No matter when you’re reading this, it’s medical coding update season! January may bring the most changes, but there are plenty of other events throughout the year to keep facilities, practices, and medical coding companies on their toes. Here’s a starting point you can use to make sure your medical coding tools provide the latest information for the areas that matter to you.
Use Preliminary Releases So You Aren’t Late to the Party
Preliminary information about code set updates comes out at various times throughout the year. For instance, you may get a preview of ICD-10-CM and ICD-10-PCS changes in late spring or early summer so you can prepare for October 1 implementation. We typically see the early list of annual CPT® code updates in late summer/early fall, with January HCPCS updates posted closer to the implementation date.
Preliminary lists are just that; they’re not final. But the early lists help with preparations, so check to see whether your medical code lookup software provides information about upcoming changes as well as providing accurate codes on the implementation dates.
Check for CPT® Updates Beyond January
You may know that Category III CPT® codes are implemented in July and January, but did you know CPT® now has Proprietary Laboratory Analyses (PLA) codes released quarterly? Updating your code sets once a year simply isn’t enough because you may be missing changes that affect you.
Bonus tip: Another area to watch is corrections. Considering the huge number of codes, it’s no surprise that the different code sets must sometimes post errata and technical corrections. Make sure your coding resource is updated with the latest corrections as well as the latest codes.
Increase Accuracy With Guideline Changes, Too
Your code set updates aren’t complete until you have the latest guidelines for the code sets. These include instructions that accompany the codes, like section notes and code-level notes in CPT®. It’s helpful if you can see which guidelines are new. For instance, SuperCoder online coding tools mark CPT® guideline updates by putting them in green text.
You also want to be sure that you have access to current ICD–10–CM Official Guidelines for Coding and Reporting, which aren’t located within the code set. Your online medical billing and coding resource may post a copy or link, or you can find the guidelines by searching online.
Stay on Top of CMS HCPCS, CCI, and Fee Schedule News
PLA coding isn’t the only coding area updated throughout the year. Medicare updates HCPCS codes, multiple fee schedules, and Correct Coding Initiative (CCI) edits on a quarterly basis.
If you think these smaller updates aren’t important, consider the impact of missing a change for one of your most common services, such as the addition of a HCPCS code specific to a drug you report, a change to a bilateral indicator on the Medicare Physician Fee Schedule, or a new rule that allows you to override a CCI edit. Ignoring quarterly updates can lead to reduced accuracy and reimbursement.
Always Have the Latest LCDs and NCDs
Speaking of accuracy and reimbursement, Medicare local coverage determinations (LCDs) and national coverage determinations (NCDs) can be a treasure trove of correct-coding guidance for your Medicare claims. These policies can see updates at any time, so choose a coding resource that updates them regularly. Individual policies, especially LCDs and lab NCDs, may provide tables showing you exactly which ICD-10-CM codes support the procedures and services you’re reporting. The policies also may detail documentation you need to support a service, frequency limitations, and other coverage rules.
Bottom line: Updating coding resources once a year isn’t enough. Either follow a detailed plan so you don’t miss important changes, or choose a reliable online coding solution that does the update work for you throughout the year.