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PAD Symposium 20 July 2006 1300 - 1500

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 2006 1300 - 1500. Agenda. What is Coding and Why is Coding Important? Types of Coding What are Relative Value Units (RVUs)?

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PAD Symposium 20 July 2006 1300 - 1500

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  1. 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

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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”

  7. RVU Example CPT 11100 – Skin biopsy Non-Facility Facility

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

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

  10. CCE OUTPATIENT PROCESS AHLTA CHCS CCE Worklist SADR M2 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.

  11. CCE OUTPATIENT PROCESS AHLTA CHCS CCE Worklist Coder SADR M2 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)

  12. CCE OUTPATIENT PROCESS AHLTA CHCS CCE Worklist Coder SADR M2 TPOCS 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)

  13. CCE OUTPATIENT PROCESS AHLTA CHCS CCE Worklist Coder SADR M2 TPOCS • ADDITIONAL NOTES: • Determine what reports you need from CCE based on how you have assigned your coders workload. • Changes made to codes in CCE do not transfer to AHLTA. • CHCS is the official record for coding; AHLTA is the official record of documentation.

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

  15. Best Coding Practices • Assessment ( See Assessment Tool) • MTF Profile • Productivity Profile • Auditing • Training

  16. 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

  17. 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

  18. Best Coding Practices • Auditing • Internal • External • Resolution of disagreements • Local • Coding Hotline

  19. 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

  20. Q&A • Questions for the panel

  21. CONCLUSION • Thank you

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