Code Warriors

Electronic health records, claim-scrubbing software and computer-assisted coding help facilities net optimal reimbursement and gird for the switch to ICD-10.

Medical coding has become the backbone of optimizing medical repayment costs. And now, with all eyes fixed on Oct. 1, 2013—the amended compliance deadline for the switch from ICD-9-CM (Clinical Modification) to ICD-10-CM or ICD-10-PCS (Procedure Coding System) codes—facilities are assessing and upgrading health IT systems to help ease the transition and prevent reimbursement errors.
 

A software prescription for coding headaches

Medical coding and reimbursement errors plague every healthcare system that accepts Medicare payments. These errors often stem from deficiencies in documentation due to manual code input, which can be the Achilles’ heel of coding and billing.  

“The cardinal rule of coding is that if it’s not documented, it doesn’t exist. The cornerstone of coding is documentation,” says Marcia Diamond, CPC, program director and instructor of coding and health IT at the Central Florida College in Orlando.

Electronic health record (EHR) systems, claim-scrubbing software and computer-assisted coding have begun to replace the archaic process of manual coding. These systems also help facilities reduce medical errors, enhance workflow productivity and ensure optimal reimbursement. These tools enable coders to ensure that codes accurately reflect the services rendered for a patient’s care, says Rita Scichilone, MHSA, RHIA, CCS, CCS-P, CHC-F and director of professional practice resources for the American Health Information Management Association (AHIMA).

“The coding process plays a key role in uses of health IT,” says Scichilone. Health IT can help to facilitate the reimbursement of care by insurance providers and gauge hospitals’ quality of care in health reporting. For instance, EHRs capture data in an electronic format and assist coders in correctly processing patient data through automated coding. “Electronic record software products hold a lot of promise for additional automation,” she says. Systems used for data capture for code assignment provide decision support tools and create new ways to collect data, which in turn can lead to effective reporting systems.  

On the other hand, electronic medical records (EMRs) can hinder coding and billing, Diamond says, if they just enable users to do the wrong things faster.    

“As much as we hear about EMRs and how good they are, every one of them is different. Just because a facility has an EMR doesn’t mean their documentation is really going to be any better,” says Diamond, who reviews facilities’ patient records for documentation and coding compliance purposes.

This is because the very function that makes EMRs valuable to physicians—their ability to provide immediate delivery of patient documentation—might not be used properly for coding and billing, Diamond says.  

EMRs also lack the ability to electronically create proper documentation and evaluation, says Diamond. Facilities may rely on their electronic coding system to code and evaluate documentation for them and assume that it’s being done correctly. In this scenario, “essentially, the coder is just accepting the code. We often find that there is a significant error rate in this process,” she says.

Although Diamond cites the dangers of using an EMR for coding and billing, other practitioners find them to be a valuable tool to achieve effective coding and billing.  

Scichilone says emerging computer-assisted coding tools and encoder tools can help “improve code assignment productivity, consistency and quality of results.”
 

Computer-assisted code

For the Eastern Maine Health System (EMHS), in Brewer, and its seven hospital affiliates, use of computer-assisted coding and its combined EMR and coding system has increased productivity levels by 30 percent at its largest center, the 411-bed Eastern Maine Medical Center (EMMC). EMMC rolled out the 3M Codefinder computer-assisted coding system in August 2009. Forty-five days after implementation the facility saw impressive results—a 15 percent increase in productivity, says Mandy Reid, RHIA, coding manager at EMMC. The solution provided the center with increased coding accuracy, helped to optimize revenue and significantly reduced the time spent coding, says Ried.

The health system’s core 3M EMR system interfaces with Codefinder to expedite coding. Codefinder’s auto-abstracting and cross-referencing component assists coders in the annotation process by identifying keywords and phrases related to diagnosis and procedural codes. The system also maps coding terminology to help reduce errors while interfacing data and scanning transcribed documents from various departments, including the ER and radiology, to streamline workflow, says Reid.

The customized Codefinder software developed for the facility’s inpatient side “ensures that a document is compliant and accurate electronically so the coder can make the last few decisions to impart the appropriate code,” she says.

When 3M conducted an evaluation of EMMC’s output after implementing the system, users saw improvements ranging from 4 percent to 45 percent in productivity, according to Reid. The system also has saved the facility $150,000 per year by completely eliminating its need for contracted medical coders, she says.

Although computer-assisted coding software has not yet been widely adopted, says Scichilone, the technology is gaining popularity because it enables facilities to use structured data input or natural-language processing (NLP) to suggest coded values for human validation.  

Encoder software can be added to existing coding software to help a facility’s billing department optimize the repayment process. Encoder systems scan codes and relay information back to the facility to determine whether specific codes are acceptable and will receive the highest returns possible.

“In-coding software scans ensure that facilities capture the services that they otherwise would have missed manually,” says Diamond.

In addition, claim scrubber software such as AllegianceMD’s Alpha II—which is usually integrated into an existing system but also can be used as a stand-alone product—helps eliminate coding errors by electronically documenting mismatched information or documentation incongruity in reports.  
 

ICD-9 to ICD-10: An IT transplant

The current ICD-9 CM codes don’t account for 30 years of medical advancements and lack the ability to expand. The new ICD-10 CM and ICD-10 PCS codes feature alphanumeric digits rather than the current numeric five-digit codes, and the shift to ICD-10 CM and ICD-10 PCS will “meet the demands of today’s healthcare needs,” says Scichilone.

However, it could be a bumpy transition. The formatting changes required by the new codes will affect data capture and storage, says Scichilone. Some vendors, such as 3M, are building ICD-10 into their software solutions, but other tools such as those available on the AHIMA website (ahima.org) can help facilities find the right software solution to smoothly transition to the new codes.

Although the compliance date seems far away, facilities have been advised to begin gearing up for the switch from the 14,025 codes used in ICD-9 CM to the 68,000-plus diagnostic codes included in ICD-10 CM. “All systems that use a coded value expressed in ICD should be evaluated to assess the impact of changes in the code or trending due to transitioning to the new system,” says Scichilone.

This transition will require facilities to make technical changes to stay compliant with HIPAA transactions and code sets, including updating to the HIPAA x12 5010 version of the claims standard by the Jan. 1, 2012 deadline set by HIPAA. This switch will enable a system to accept the ICD-10 CM or ICD-10 PCS code sets and the data interchange for claims processing.

Currently, AHIMA and AAPC (aapc.com)offer cross-coder tools on their websites so facilities can get an early idea of what the ICD-10 codes will look like. According to Diamond, facilities can type in ICD-9 codes that are then translated to ICD-10 codes.

“Facilities should not fear the additional code sets,” say Scichilone They will actually make it much easier to correctly classify conditions or procedures to an optimal code which more accurately reflects a patient’s condition.”