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As we begin the fourth year since the introduction of ICD-10, some practices are beginning to see an increase in denials and reduced reimbursements due to the use of unspecified diagnosis codes. Now that the grace period has passed, insurance companies are expecting more from practices with regards to coding specificity. If your practice is experiencing an increase in denials because of unspecified ICD-10 codes, here are some easy tips to improve diagnosis code specificity.

What is an unspecified ICD-10 code?

An ICD-10 code is considered unspecified when the terms “unspecified” or “NOS” are included in the code description. In some situations, an unspecified code really is the best option. However, an unspecified code should not be your default when a more specific code is known by the physician. For codes whose definition includes laterality (right, left, bilateral), there really is no benefit to reporting the unspecified laterality option. In addition, for a patient who suffers from Type 1 Diabetes Mellitus with Complications, it is better to select an option which specifies the type of complication rather than just DM Type 1 w/ Unspecified Complications (E10.8). The more specific you are, the greater reimbursement potential you have.

How do we solve the problem of ICD-10 specificity?

For a practice experiencing denials because of an overuse of unspecified ICD-10 codes, here are 3 steps you can take:

1. Identify the top unspecified codes in your practice

In order to avoid the overuse of unspecified ICD-10 codes, you first need to know which unspecified codes you are using. Run a data usage report from your EHR or PM system, and identify your most commonly used unspecified codes. Then evaluate which unspecified codes must truly remain in use, and which ones have room for improvement.

2. Streamline your data entry

For unspecified codes you do not want to report, it is better to remove temptation and not make it easy for your doctors to select an unspecified code. Out of sight, out of mind! For those unspecified codes you need to replace, it is worth investing in revisions to your EHR templates or electronic encounter forms. In this situation, you are not picking the diagnosis for the physician, but you are providing them with the best possible diagnosis options first.

3. Use third-party software to review claims data

We do not want to turn doctors into coders; however, with software like AccelaSMART, your billers can be equipped with tools to help them identify unspecified codes. For example, coding review and/or validation tools can identify unspecified codes and flag at risk encounters. If some insurance companies accept unspecified codes but others reject them, you can set up rule filters to be insurance-specific. That way, the rule is only triggered in situations where an unspecified code is a liability.

The White Plume Difference

White Plume Technologies constantly strives to improve encounter revenue possibilities for our clients. We offer an analysis of unspecified codes as part of our Advanced Revenue Cycle Analytics, and we offer recommendations for improvement.

Reducing denials and getting the full reimbursement on your claims is difficult. With thousands of codes to keep up with, maintaining a health revenue cycle can be a huge challenge. If you want a better way to protect your revenue cycle from problems like the overuse of unspecified codes, schedule a free revenue cycle analysis today.