tci Medicare Compliance & Reimbursement - 2023 Issue Q3

Factor in This Claims Insight to Better Ensure Appropriate Pay

The Centers for Medicare & Medicaid Services (CMS) and many other payers use ICD-10-CM to process claims, relying on diagnosis codes to demonstrate medical necessity for providers’ services. Additionally, Medicare quality reporting programs rely on accurate diagnosis coding to evaluate appropriate procedures — so missing the boat now could impact your bottom line later. As you prepare to implement the new ICD-10-CM changes on Oct. 1, there are a few things you need to address, says Robin Peterson, CPC, CPMA, manager of professional coding services, Pinnacle Integrated Coding Solutions, LLC in Centennial, Colorado. First, review current documentation for each...

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