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To prepare for ICD-10, agencies must take their auditing to next level right away

Agencies should audit 100% of their claims for coding accuracy in order to identify and resolve issues in processes so that they will get paid properly and avoid billing delays related to ICD-10.

During an audit, agencies should examine the codes that have been assigned.

Look, for instance, for anomalies such as missing seventh characters, a nine in the fourth or fifth position, and manifestation codes assigned without their etiology as examples, says Trish Twombly, senior director for DecisionHealth in Gaithersburg, Md.

Prior to ICD-10, an average agency might audit about 10% of its claims for coding accuracy, Twombly notes. And many agencies are behind a few quarters in the claims that they do audit, adds Brandi Whitemyer, AHIMA-approved ICD-10 trainer and product specialist for DecisionHealth.

But a complete audit of current claims would be the best way to identify gaps in coding, billing and documentation, Whitemyer contends.

Also, make sure your coders are not relying on general equivalency mappings (GEMs) to assign codes. Many software programs have features built on the GEMs, which weren’t meant to code individual claims and could lead coders to a code that will at best be incorrect or at worst put claims at risk for additional documentation requests.

GEMs were created to map codes — not to provide help in coding medical records.

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