Insurance news
ICD-10 This week
Written by Editor   
Wednesday, November 18, 2015 12:53 PM

So Far, So Good

The new ICD-10 coding system has been in place for nearly 4 weeks, and so far implementation appears to be proceeding relatively smoothly. Some worried that physician practices wouldn't be ready to implement the new system when it debuted on Oct. 1, but that doesn't seem to be an issue thus far.

Medicare Part B contractors have been listing a few issues on their websites. Despite these issues, overall it has been positive.  The ongoing concern now, experts said, is what will happen on the "back end" when the insurers process more of the claims they've received. We are still in limbo in terms of ... how claims will be adjudicated.  Humana and UnitedHealth Group both said that things were going smoothly for them, but also that they taken a fairly liberal approach to coding – but they also said that was not going to last forever.  The biggest challenge is going to be seeing how many payers are actually going to leverage their ability to deny services because providers haven't documented the diagnosis code descriptors in their commentary of electronic health record notes, which is required to meet medical necessity. If the diagnosis cannot be deciphered from the notes to match what diagnosis code was billed, then the payer can deny the claim or recoup monies.

Changes to the 59 Modifier
Written by Editor   
Thursday, October 22, 2015 12:00 AM

The National Correct Coding Initiative (NCCI) edits were developed by the Centers for Medicare and Medicaid Services (CMS).  The NCCI edit program is used by carriers and third party administrators in an effort to thwart abusive billing practices of codes that should not be used together.

For doctors of chiropractic, three common therapeutic procedure codes are identified by the edits when billed with chiropractic manipulative treatment (CMT) codes: 98940, 98941, and 98942. These procedure codes are 97112 neuromuscular re-education, 97124 massage therapy, and 97140 manual therapy.

There are exceptions to the NCCI edits. One is when the 59 modifier is used to indicate to the carrier that a “distinct procedural service” is involved and the procedures should be paid separately. The CMS released new subsets of the 59 modifier in January 2015.

ICD-10 Tip
Written by Editor   
Thursday, October 22, 2015 12:00 AM

The ICD-9 code set was implemented in 1979 and is considered outdated and obsolete due to numerous changes and discoveries in healthcare. 

As of Oct 1, 2015 thousands of DCs in the United States reported their first set of ICD-10 codes. You may be wishing that you could have avoided this "moment in history," but with time and practice you will soon know the ICD-10 codes just as you did the ICD-9 codes.

As you take on this challenge, remember to start with what you know - the ICD-9 code. Until you are familiar with the different Chapters, code options and Instructional Notes you may want to continue to code your cases in ICD-9 first and then follow the 5 simple steps to coding, outlined in ACA's ICD-10 Coding for the Chiropractic Clinic on demand webinar. We have listed them below for your consideration:

Another Set of Codes?
Written by Editor   
Wednesday, October 21, 2015 12:00 AM

Now that we have officially transitioned to coding with ICD-10-CM, there is another set of codes you will want your billing staff to be acquainted with, that is the Claim Adjustment Reason Codes (CARC).

These codes communicate "why a claim or service line was paid differently than it was billed." This is important information as your clinic looks for ways to speed up the process of managing probable denials.

In the weeks following ICD-10 transition, ACA encourages clinics to make a top ten list of denial codes and keep it handy as you monitor claim status daily.

A complete list of CARCs can be found here and are reproduced below.

One More ACA ICD-10 Workshop Nov 7
Thursday, October 08, 2015 04:49 PM

This meeting date has been cancelled.  Sorry for the inconvenience.

ICD-10 is here. Is your practice ready?  Because of overwhelming feedback the Texas Chiropractic Association will host one more ACA-approved ICD-10 Training Workshop on November 7 in Longview.

This class will surely sell out, as have our previous three in Houston, Dallas and Austin. There are only 50 available spots... don't miss out!

The transition from ICD-9 to ICD-10 is here, effective October 1. It's not too late to ensure that you and your staff are up to speed on the new code. There’s no reason to struggle with the new coding system, resulting in costly delays or denials that could compromise your clinic’s cash flow and cut your reimbursements.

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