Posted Thursday, September 23, 2021
Action Item: Make sure your physician orders are changed to reflect new ICD-10-CM codes on October 1.
With all the attention given to ICD-10-CM codes updates for FY2022, don’t forget to request a change in physician orders, where necessary, to match the new codes.
Even if the change in the ICD-10-CM description seems minor to you, every little distinction is important to payers, so if there is any discrepancy between the code and the physician order, your claim will be denied.
For example, if the ICD-10-CM of C16.0 was used for a primary diagnosis of “malignant neoplasm of the cardia” under the FY2021, that coding has changed to C49.A1 for FY2022. Your physician order will now need to specify “gastrointestinal stromal tumor of esophagus” to remain consistent.
The bottom line is that you will need new physician orders if the diagnosis and coding changes even a little bit.
Physician Orders Need to Change at the Same Time as the ICD-10-CM Code
For home health and hospice providers, remember that the physician orders need to change at the same time as the ICD-10-CM code to prevent a return to provider (RTP) delay in reimbursement.
”It’s crunch time,” said Cindy Keim, Corridor’s Director of Clinical, Regulatory and Quality Affairs.
“This is the countdown to October 1st. Get your orders in place and be prepared to change those codes on October 1, and remember, this is in effect for both home health and hospice clients,” she said.
Even though the changes go into effect for all health care providers, unlike home health, hospice has a limited number of diagnoses that can be used for a primary. Therefore, the changes for hospice for FY2022 are much smaller in number than in the past, and any change will most likely only affect the secondary diagnosis. Because of this limited impact, there should be minimal RTP/reimbursement delays for hospice.
So, for hospice clients, pay particular attention to changes in any secondary diagnosis that need a new code and a physician order, because it will still impact reimbursement.
If your agency has a good process in place to make the annual coding changes and a team to track physician orders, you should be able to make a smooth transition into FY2022. For additional guidance, see Corridor’s previous blogs below.
With all the details that need attention to stay in compliance with ever-changing regulations, you may find that you need help implementing the FY2022 ICD-10-CM coding changes into your organization’s claims submission process. At Corridor, our coding and reimbursement experts can put processes in place avoid claims delays and rejections. Please contact Corridor at 1-866-263-3795 or by clicking here.
For over 30 years, Corridor has partnered with home-based care providers, delivering powerful solutions to support the unique challenges of caring for patients in the home. Our team of operating executives, clinicians, and nationally renowned industry experts have run provider organizations and resolved the same challenges you face.
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