Tips to Maximize ICD-10 Coding Reimbursements

Posted by Continuum on Apr 27, 2016 4:28:14 PM

ICD-10: three letters and two numbers that caused much anxiety and stress for the medical community.                           Continew-icdImplmentaionImg3-1.jpgnuum’s coding team effectively prepared its clients for a smooth transition with little incident. It took approximately two years of hard work to prepare for the update to ICD-10, which went into effect in October 2015.

While it's been only six months, experts say much of the trepidation and hype were oveblown. The fear of denials, lost revenue, and work flow is nowhere to be seen.

A Physicians Practice survey revealed that 47.3 percent of readers say they are having no problems with the ICD-10 transition and have not seen an increase in claims rejections. Another survey found that 60 percent of practices said they have not seen an impact on monthly revenue1.

All of this is great news. However, Continuum’s team stresses that once Medicare’s one year ICD-10 coding leniency is lifted on October 1st, practices may see more denials and or payment delays. Here are a few tips to help avoid future issues:

  1. Accurate coding. Ensure you use the most accurate codes by reviewing codes and clinical documentation together. While a code may be accepted by a payer, it’s not necessarily the best one for the care provided. Due to the large number of codes in ICD-10, physician practices will need time to adjust. Take this first year to review everything.
  2. Well-documented coding. Review clinical documentation now to help identify areas for improvement and potential audit red flags. Does the documentation match the codes? This is more important now than ever before due to the numerous codes (and details) associated with ICD-10.
  3. Analyze denials. Most initial reports indicated that denial rates remained the same or increased less than 10% after ICD-10’s implementation2. However, it can take time to see and/or measure true results. Now that you have several months’ worth of data to assess, conduct a thorough analysis of your top denial reasons. Keep an eye out for new top denial reasons as a result of ICD-10.
  4. Conduct an ICD-10 review. Initially, many physicians were most concerned with submitting error-free claims while achieving volume and productivity levels they maintained prior to ICD-10’s launch. This is a great time to make sure all teams in your office are fully compliant. In addition, assess how your current information technology systems are working for you now. Are there ways to modify or enhance your systems to better optimize processes and reporting.

To learn more about Continuum’s Coding services, please contact our offices at 856.782.3300 x2419 or visit,



1Physicians Practice, April 2016, How Practices are Faring with ICD-10 at Six Months

2MGMA Connection, April 2016, 4 Steps to Optimize post-ICD-10 Transition Success



Topics: coding, icd-10, payer reimbursement

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