the alphabetic index**Revisions published annually on October 1st.6/16/2016www.RTWelter.com info@RTWelter.com13
Applications to assist with ICD-10 Coding ICD10 Lite by iPremiumAppsICD10 by TVN LabsICD10 Codes by Black-Night LabsICD-9 to ICD-10 Helper6/16/2016www.RTWelter.com info@RTWelter.com14
Other FREE ICD-10 Resources www.ICD10Charts.com www.ICD10Data.com www.Roadto10.org6/16/2016www.RTWelter.com info@RTWelter.com15
Troubleshooting in the ICD-10 World! ALWAYS code according to providerdocumentation! Remember the golden rule: If it isn’t documented, itdidn’t happen! Query your provider if specificity is not presentin documentation Review the category of the code to see ifadditional specificity is now required6/16/201616
Troubleshooting in the ICD-10 World! Look up the code to identify any notable Excludes 1 notes Two codes cannot be submitted together Should have been called the includes notes Excludes 2 notes Two codes can be submitted together6/16/201617
ICD-10-CM Conventions Excludes 1 notes to indicate when the code can’t beused with another code. Used when a condition cannotoccur together, such as a congenital form of a conditionwith an acquired form of the same condition (NOTCODED HERE)6/16/201618
ICD-10-CM Conventions Excludes 2 notes to indicate that the conditionexcluded is not part of the conditionrepresented by the code, but that the patientmay have both conditions at the same time.6/16/201619
LARC Clinical Examples 18‐year‐old new client would like informationon LARCs. After a lengthy discussion, the patient decideson the Mirena IUD. NP places the IUD with no complications.www.RTWelter.com20
LARC Clinical ExamplesCPT and HCPCS codes for the encounter: 58300 - Insertion of intrauterine device (IUD) J7298 - Mirena6/16/2016www.RTWelter.com info@RTWelter.com21
LARC Clinical ExamplesICD-10 code(s) for the encounter: Z30.430 – Encounter for insertion of intrauterinecontraceptive devicewww.RTWelter.com22
LARC Clinical Examples 25‐year‐old new client would like to discussbirth control options. She recently had sexand would like ECP, but also wants resourceson LARCs. Provider documented a detailed history,expanded problem focused exam, and lowcomplexity MDM.www.RTWelter.com23
LARC Clinical ExamplesCPT code for the encounter: 99213 - Office or other outpatient visit for theevaluation and management of an established patient,which requires at least 2 of these 3 key components: Anexpanded problem focused history; An expandedproblem focused examination; Medical decision makingof low complexity. Counseling and coordination of carewith other physicians, other qualified health careprofessionals, or agencies are provided consistent withthe nature of the problem(s) and the patient's and/orfamily's needs. Usually, the presenting problem(s) areof low to moderate severity. Typically, 15 minutes arespent face-to-face with the patient and/or family.6/16/2016www.RTWelter.com info@RTWelter.com24
LARC Clinical ExamplesICD-10 code(s) for the encounter: Z30.012 – Encounter for prescription of emergencycontraception Z30.09 – Encounter for other general counseling andadvice on contraceptionwww.RTWelter.com25
LARC Clinical Examples– Dori has had a nexplanon implant for 3 years. Sheis not planning on having a child for 3–5 years, andwould like another implant. She is also a cigarettesmoker and would like resources on how to quit.– The nurse practitioner removes the old implantand inserts a new one during the same encounter.She also provides smoking cessation (8 minutes)counseling to the patient for tobacco dependence.6/16/2016www.RTWelter.com info@RTWelter.com26
LARC Clinical ExamplesCPT and HCPCS codes for the encounter: 99406 - 25 - Smoking and tobacco use cessationcounseling visit; intermediate, greater than 3 minutesup to 10 minutes 11983 – Removal with reinsertion, non-biodegradabledrug delivery implant J7307 - Etonogestrel (contraceptive) implant system,including implant and supplies6/16/2016www.RTWelter.com info@RTWelter.com27
LARC Clinical ExamplesICD-10 code(s) for the encounter: Z30.49 – Encounter for surveillance of othercontraceptives F17.210 – Nicotine dependence, cigarettes,uncomplicatedwww.RTWelter.com28
LARC Clinical Examples– Laura has had an IUD for 3 years. She has decidedto have a child and would like the IUD removed.– The nurse practitioner removes the IUD.6/16/2016www.RTWelter.com info@RTWelter.com29
LARC Clinical ExamplesCPT code for the encounter: 58301 - Removal of intrauterine device (IUD)6/16/2016www.RTWelter.com info@RTWelter.com30
LARC Clinical ExamplesICD-10 code(s) for the encounter: Z30.432 – Encounter for removal of intrauterinecontraceptive devicewww.RTWelter.com31
LARC Clinical Examples 19‐year‐old established client is havingmenstrual irregularity following placement ofthe nexplanon implant. She is alsoexperiencing symptoms of mild depression. Spent 30/35 minutes discussing the causes ofdepression and various treatment options.The patient would like to keep the implant butuse Lysteda to stop the period.www.RTWelter.com32
LARC Clinical ExamplesCPT and HCPCS codes for the encounter: 99214 - Office or other outpatient visit for the evaluation andmanagement of an established patient, which requires at least 2 of these3 key components: A detailed history; A detailed examination; Medicaldecision making of moderate complexity. Counseling and/or coordinationof care with other physicians, other qualified health care professionals, oragencies are provided consistent with the nature of the problem(s) andthe patient's and/or family's needs. Usually, the presenting problem(s) areof moderate to high severity. Typically, 25 minutes are spent face-to-facewith the patient and/or family. J8499 - Lysteda6/16/2016www.RTWelter.com info@RTWelter.com33
LARC Clinical ExamplesICD-10 code(s) for the encounter: N92.6 – Irregular bleeding NOS Z30.49 – Encounter for surveillance of nexplanon F32.0 – Major depressive disorder, single episode, mildwww.RTWelter.com34
LARC Clinical Examples Jen had an IUD inserted 2 weeks ago and nowcomplains of pain at the insertion site withaccompanying left lower quadrant abdominalpain. The nurse practitioner examines the insertion siteand does not visualize any issues. The providerhas a 15 minute discussion regarding whether tokeep or remove the IUD. The patient decides not to have the IUD removedand will return in a month if symptoms persist.www.RTWelter.com35
LARC Clinical ExamplesCPT code for the encounter: 99213 - Office or other outpatient visit for theevaluation and management of an established patient,which requires at least 2 of these 3 key components: Anexpanded problem focused history; An expandedproblem focused examination; Medical decision makingof low complexity. Counseling and coordination of carewith other physicians, other qualified health careprofessionals, or agencies are provided consistent withthe nature of the problem(s) and the patient's and/orfamily's needs. Usually, the presenting problem(s) areof low to moderate severity. Typically, 15 minutes arespent face-to-face with the patient and/or family.6/16/2016www.RTWelter.com info@RTWelter.com36
LARC Clinical ExamplesICD-10 code(s) for the encounter: Z30.431 – Encounter for routine checking ofintrauterine contraceptive device R10.32 – Left lower quadrant painwww.RTWelter.com37
QUESTIONS?6/16/2016www.RTWelter.com info@RTWelter.com38
On Behalf of RTWelter & Associates 6/16/2016www.RTWelter.com info@RTWelter.com39
Applications to assist with ICD-10 Coding ICD10 Lite by iPremiumApps ICD10 by TVN Labs ICD10 Codes by Black-Night Labs ICD-9 to
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5. The batch will close and so will the OPIE Billing application. 6. To return to OPIE Billing, create a new batch. Get Started in Billing - Set up Global Settings in Billing Admin Rights in OPIE are required to access Billing Settings. 1. Log into OPIE Billing, go to the top left part of the Window to the menus: File, Windows, Help and click .
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