Culturally Competent Coding Managing and Measuring Data Capture Cross Cultural Health Care Conference February 11-12, 2010 Jeri Leong, R.N., CPC, CPC-H, CPMA Healthcare Coding Consultants of Hawaii, LLC

Objectives Explain the coding process – how data is captured for reporting purposes Identify culturally sensitive issues that affect the accuracy of information collected Provide examples of non-traditional support services Describe barriers that affect recognition of codes Discuss potential solutions that may enact change

The Coding Process Current Procedural Terminology – ‘CPT’® International Classification of Diseases, 9 th Edition, Clinical Modification – ‘ICD-9-CM’ Health Care Procedural Coding System Level II – ‘HCPCS’ Code sets assist in reporting clinical data, processing third party claims, and data capture for research and statistical purposes

Barriers Current coding systems do not effectively address alternative or complimentary medicine circumstances Culturally sensitive issues such as language interpretive services are not seen as a priority for third party reimbursement Enabling services which are critical to delivery of health care are not well represented in conventional code sets

Examples Advance Directive Preparation – S0257 Counseling and discussion regarding AD’s and EOL care planning Language and Communication Needs – T1013 Sign language or oral interpretive services, per 15 minutes Transportation – T2001 Non-emergency transportation; patient attendant/escort

Examples Outreach and Case Management – T1017 Targeted case management, each 15 min Medical Home, Care Coordination – S0280, S0281 Medical Home program, comprehensive care coordination & planning (initial and maintenance) Telehealth – Q3014 originating site; use CPT® codes for destination

Barriers to Change Diversity within a culture can affect the provision and utilization of care – Changing demographics of population groups – Cultural values, assumptions and beliefs affect patient care and third party reimbursement Existing reimbursement methodologies do not recognize complementary medicine Conventional and alternative updates must be based on data to effect change

Solutions Expand the list of codes to accurately capture non-conventional services Educate healthcare professionals on ways to map specialized services to potential reimbursement sources or quality measure reporting Work with health plans and government entities to expand coverage

Questions and Discussion Mahalo! Jeri Leong, R.N., CPC, CPC-H, CPMA Healthcare Coding Consultants of Hawaii, LLC Visit us on the web: