Anesthesia Providers are Part of the ICD-10 Process

This article will discuss the difficulty anesthesia providers will have determining the correct ICD-10 code given the level of specificity required. Because we have no access to previous medical history, we will rely heavily on information from the surgeon. With ICD-10 there is no way to know how much information is actually needed to code correctly until trying to code the case. Therefore, it is my opinion that the best way to determine the code is to have the anesthesia provider choose the code before billing is submitted. There are a number of ways for the provider to choose the correct code, from using the ICD-10 in book form to automated systems that allow the provider to “drill down” until a billable code is reached. With the available technology, this has proven to be the simplest way.

Will this do away with the need for certified coders? Absolutely not. It is  crucial that the code chosen by the anesthesia provider be reviewed before the claim is submitted. Providers should be trained and educated in the appropriate aspects of ICD-10. Anesthesia covers a multitude of diagnosis categories so we must train in all categories. The providers we have met with understand the logic behind having them code it themselves and are very open to this mindset. As we start to train groups it has become imperative that they query the surgeon in order to choose the correct code. This has proven to be educational for the surgeons also and made them realize the need for better documentation for their own coders. And the countdown begins, just 43 days until October 1!

–Pam Stopher, CPC, ACS-AN


Anesthesia Billing

For the next few months we will focus on anesthesia.

Anesthesia is a most unique specialty in many ways. From patient registration to claim payment, it’s unlike any other. Because anesthesia typically doesn’t see patient demographic information until after the procedure, you need to work quickly once you have received the information, whether electronic or paper.

Invest in the manpower it takes to:

  • verify the insurance information given (policy #, insurance carrier, insured’s name and date of birth, etc.)
  • check deductible (We always recommend holding the anesthesia claim until deductible has been met, of course, keeping timely filing in mind.)
  • verify patient mailing address
  • check for outstanding balances

If procedure is elective (total joint replacement, gastric bypass, etc.), contact the patient two days after surgery to give the name of your anesthesia group to advise them of your policies and procedures. Let them know you’ll be glad to file their insurance, making sure the insurance company has paid all they were obligated to pay, before sending a bill for their balance.

Once the carrier has made payment, call the patient to let them know their balance and see how they want to pay the balance. We find many times they will pay right then over the telephone. If not, help them arrange a payment plan. We have found this process very effective and recommend it to all practices.

If the patient’s demographic indicates self pay, contact them immediately to determine if this information is correct and either arrange a payment plan, or hopefully, obtain insurance information not given at time of admission

Time spent prior to claims filing is well worth the effort.

Next month we’ll cover self-pay cases…

Pam Stopher


Preparing for ICD-10

October 1, 2015 is just a little more than six months away, and we had better be ready. It seems that the annual delay will not happen this year, and like it or not–here it comes. Best practices and their billing services will do everything possible to embrace this change, if for no other reason than to see to it that our practices have a normal monthly income. At this time, we are preparing to renew our efforts of implementation and testing to be ready on October 1. We encourage you to do the same.

The hardest part will be for those of us who know so many codes by memory, as we will have to erase that memory card and start clean. Yes, there are more characters in the code to learn, but ongoing learning helps keep the brain busy and alive.

So, hang on, ICD-10 here we come!


ICD-10 Will it Happen or Will it Not?

As of now ICD-10 is scheduled to take effect on October 1, 2015. And yes, we’ve had a “go-live” date on more than one occasion over the past several years. Hard to say whether or not it will really happen this time. Some in the industry welcome it with open arms, some prefer it go away completely. Those I have spoken with who have studied it for some time assure me it’s a much easier system with more logical way of thinking than ICD-9, which sounds good to me.  The biggest problem I see is that for many coders we have memorized the codes we use most often and coding work will be slowed down to a crawl.  For our business we plan to  bring in extra coders to help so that billing schedules can be kept. Will this be costly? Yes, but it’s just a part of doing business and keeping our clients satisfied.

Last year time and funds were spent training heavily for the transition. Once the delay was announced, I decided not to implement any more formal training until April 15th.  I believe if it is going to be postponed again, it will be done by then. Last year a 1 one year delay was a last minute addition to the SGR patch legislation passed by Congress and signed by President Obama in the spring of 2014.

Stay tuned for more information on ICD-10


Payers – Can’t Live with ‘em and Can’t Live without ‘em

Our payers are obviously a huge part of our lives. When things are going smoothly, life is good but let one little edit get out of kilter and claims are rejected and delayed.  Claims can be paid today and then BAM all of a sudden your provider’s claims process as non-par. How could that happen? Through absolutely no fault of your own an error occurs on the payer’s part and claims are all processed incorrectly. After 45 minutes on the phone you convince the clerk that your provider is in network and you are told they will reprocess the claim, you should have payment within 30-45 more days. After a long wait you receive additional payment but of course, some are denied as duplicate, so more time is spent getting your claim paid correctly, again, through no fault of your own.  Once a claim is paid incorrectly it can turn into a nightmare to actually get the money due your provider. The key is to continue to pursue it because the provider is due the money. Once this snafoo is cleared up, you can sit back, process your claims and wait on the next one to come along. Because, it saddens me to say, that it will……

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