Best Practices in Clinical CodingPanel: Capt. Clarence Thomas, Jr. BUMED, Ms. Michele Gowen, RHIA, CCS, and Ms.

Erica Kreyenbuhl, CPC PAD Symposium

20 July 2006

1300 - 1500

Agenda

What is Coding and Why is Coding Important?

Types of Coding What are Relative Value Units (RVUs)? CCE Outpatient Process Coding Issues Best Clinical Coding Practices Questions and Answers Conclusion

What is Coding and Why is Coding Important?

Medical coding is classifying data and assigning a representation for that data.

Permits retrieval of information for users. Identifies why patients are being seen.

(ICD-9-CM) Identifies and quantifies the services you have

provided. (CPT and HCPCS) Accurate workload representations. Reimbursement

Types of Coding

ICD-9-CM Diagnoses classify morbidity and mortality Used for statistical purposes, indexing of hospital

records and data storage and retrieval Procedures used only for inpatients DRG IBWA Updated annually 1 October

Types of Coding

HCPCS (Healthcare Common Procedure Coding System) Level I – CPT

Intended to be used for reimbursement Procedure and E&M codes

Level II – HCPCS Non-physician services Supplies Pharmaceuticals and Injectables

Updated annually 1 January

What are Relative Value Units (RVUs)?

What are RVUs used for? Business Planning Budget Development (PPS) Productivity Reporting/Analysis A way to compare resources used to produce a service

“Work”

“Practice Expense”

“Malpractice Expense”

RVU Example

CPT 11100 – Skin biopsy

Work RVUs 0.81 0.81

Practice Expense RVUs 1.25 0.37

Malpractice Expense RVUs 0.03 0.03

Total RVUs 2.09 1.21

Non-Facility Facility

CCE OUTPATIENT PROCESS

AHLTA

1. Provider enters the documentation into AHLTA and selects codes.

CCE OUTPATIENT PROCESS

AHLTA CHCS

1. Provider enters the documentation into AHLTA and selects codes.

2. Data from AHLTA transfers into CHCS.

CCE OUTPATIENT PROCESS

AHLTA CHCS CCE

1. Provider enters the documentation into AHLTA and selects codes.

2. Data from AHLTA transfers into CHCS.

3. SADR goes to M2 and CCE. Designated personnel run CCE worklists.

SADRM2

Worklist

CCE OUTPATIENT PROCESS

AHLTA CHCS CCE

1. Provider enters the documentation into AHLTA and selects codes.

2. Data from AHLTA transfers into CHCS.

3. SADR goes to M2 and CCE. Designated personnel run CCE worklists.

4. The coder reviews the documentation, verifies the codes assigned and makes any necessary changes to the codes in CCE. (Verifying is NOT auditing)

SADR

Coder

M2

Worklist

CCE OUTPATIENT PROCESS

AHLTA CHCS CCE

1. Provider enters the documentation into AHLTA and selects codes.

2. Data from AHLTA transfers into CHCS.

3. SADR goes to M2 and CCE. Designated personnel run CCE worklists.

4. The coder reviews the documentation, verifies the codes assigned and makes any necessary changes to the codes in CCE.

5. Updated data is sent back to CHCS. (SADR goes to M2 and TPOCS)

SADR

Coder

M2

Worklist

TPOCS

CCE OUTPATIENT PROCESS

AHLTA CHCS CCE

ADDITIONAL NOTES:

1. Determine what reports you need from CCE based on how you have assigned your coders workload.

2. Changes made to codes in CCE do not transfer to AHLTA.

3. CHCS is the official record for coding; AHLTA is the official record of documentation.

SADR

Coder

M2

Worklist

TPOCS

Coding Issues

IDCs DoD Extender Codes MHS Coding Guidelines Superbills Code Table Updates T-Cons Surgical follow-up visits within global period

Best Coding Practices

Assessment ( See Assessment Tool) MTF Profile Productivity Profile Auditing Training

Best Coding Practices

MTF Profile Departments Providers

Number Type

Encounters v Services (primary care adult v primary care pediatrics) Number Type RVU values Complexity of coding

Best Coding Practices

Productivity Profile Coders

Certifications Experience

Quantifying Your Encounters or Services Number Coded Number Queried Number Non-coded Other Non-coding Activities

Systems Manual v Electronic Time Studies

Determine how long each step takes Helps identify obstacles to production goals

Best Coding Practices

Auditing Internal External Resolution of disagreements

Local Coding Hotline

Best Coding Practices

Training Content

Audit Results Feedback from Coders (data regarding any changes

made to codes in CCE) Methods

Computer Based Training Specialty-specific instructor-led group One-on-One with each individual provider

Q&A

Questions for the panel

CONCLUSION

Thank you