The medical billing system may be wonderful for insurance companies, but the huge volume and multiple combinations of billing codes make it a challenge for physicians and coders. Significant changes to the system like ICD-10 and then the yearly updates to CMS codes have made it even more difficult for practices across the country. However, certain medical specialties have faced, and continue to face, unique payment challenges. Here’s a look at five medical specialties that deal with some of the biggest coding challenges in the business. 

1. Nephrology 

Nephrology just can’t seem to catch a break when it comes to coding changes. When everything changed over to ICD-10, chronic kidney disorder alone went from a single code to five different codes. Even after ICD-10 implementation, things have continued to change with all the updates to CPT, ICD-10, and E&M coding. From new codes for diabetes to new codes for documenting hypertensive chronic kidney disease, the constant changes make it tough to stay on track of everything while still offering the best care for your nephrology patients. 

2. Radiology 

Another specialty that facing big coding challenges is radiology. Radiologists are required to provide significant details on a patient’s indications and medical history for medical billing and coding, including details like specific anatomical location and laterality. One big challenge for radiology clinics is that a lot of their ability to bill correctly for services ordered depends on adequate documentation provided by the ordering physician. To ensure steady cash flow, radiology practices must make sure they do very detailed and timely reviews of their denials or it’s easy to lose money. 

Continuing changes to radiology continue to make coding more complex. For 2019 alone, there were changes made to fine needle aspiration codes, a new code for reporting magnetic resonance elastography, and the deletion of the old codes for breast MRI with computer aided detection. 

3. Cardiology 

When ICD-10 was rolled out, it came with a lot of new cardiology-specific procedure codes, and it’s extremely easy for miscoding to happen in this field. While there were plenty of additions over the past couple of years for cardiology coding, for 2019 there weren’t as many revisions and additions to worry about. However, there were additional codes added for cerebral infarction and a new subcategory was added for hereditary cerebrovascular diseases. 

Cardiology practices face some specific coding challenges. Problems with documentation are a huge issue, and coding for some of the common cardiac procedures can be quite tricky. Any gaps in documentation can lead to the inability to code some components, resulting in lost revenue. Cardiology cases are often very complex as well, so it’s particularly important to code comorbidities to show the complexity of the case.  

4. Orthopedics 

Musculoskeletal and injury codes got a massive expansion with ICD-10, resulting in a significant number of new codes for orthopedic practices. With ICD-10, you’re required to make sure you note laterality, provide greater site specificity, and include place of occurrence codes when injuries occur. Simply diagnosing a patient with spinal stenosis isn’t enough – physicians now need to make sure they document the specific spinal region so it can be coded correctly. 

One of the toughest challenges for orthopedic practices has been getting providers up to speed on all the latest changes. With so many changes in documentation requirements and coding, it’s essential for orthopedic practices to invest in provider training to improve these areas. 

5. Pediatrics

The volume of codes for pediatrics has significantly increased over the past few years. Pediatric practices often deal with a high patient volume and keeping the practice profitable can often be difficult, especially when billing and coding errors occur.  Along with the huge changes that came about with the move to ICD-10, there were a lot of ICD-10-CM coding changes for 2019 as well. In fact, there were 25 brand new codes just for newborn complications for practices to learn. Along with the additional 25 codes, there were new and revised Z codes to learn for 2019 as well, with more coding choices available to describe pediatric behavioral disorder screenings, mental health, and types of developmental delays. 

With all of these specialties, the sheer volume of codes and the regular updates to codes make it challenging to prevent coding errors that cost your practice. Finding coders that have practice-specific training to deal with the unique complexities of your specialty often proves difficult. It’s not surprising that many specialists are now choosing to outsource their medical billing and coding to professionals who fully understand the complexities that come with coding for their specialty. 

Established companies like M-Scribe have teams of professional Coders that have in-depth education, CPC certifications and training on the latest coding changes, helping practices navigate changes to ensure they’re getting optimal reimbursements. To learn more about how we can help your practice improve coding accuracy to boost revenue, contact us today at 770-666-0470 for more information.

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