Data Insights

Holidazed and confused: Making sure your coders are ready for Jan. 1 updates

MGMA Stat

Coding & Documentation

Electronic Health Records

Veronica Bradley CPC, CPMA
The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders “Does your practice provide training to staff for yearly code updates?” A majority (69%) responded “Yes,” while 31% reported “No”.

This poll was conducted on December 3, 2019, with 1040 applicable responses.

Updating codes is essential in a medical practice, as ICD-10-CM diagnoses codes are revised and released on Oct. 1 each year, and CPT codes are updated each year on Jan. 1. Similarly, HCPCS includes procedural, professional and durable medical equipment codes, which are updated each year on Jan. 1. Additionally, both CPT and HCPCS codes can be updated quarterly, and it’s important for a practice to review any updates from its Medicare Administrative Contractor (MAC) throughout the year.

The Centers for Medicare & Medicaid Services (CMS) also publishes quarterly updates that can be found on the CMS website.
Why are codes updated? New diseases, treatments and medical advances necessitate revising, adding or deleting codes.
 
The repercussions of not keeping up with updates can be detrimental to a medical practice:
  • Lack of updating codes can prevent timely processing of claims or cause denials.
  • Level of specificity may cause a lag in payment of claim as the payer may request a more specific code on a diagnosis that has been updated in its system but not yours.
  • Capturing chronic conditions may also be impacted as codes are updated.
  • A deficit in quality measures may cause loss of eligibility of participation in certain programs including grants and Medicare and Medicaid programs.
  • A medical practice may also miss commercial payer benchmarks causing loss of incentives.
  • Nonetheless, financial impact is at its greatest when codes are not updated.
 
It is imperative that your EHR is updated on corresponding dates whether the vendor states it is automatically updated or requested by your medical practice. Be aware of auto updates or vendor-initiated updates by rechecking the codes in the EHR. Also be aware of any additional charge a vendor may require upon updating codes. Regardless of method of delivery, it is crucial that all coding updates occur when expected.
The impacts can be prevented by ensuring your EHR is up to date and educating physicians and staff on code changes. Add the dates on your calendar and enroll in a newsletter, webinar and/or professional coding organization to ensure your medical practice does not miss any updates on ICD-10-CM, CPT or HCPCS coding updates. Coding and billing staff should be made fully aware of changes and relay the information to all who have a role in coding. There are many resources to keep a practice updated.

Additional resources:

 
Would you like to join our polling panel to voice your opinion on important practice management topics? MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat are available at: mgma.com/stat

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About the Author

Veronica Bradley
Veronica Bradley CPC, CPMA
Senior Industry Advisor MGMA Englewood, CO

Veronica Bradley has more than 20 years’ experience in medical coding and auditing in various specialties. She has worked in private practice, group practices, academic school of medicine and hospitals. She focuses on education based coding guidelines and code capture accuracy for all medical practice staff. She believes coders should build rapport with healthcare providers to ensure healthy communication across the charge capture process.
 
Veronica has an associate degree from Arapahoe Community College in health information technology and is finalizing capstone work for a bachelor degree in health information management with a minor in healthcare administration from Regis University, Denver. In her free time, Veronica appreciates spending time with her family, enjoying the beautiful Colorado scenery.

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