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S E P T E M B E R 2 0 1 5 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
• time parameters
• complications
• laterality
• any contributing factors
Make capturing info easy
Consider creating a template or checklist to help your doctors
record the information above. You can add an "indications paragraph"
in the operative notes section, where the surgeon can list all of the
essential information about the procedure. Note that many EMR ven-
dors allow you to customize your chart templates. This simple addi-
tion to your records can help you avoid major coding confusion.
Be clear about ICD-10-PCS
Ambulatory surgery centers likely will not have to worry about
the procedure portion of ICD-10 (known as ICD-10-PCS) since most, if
not all, centers use CPT codes to bill for procedures performed.
However, double check that your payers' contracts do not require
PCS codes and confirm this with each one before Oct. 1.
Think outside of your box
You know how ICD-10 is changing your facility, but what about
your business partners? Do you know where they stand? Check in
with anyone you work with outside of your facility to ensure they're
ready for ICD-10. This includes groups like payers, third party billing
companies and software vendors.
Give your forms a facelift
The codes are changing, so your documents will have to, too. ICD-
10 requires more specificity, so check that documents like ABNs, history
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