If you run an acupuncture clinic then you must know how frustrating it is to deal with insurance claim denials. You provide excellent care and document everything which is a time time-consuming task and as a result, the claim is denied at the end. All this situation is frustrating, and it can impact your cash flow. And when dealing with coding for conditions like prediabetes then things get more complicated.
Prediabetes is a very critical condition in which there are more likely chances of diabetes diagnosis and due to which the blood rises abnormally. As this disease rises at a larger scale, the need for associated billing and coding also needs to be more perfect. The fact is that most acupuncturists face frequent denials of claims and the reason is just some common mistakes that they make during coding. If you want to reduce denials and get paid faster then it is very important to know the common mistakes in acupuncture billing, especially when using ICD-10 codes for prediabetes.
Why Do Insurance Denials Happen in Acupuncture Billing?
Before we go into the specifics of prediabetes coding, let’s talk about why claims get denied in the first place. There are different reasons behind the rejection of claims in acupuncture billing services including:
- If medical billers use incorrect ICD-10 coding or fail to include all relevant codes then the claims will be denied automatically or if they forget to add supporting diagnosis codes for medical necessity.
- Lack of medical necessity also causes claims to be denied. Insurers mostly deny claims if they believe acupuncture isn’t medically necessary for the diagnosed condition then you need solid documentation to prove why acupuncture is essential for your patient’s treatment plan.
- Billing for Non-Covered Services is another major reason. Some insurance plans don’t cover acupuncture for certain conditions like prediabetes that’s why it is important to always verify benefits before submitting claims.
- To reduce denials it is also important to rectify errors in patient information because a tiny mistake like a misspelled name or incorrect birthdate can trigger a denial.
- It is also critical for providers to be credentialed. If any acupuncturist is not properly credentialed with a particular insurer then the claims can be rejected outright.
What is Prediabetes?
As the name shows prediabetes is a condition before diagnosing diabetes which means that your blood sugar levels are higher than normal but not on the level of diabetes instead there are chances to diagnose diabetes in the future if you do not control it at the time of prediabetes. It is very important to identify and manage it on time to prevent the progression of diabetes.
Different treatment options are available for prediabetes and acupuncture service is one of them. Different researchers also suggest that acupuncture therapy can be useful in helping prediabetic patients.
Understanding ICD-10 Coding for Prediabetes
The WHO has introduced its 10th version of ICD codes. These codes are designed to highlight the importance of prediabetes treatment which ultimately improves the health of adults. Prediabetes has some unique codes that help to identify the risk factors and treat them properly on time. These codes help the patients to get timely insurance reimbursement and diagnosis of prediabetes before it turns into a severe diabetes case.
Importance of Accurate Coding
Accurate ICD-10 coding is essential for the following reasons:
- To make sure that healthcare providers receive appropriate payment for services they deliver.
- In the healthcare industry, coding compliance is required and helps in upholding regulatory requirements.
- Accurate coding shows the right diagnostic condition which supports accurate health analysis and the right treatments.
ICD-10 Coding for Prediabetes
In ICD-9, a code was classified as 790.29 for abnormal glucose level which shows that there is no specific code for the prediabetes condition. But with the increasing need, the ICD-10 code specifies the primary code for the prediabetes condition which is R73.03, and became effective on October 1, 2017. This code is used primarily in the United States while other countries have different numbering systems for similar conditions. Different codes were introduced for blood examination including:
- R70-R79: This range is for “Abnormal findings during blood examination.
- R73: This code specifies the “blood glucose level.”
- R73.0: This code specifies “Abnormal glucose.”
Strategies to Avoid Common Pitfalls of Coding
The 32% coding errors cause claims to be denials and to resubmit denial claims, acupuncture practices spent an average 25$. That’s why denial always impacts the revenue cycle management of practices. To improve overall cash flow, healthcare providers need to resolve these coding issues but how? Here’s the solution. If medical billers follow different strategies then they can reduce billing mistakes. These strategies include:
Verify Insurance Coverage Before Treatment
Before you even think about submitting a claim it is important to first confirm whether the patient’s insurance covers acupuncture for prediabetes. Check:
- Coverage policies for acupuncture.
- Any pre-authorization requirements.
- Patient copays and deductibles.
Ensure Comprehensive Documentation
Insurance companies prefer having detailed documentation for more clarity. To avoid denials, ensure that every relevant detail regarding the patient’s health is carefully documented. This includes the patient’s symptoms and how they relate to prediabetes,
test findings, clinical evaluations, progress notes after each session, and any other patient information that contributes to the diagnosis of prediabetes.
Use the Correct Codes
Always ensure that you are using the right ICD-10 code. Along with R73.03 for prediabetes, make sure you’re using the right CPT codes for acupuncture services such as:
- 97810 for the initial acupuncture session.
- 97811 for a follow-up acupuncture session.
- 97813 for an initial session with electrical stimulation.
- 97814 for a follow-up session with electrical stimulation.
Double-check the coding standards and ensure the code accurately represents the patient’s conditions.
Stay Updated with Code Changes
Regularly review ICD-10 coding system updates. To keep informed about the changes, subscribe to code updates from authoritative sources, attend training sessions, and engage in professional development activities. These practices help you to reduce all the denial mistakes.
Submit Claims Correctly the First Time
To avoid unnecessary delays, double-check:
- Patient’s name, date of birth, and insurance ID.
- Diagnosis and procedure codes.
- Place of service codes.
- Provider information and NPI number.
Invest in Training and Education
It is very crucial to invest in ongoing training and education for medical coders and healthcare providers. This investment guarantees that your staff remains up to date on the newest coding standards and practices which reduces the probability of mistakes and denials.
Outsource Billing and Coding Services
As an acupuncturist, if you do not have enough time to deal with the complexities of billing and coding and you want to increase the revenue of your practice then the best option is to outsource your billing services to a professional acupuncture medical billing company. Here M&M Claims Care is the best choice to fulfill your needs. The years of experience of the company show their results. They provide specialized acupuncture billing services to boost your income and meet your expectations. M&M Claims Care provides a 99% first-pass claim rate to make your billing processes more efficient.
