Best Practices in Clinical Coding Panel: Capt. Clarence Thomas, Jr. BUMED, Ms. Michele Gowen, RHIA, CCS, and Ms. Erica Kreyenbuhl, CPC PAD Symposium 20 July

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 – Skin biopsy Work RVUs0.81 Practice Expense RVUs Malpractice Expense RVUs0.03 Total RVUs Non-Facility Facility

CCE OUTPATIENT PROCESS AHLTA 1. Provider enters the documentation into AHLTA and selects codes.

CCE OUTPATIENT PROCESS AHLTACHCS 1. Provider enters the documentation into AHLTA and selects codes. 2. Data from AHLTA transfers into CHCS.

CCE OUTPATIENT PROCESS AHLTACHCSCCE 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. SADR M2 Worklist

CCE OUTPATIENT PROCESS AHLTACHCSCCE 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 AHLTACHCSCCE 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 AHLTACHCSCCE 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