In Touch EMR and In Touch Biller Pro have built-in compliance mechanisms to minimize claim denials.
It is essential that every single ICD-10 code that is used by the clinician is mapped to the claim with a supporting diagnosis. The clinician is now specifying:
- Why a certain CPT code was billed (this can be documented in the flowsheet)
- Which ICD-10 code it is mapped to (this can be documented in the billing tab, by entering a supporting diagnosis)
If the clinician enters ‘1’ as a supporting diagnosis pointer for all the CPT codes, then the ICD-10 code mapped to ‘1’ (which is the 1st ICD-10 code) is the only one that will appear on the claim in In Touch Biller Pro.
Mapping the appropriate ICD-10 codes (by using supporting diagnosis correctly) is best practice for billers and coders, and helps clinicians remain compliant.
How to Use Supporting Diagnosis in In Touch EMR and Transmit Codes to In Touch Biller Pro
Scenario 1: PARTIAL MAPPING WITH SUPPORTING DIAGNOSIS
As a best practice measure, we recommend that you map all CPT codes to their corresponding ICD-10 codes in each claim that is submitted. A minimum of one supporting diagnosis pointer is required for every CPT code before the claim can be finalized in In Touch EMR.
In the example claim below, note that there are 5 ICD-10 codes with the respective supporting diagnoses 1, 2, 3, 4 and 5 generated from In Touch EMR. Your scenario will be different depending on your ICD-10, CPT and supporting diagnosis selections.
1) L02639
2) L97404
3) R262
4) R269
3) R260
In this example, let’s take a close look at the yellow zone.
You will notice that only 1, 2 and 3 have been mapped in the yellow zone. Since diagnosis pointers 4 and 5 have not been used in the yellow zone, they will not appear on the claim form in In Touch Biller Pro. This is explained in more detail in the next slide.
Note that there are 6 CPT codes highlighted in the red zone. (The last two codes represent non payable G codes.)
When the clinician makes the selections in the yellow zone below, the clinician is telling the system that:
CPT code 97150 is mapped to ICD-10 code R262 (since supporting diagnosis 3 was selected in this row)
CPT code 97001 is mapped to ICD code L02639 (since supporting diagnosis 1 was selected in this row)
CPT code 97035 is mapped to ICD code L97404 (since supporting diagnosis 2 was selected in this row)
CPT code 97110 is mapped to ICD code L97404 (since supporting diagnosis 2 was selected in this row)
CPT code 97140 is mapped to ICD code L02639 (since supporting diagnosis 3 was selected in this row)
CPT code 95851 is mapped to ICD code L02639 (since supporting diagnosis 3 was selected in this row)
In this example, all 5 ICD codes have not been mapped since supporting diagnoses 4 and 5 are not specified in the yellow zone. Therefore, this claim scenario is called ‘partial mapping with supporting diagnosis’
CLAIM TRANSMISSION TO IN TOUCH BILLER PRO WITH SCENARIO ONE (PARTIAL MAPPING)
When the claim is finalized in In Touch EMR, it is transmitted to In Touch Biller Pro, where the order of the 6 CPT codes remains unchanged, as seen in the red zone below.
Since supporting diagnoses 1, 2, 3 were selected, the first three ICD codes corresponding to these supporting diagnoses are transmitted to In Touch Biller Pro.
On the other hand, supporting diagnoses 4 and 5 were not selected in In Touch EMR (as shown in the previous slide). Therefore, the ICD codes corresponding to 4 and 5 are not carried over and do not appear in the diagnosis section (as highlighted with the arrow below).
Also, the order of ICD codes is the same, and remains unchanged.
1) L02639
2) L97404
3) R262
The diagnosis pointers in the yellow column below exactly match with the corresponding CPT code as intended by the clinician, when the claim was finalized in In Touch EMR. This reduces claim denials, and is best practice for billing and coding.
With the claim below, the biller is telling the payer that:
CPT code 97150 is mapped to ICD code R262
CPT code 97001 is mapped to ICD code L02639
CPT code 97035 is mapped to ICD code L97404
CPT code 97110 is mapped to ICD code L97404
CPT code 97140 is mapped to ICD code L02639
CPT code 95851 is mapped to ICD code L02639
This is the exact same claim that was generated in In Touch EMR, and the biller can now proceed to review the claim and submit it for payment.
Scenario 2 - COMPLETE MAPPING WITH SUPPORTING DIAGNOSIS
In the example claim below, note that there are 4 ICD codes with the respective supporting diagnoses 1, 2, 3 and 4 generated from In Touch EMR. Your scenario will be different depending on your ICD, CPT and supporting diagnosis selections.
1) L02639
2) L97404
3) R262
4) R269
If you take a close look at the yellow zone, you will notice that all 4 supporting diagnoses pointers have been mapped in the yellow zone (unlike the previous scenario).
Note that there are 6 CPT codes highlighted in the red zone.
When the clinician makes the selections in the yellow zone below, the clinician is telling the payer that:
CPT code 95832 is mapped to ICD code L02639 (since supporting diagnosis 1 was selected in this row)
CPT code 97035 is mapped to ICD codes R269 and L02639 (since supporting diagnoses 4 and 1 were selected in this row)
CPT code 97018 is mapped to ICD code R262 (since supporting diagnosis 3 was selected in this row)
CPT code 97150 is mapped to ICD codes L97404 and L02639 (since supporting diagnoses 2 and 1 were selected in this row)
CPT code 97002 is mapped to ICD codes L02639 (since supporting diagnosis 1 was selected in this row)
CPT code 97110 is mapped to ICD codes L02639 and L97404 (since supporting diagnosis 1 and 2 were selected in this row)
In this example below, all 4 ICD codes have been mapped since supporting diagnoses 1, 2, 3 and 4 have all been used in the yellow zone. Therefore this claim scenario is called ‘complete mapping with supporting diagnosis’
CLAIM TRANSMISSION TO IN TOUCH BILLER PRO WITH SCENARIO TWO (COMPLETE MAPPING)
When the claim is finalized in In Touch EMR, it is transmitted to In Touch Biller Pro, where the order of the 6 CPT codes remains unchanged, as seen in the red zone below.
The order of the ICD codes also remains unchanged
1) L02639
2) L97404
3) R262
4) R269
If you look at the ‘supporting diagnosis’ in the yellow column below, you’ll notice that all the pointers exactly match the corresponding CPT codes. This reduces claim denials, and is best practice for billing and coding.
With this claim, the biller is telling the payer that:
CPT code 95832 is mapped to ICD code L02639
CPT code 97035 is mapped to ICD codes R269 and L02639
CPT code 97018 is mapped to ICD code R262
CPT code 97150 is mapped to ICD codes L97404 and L02639
CPT code 97002 is mapped to ICD codes L02639
CPT code 97110 is mapped to ICD codes L02639 and L97404
This is the exact same claim that was generated in In Touch EMR, and the biller can now proceed to review the claim and submit it for payment.