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Best Practices for Implementing New Medical Codes and Guidelines

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Scot Nemchik, CCS, CRC, CLSS
September 10, 2021

In just a few weeks, ICD-10-CM and ICD-10-PCS turn six! On that same date, we’ll be implementing annual changes to the Inpatient Prospective Payment System (IPPS), including changes to the ICD-10-CM and ICD-10-PCS code sets, for the fifth time. It seems that ICD-10 is dialed in pretty well at this point. Evidence to this point is the relatively small number of new codes added this year—153 for ICD-10-CM and 127 for ICD-10-PCS. Despite this new code ‘slow down’ it is still as important as ever to empower code stakeholders to utilize new codes with accuracy and efficiency. One needs only to look as far as the recent COVID-19-related diagnosis codes and their role in publicly reported data; these are not codes to be taken lightly.

One thing is for certain: there will be new codes next year, and the year after that, and the year after that. Let’s use the remainder of this article to discuss some best practices for implementing and socializing new codes throughout your code stakeholder community and empowering your coders to apply them with confidence and precision.

Take advantage of proposed changes and data organization

Preparation can begin as early as the second quarter of the calendar year. Each year in mid-April, CMS posts proposed changes to IPPS, including changes to ICD-10-CM and ICD-10-PCS. This offers our first glimpse of what to expect come mid-August when CMS publishes the final changes to IPPS. How cool is it that we can begin preparing for new codes six months before we actually need to use them? Come mid-August, we need only to keep an eye out for deviations from the proposed rule, perhaps a couple of codes that were deemed necessary sometime after mid-April.

You’ll find that CMS is meticulous about data organization, right down to the worksheet names used in their code change files—Table 6A for New Diagnosis Codes, Table 6B for New Procedure Codes, Table 5 for Medicare Severity Diagnosis-Related Groups (MS-DRGs), etc. Year after year, you can expect to find what you are looking for in the same spot and in the same format as years prior.

Understand the impact of code changes

The next steps involve assessing the potential impact of new codes within your organization. Armed with some organizational data easily extracted from most EMRs, we can compare incoming new codes with those that are frequently encountered within our facility or practice. Changes to high-volume codes, or the guidelines that govern their assignment, should be treated with urgency. The cumulative effect of coding uncertainty or imprecision for a commonly occurring code can be devastating. Get out ahead of these where occurring!

It’s important to remember that our providers are code stakeholders as well. Without much effort, we can create and distribute a document summarizing impactful code changes, even the codes themselves. If nothing else, this serves as a reminder of annual ‘coding dynamics’ and provides some concrete examples of the coding terminology we interact with on a daily basis, and may help to bridge the gap between clinical lexicon and the codes themselves.

Activating early on annual code changes can make this yearly event exponentially more manageable, improves coding confidence and efficiency, and increases data integrity. Learn more about Ciox’s medical coding services to help support your organization.

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