Choose your words wisely: How ICD-10 choices can impact your bottom line

As insurance payers increasingly rely on automation and algorithm-driven claim reviews, emergency physician groups face growing financial risk. Instead of evaluating the full clinical picture, many payers now base reimbursement decisions almost entirely on ICD-10 diagnosis codes.

“We’re seeing a growing disconnect in how payers are valuing physician services,” says Dr. Andrea Brault, president and CEO of Brault Practice Solutions. “And a lot of that comes down to the words physicians are using in their diagnosis line. If the claims don’t pass automated review, even high-acuity visits are at risk of being down-coded.”

A Brief History of Diagnosis-Centric Reimbursement

“Historically, emergency physicians were taught to ‘think in ink’ — to document their clinical reasoning within the Medic