Experienced medical billers and coders have probably seen their fair share of unspecified codes throughout their careers. However, best practices for how to use (or not use) these codes have continually shifted. The landscape of diagnosis codes has changed a lot over the past decade due to the transition to ICD-10. So it only makes sense that the right way to handle unspecified diagnosis codes has also changed. To put it bluntly, the right way to handle unspecified codes is to not use them at all.
If you’re mentally preparing an argument in favor of using unspecified codes, hear us out.
Why are People Using Unspecified Codes?
If you shouldn’t use unspecified codes, then why do they exist? Unspecified diagnosis codes have become relics leftover from previous versions of the ICD. Many of them are disappearing, but some remain. That doesn’t mean you should use them.
Unspecified codes are sometimes used when the information in the medical record is insufficient to assign more specific codes. Since most physicians do their own coding, there should be no reason to use them intentionally. Physicians know the importance of comprehensive documentation when it comes to getting claims paid.
Other times, they are chosen by mistake by someone working quickly. If someone filling out a claim isn’t paying enough attention to what codes they’re choosing in the EHR so they choose the first one that looks right. In rarer cases, unspecified diagnosis codes are the result of a lack of knowledge or a desire to cut corners.
Why You Shouldn’t Use Them
Now that we’ve examined why an unspecified code might end up on a claim, let’s talk about why they SHOULDN’T be there.
Unspecified Codes are Outdated
It’s true that unspecified codes were once acceptable on insurance claims. But the times, they are a-changin'. ICD 10 is phasing unspecified codes in a big way. That’s why there are so many more specific codes than there were in ICD 9.
Codes that were valid a year or so ago may not be valid now. And as things keep being updated, codes that are valid now won’t be valid for much longer. So it’s best to get out of the habit of using them now.
There are Specific Codes For What You Need
The entirety of ICD-9 had about 14,000 codes. ICD-10 is estimated to include more than 69,000. That’s nearly five times as many codes to choose from. There are so many codes in ICD-10 that get down to the real nitty gritty of a diagnosis that there’s very little chance one of them isn’t a better fit than an unspecified code.
For example, the number of codes for glaucoma in ICD-10 is somewhere around 300. These codes include designations for the type of glaucoma, whether it is primary or secondary to another condition, laterality, staging, and more. If there isn’t enough information in the documentation to code something other than H40.9 - Unspecified Glaucoma, then there’s probably a larger issue to address.
They Can Delay Revenue
Maintaining a steady stream of revenue is a priority for an optometry practice. Using unspecified codes in claim submissions is a surefire way to interrupt that stream. Insurance companies will deny claims that come through with unspecified diagnosis codes. That’s why medical billers will remove unspecified codes before submitting a claim.
If the codes removed by a biller need to be replaced, then a coding review is required. Not only does this prolong the reimbursement process, but it eats up the valuable time of physicians, administrators, coders, and billers. So, bottom line: if an unspecified code is used then it is going to take longer to see your money.
Tips on Avoiding Unspecified Codes
There are ways you can alter your processes to eliminate unspecified codes from claims. It might take a little time upfront to implement the changes and there may be an adjustment period for staff, but it will pay off exponentially in the long term.
Cut out unspecified code usage in three easy steps:
- Physicians: Don’t code with them. You’re already taking the time to document a visit for the patient’s medical record. Use that documentation to assign a more specific and accurate code right off the bat.
- Front Desk Staff- Don’t choose unspecified codes in the system. Take the time to choose the exact code the physician assigned when you’re in the EHR.
- Practice Managers - Remove unspecified codes as options in the EHR dropdown. If the code isn’t there, it’s impossible to use them on a claim, even by mistake.
Contact Applied Medical Systems
If you want to talk to one of Applied Medical Systems’ team members about the dangers of using unspecified codes and how you can refine your billing process, get in touch. We have the experience, expertise, and resources to help you increase the efficiency and profitability of your practice. You can reach us by phone at (800) 334-6606 or (919) 477-5152. You can also contact us online.