As ASCs continue to adapt to ever-changing trends and opportunities in the healthcare industry, we wanted to share important coding updates from FY 2022 ICD-10-CM (to be used from October 1, 2021 through September 30, 2022) and suggest some tips to help optimize your revenue cycle processes. At Simplify our strategic approach is designed to improve efficiency and optimize reimbursement – beyond just billing and coding – backed by decades of experience and industry insight. Your success is our priority and we are here to help you!

October 1st ICD-10-CM Release:

With the change to the fall season comes anticipated updates to the ICD-10-CM code set. I look forward to these updates each year, as it brings necessary adjustments and additional specificity to the various diagnosis codes. On October 1st the Centers for Disease Control and Prevention (CDC) released 159 new diagnosis codes along with 25 deletions and 27 revisions. ASCs may be particularly interested in the codes in Chapters 2, 6, 11, and 13 of the ICD-10-CM manual. These codes are relevant to specialties such as Orthopedics, GI, Pain Management, and Obstetrics/Gynecology.

Below are a few notable updates and additions:

Chapter 2 Neoplasms (C00-D49) – 3 New codes

New codes for malignant bilateral ovaries as primary and secondary, C84.7A Anaplastic large cell lymphoma, ALK-negative, breast.

Chapter 6 Diseases of the Nervous System (G00-G99) – 10 new codes

Expansion of toxic encephalopathy (G92), G04.82 Acute flaccid myelitis, G44.86 Cervicogenic headache.

Chapter 11 Diseases of the Digestive System (K00-K95) – 13 new codes

New subcategory, Gastric Intestinal Metaplasia (K31.A-), K22.81 Esophageal polyp, K22.82   Esophagogastric junction polyp, K22.89   Other specified disease of esophagus (hemorrhage of the esophagus NOS).

Chapter 13 Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) – 23 new codes

Three codes under subcategory M31.1- to allow reporting hematopoietic stem cell transplant-associated thrombotic microangiopathy, Expansion of Sjogren Syndrome (M35.0-), Non-Radiographic Axial Spondyloarthritis (M45.A-), and Low Back Pain (M54.5-).

RCM Quick Tips -- Process Improvement Checklist:

Are you maximizing your efficiency when working the A/R? Is process improvement part of your month close review? Here are some things to consider:

1.  Review of internal delays

What are some of the reasons claims are held during the month? If missing documentation is the culprit, is it one physician or one implant representative holding claims up?

2.  Review of payer delays

a.  Are the payers delayed due to missing, or the need for additional, documentation?

Do you have a process in place or could your process be improved?

b.  Have you leveraged your clearinghouse?

Are their payers you could submit claims to or receive remits electronically versus by paper?

c.  Have you reviewed your contracts recently? If a payer is consistently delinquent, not meeting the contract expectations, it may be time to renegotiate.

3.  Review of patient payment delays

a.  Are you sending out patient estimate letters? Financial communications? Expectation of a down payment on the DOS

b.  Setting up payments plans electronically, again leveraging the clearinghouse, patient portal – auto payment plans

4.  Review of denials

a.  How many denials did you receive last month?

i.  Were there coding errors?

ii.  Patient data entry errors

b.  If coding errors, have you conducted an audit, additional education for your coders?

c.  If patient data errors

i.  Do you utilize benefit verification tools

ii.  Educate staff on importance of correct data entry

d.  Medical Necessity – was an auth on file

Have you educated the providers on proper documentation?

Teamwork: “Teamwork makes the dream work,” by John Maxwell is one of my favorite quotes. A synchronous relationship between coders and billers is essential in maximizing reimbursement. While coders bring a skillset of medical terminology, anatomy, and coding regulations, billers bring a skillset of payer contracts, billing regulations, and reimbursement strategies. Together they work to problem solve, communicate, and process improve all aspects of the revenue cycle working toward a common goal: to maximize reimbursement and ensure compliance. I have had the opportunity to work in all aspects of revenue cycle, not only in an ASC, but also as a service provider and educator. The relationship I have had with coders and billers has been rewarding over the years. It is exciting to create positive change and financial growth in an ASC.

Here are a few tips that allow coders and billers to collaborate effectively in either a remote or in office setting:

  • Weekly or monthly check-ins - Hold meetings to discuss high level information regarding the financial state of your ASC and what process improvements need to be made. Give praise and constructive feedback. Allow staff to present success or struggles they have had and work as a group to assist in creating a solution.
  • Information sharing and goal setting - If monthly or annual goals are set, make sure they are clear and visible to your departments. Check in with staff during touch-base meetings to discuss goal progress and strategies. Being transparent about this information allows staff to see the bigger picture, take ownership, and work together as a team to accomplish the goals.
  • Educational and brainstorming sessions - Knowledge share is a valuable and powerful tool. Allotting time for staff to attend a virtual or in person education session at least annually, not only benefits the staff member, but also the ASC. Inserting time into the touch-base meetings to discuss updates or educational material relevant to ASCs or specific specialties can only enhance the staff’s ability to excel in their department.