Coding for Radiology Practice Managers

Brigette LaBar

October 12, 2009

Disclosure:Nothing to disclose

I’m not a coder, but I play one on T.V.!

Session Learning Objectives

• The value of a well-managed coding program

• What to track

• Tools

So… You’re not a “coder”

ICD-9

The International Statistical Classification of Diseases and Related Health Problems provides codes to classify diseases signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. Every health condition can be assigned to a unique category and given a code, up to six characters long.

More Definitions

HCPCs

The Healthcare Common Procedure Coding System (HCPCS) is a set of health care procedure codes based on the American Medical Association's Current Procedural Terminology (CPT). There are three levels of HCPCs

Types of CPT Codes

Level I: CPT-4 codes

Level II: DME, Ambulance, Drugs

Level III: Local & temporary codes

Bonus Staff for Certification!

• Types of CertificationCPC – AAPCCCS – AHIMARCC – RBMAInternal/ProprietaryComputer-assisted coding tools

Certification

Benefits of a well-managed coding program

• Maximize reimbursement

• Reduce compliance risk

• Ensure charge capture

• Identify and manage costs

• Minimize write-offs

“How is it a write-off?”

“They just write it off.”

“Write it off what?”

“Jerry, all these big companies …they write off

everything.”

“You don’t even know

what a write-off is.”

“Do you?”

“No, I don’t.”

“But they do, and

they’re the ones writing

it off.”

“It’s a write-off for them.”

What to Track

• Throughput & Output

• Accuracy based on internal audit

• TAT

• Denials

Computer Assisted Coding

• 70% acceptance of CAC

• Decisions supported by valid data

• Efficient workflow

• Identify & correct errors sooner

• Facilitates audit process

• Replace payer specific “cheat sheets” with embedded rules

Output

• Track by coder, identify outliers

• Create internal standards

• Evaluate learning curve of new staff

• Encourage team to excel

Throughput

• External benchmark comparisons – will vary by:Procedure mixUtilization of technology – CACQuality of electronic report

Throughput

• Should be one of your KPIs

• Analyze trendsHour of dayDay of weekIdentify faulty facility interfaceNew rad, new coder

• Post group results in common area

Accuracy

• QA audit process

• FrequencyInternal: Quarterly, rotate coders

audited monthlyAnnual external audit

• Sample size

Audit Program

• Use results to do a focused audit of areas of concern

• Share the trended results with partners to demonstrate the ROI of your coding program

• Share results to educate and improve quality of dictation

Uncodable “Reasons”

• MVA• Check for Dates• R/O Pneumonia• Pre-Op• Smoker• Follow-up• Cancer• Screen• Suspect XX or Rule out XX or Evaluate for XX• Per Your Report

Non-Specific Finding Guideline to Improve

Specific Clinical Indications

MVADocument the clinical indication in addition to

MVA

Where does it hurt? List all OR What part(s) of body rcvd trauma? Date of accident

Check for DatesSpecify the reason a size-date discrepancy is

suspected Large for date OR Small for date Complications of pregnancy - specify

R/O Pneumonia Specify the reason pneumonia is suspected SOB, difficulty breathing, Cough, Fever Abnormal test results

Pre-Op Specify the operation to be performed Fever, Back Pain Abnormal test results

Smoker Document the clinical indication SOB, difficulty breathing, Cough Abnormal test results

Follow-up Specify what is suspected and why Where does it hurt? Swelling, Abnormal weight loss Abnormal test results

Cancer List specific primary/secondary site Where does it hurt? Swelling, Abnormal weight loss Abnormal test results

DEXA Screen Once every 365 days Is patient post-menopausal?

Suspect XX or Rule out XX or Evaluate for XX

Document the reason XX is suspected Where does it hurt? Swelling, Abnormal weight loss Abnormal test results

History of XX Do NOT use if condition still exists Be specific about the disease Document clinical indications that disease has returned

Compliance

• What’s the “magic” number?

• Reporting coding errors to payers

• RACs

• Creating Coding Guidelines

• LCDs, NCDs, Payer-specific rules

• ACR documentation requirements

Turn-Around Time

• Time from receipt of report to code• Track by physician – sending reports back costs $• Most common reasons reports are sent back or

downcoded: Lack of reason for exam Undocumented views, contrast Ltd vs. complete

2009 Denial Rates by Payer

* Source: athenahealth

Coventry Healthcare 9.3%

Medicare-B 8.7%

Champus/Tricare 7.7%

Wellpoint 7.3%

United Health Group 7.2%

Cigna 5.9%

Aetna 5.6%

Common Coding Denials

• Not medically necessary• Missed 5th digit• Age inappropriate – The “Golden Rule”• Modifier errors• Payer non-compliance with CCI• Payer insists on medical documentation –

coding isn’t “enough”

Interfaces

• Risks associated with accepting codes

• Load errorsCPT extracted from the title15% error rate8% discrepancy rate

• Compare performed procedure to coded procedure

Education•Support continuing education for coders•A/R follow-up staff•Clinical staff•Yourself!•Keep resources current:

CPT and ICD booksNCD/LCD informationCoding & Dictation guidelines

ICD-10

•When is it coming? Oct. 1, 2012

•What will change? 155K+ codes alpha-numeric codes

Questions?