Everyone remembers the anxiety surrounding the finalized transition to ICD-10 in 2015, And while ICD-10 Monitor notes that the volume of changes is slowing, the 2019 Spine Surgery coding changes are significant. Organizations that don’t act quickly may find themselves facing confusion at best, delays and denials at worst, and a definite impact to revenues.
It’s easy to see why. Spinal coding is complicated - and even highly experienced coders struggle to understand it. For instance, spinal fusion coding ALWAYS requires notation of a device – if there is no device, there is no fusion. Yet, until recently, 87 spinal fusion procedure codes included the device character “Z,” indicating “no device.” Removal of the Z character should reduce error rates but could increase confusion in coding.
Ask yourself: When looking at a given procedure, will your coders know whether it’s a release or a reposition of the spinal cord - with or without a device? If you think that the difference is small, think again. MS-DRG 520 (Back and neck procedures except spinal fusion without CC/MCC) has a relative weight of 1.3141. MS-DRG 517 (Other Musculoskeletal System and Connective Tissue OR Procedures without CC/MCC) has a relative weight of 1.3809. Do the math and it’s easy to see how a 10 percent error rate could equate to over $1 billion money returned to CMS.
Now, consider this: The most frequent MS-DRG for spinal fusion is 460 (Spinal fusion except cervical without MCC) and it has a relative weight of 4.0375 – equating to an average Medicare payment of $24,458.68 and an average commercial payment of $28,882.77, multiplied by 80,000 cases a year. And, according to data submitted to CMS, that number is rising.
With that in mind, here are four steps you should be taking to avoid errors and mitigate future risk:
- Review all of your claims with dates of service between January and September of 2018 containing MS-DRG of 453-460 or MS-DRG 471-473 codes
- Determine how they would have had to be coded under the new changes
- Determine the potential financial risk of coding errors
- Educate and train your coding staff to ensure a thorough understanding of spinal fusion procedure coding – and the potential impact of errors.
Bonus tip: You don’t have to take these steps alone. At himagine solutions, our extensive staff of subject matter experts in all areas of coding brings more than 20 years of experience to our services. In addition to direct coding support, we offer focused DRG audits and analyses to identify both potential risks and mitigation opportunities. We also offer our clients the same monthly education we provide to our employees (which earns your coders 1 CEU per session).
Without a doubt, these new changes add complexity to an already complex procedure coding set. But by taking the right steps now, you can reduce their impact and take them in stride.