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Tips and tools for rehab professionals: Coordination of the ICD-9 coding process

Rehab Regs, February 20, 2009

Due to the size of their practice or specific internal procedures, some therapy practices may rely on administrative personnel, such as coding and billing specialists, to handle the assigning of the ICD-9 codes to therapy. This can be a helpful scenario to ensure correct coding, but can also be a potential pitfall to problems relating to ICD-9 coding. When the ICD-9 coding process is separated between the evaluating therapist and the billing coordinator, there can be potential miscommunications and inaccuracies. A concerted effort must be made to ensure that both the therapist and the coder agree that the ICD-9 codes used are the best representation of the patient’s condition, resulting in a correctly coded claim. Too often, codes are assigned strictly by a coding specialist who has never laid eyes on the patient to verify the relation of the codes to the therapist-established plan of care.

This disconnect between the billing specialist and therapist can also exacerbate misunderstandings or inaccurate coding patterns on the therapist’s behalf. For example, if a therapist is putting an expired code on a claim and the coder is correcting it prior to submission, the therapist won’t know to change the procedure unless notified of it.

Similarly, the billing personnel may also identify when a claim is missing an ICD-9 code that is necessary for the claim to process through the Medicare contractor as dictated by the local coverage decisions. The billing specialist and therapist should collaborate to identify what codes may be appropriate and seek physician input when necessary. This will serve to educate the therapist and prevent any future problems.

This is an excerpt from HCPro’s book, The Essential Guide to ICD-9 Coding for Therapy Professionals, written by Kate Brewer, PT, MBA, GCS.

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