How to Make Medical Coding a Day at the Beach

Coding’s a Beach, Enjoy the Waves!

Accuracy, precision, attention to detail, consistent documentation and coordination, communication, knowledgeable, educated.  These are all pieces of a strong coding process.  Revenue Cycle Management processes are only as good as the code assignment used to begin the claim process.  How can a provider be certain that their code assignment is a day at the beach?

Accuracy

Much like a beach requires sand and water, the necessities of a good coding process are ensuring proper code assignment for procedure and diagnosis codes. Using the correct codes to document the services provided is critical to a successful process.  Coding goes beyond checking a box on a super bill, but in its truest state is the assignment of defined codes to depict the procedures, services, and reasons for patient treatment.  There are more than 10,000 CPT codes and over 70,000 ICD-10 diagnosis codes, not to mention lists of HCPCS codes, modifiers, and Quality Payment Procedure codes.  In fact, there may be more code options than grains of sand on your favorite beach.  It is imperative that the accurate codes be selected to detail the patient care.

TIP: CPTs should always be coded from the documentation of the service provided.  ICD10 should be used to code the findings of the service.   If the findings are negative, then signs and symptoms should be used.

Radiology Medical Necessity

In the age of AUC (Appropriate Use Criteria) and CDS (Clinical Decision Support) providers are held to standards to ensure the services ordered are necessary for the patient’s care.  Although it is the ordering physician’s responsibility to identify the patient’s medical necessity for diagnostic imaging to be performed, it is the interpreting physician who is penalized for lack thereof.

Carefully review the orders to determine what codes will capture the story of the patient and the medical need being evaluated.  Ensure the proper rules are being followed for laterality & contrast, watch for phrases such as rule out, possible or probable as these can be red flags for medical necessity.  The tide and currents of medical necessity can pull the strong coder under if they are ill-prepared.

TIP: Review the orders for the reason for exam/signs or symptoms.  This should be narrative text, the ICD-10 code cannot be substituted.

Pathology Nuances

Pathology is an extremely intricate specialty.  Coding processes for pathology must likewise be detail-oriented.  A coder must carefully review every detail of the pathology report to assign the proper codes.  Special care must be given to the specimen source, techniques, stains, and more for each specimen.  Proper modifier application can be key to telling the payer a separate structure was examined to support the multiple units per case often reviewed.

Exercise caution as there are many ways for pathology nuances to ruin your day at the beach.  Use specific, detailed statements to dictate the specimen and processes utilized from gross to microscopic analysis.  Doing so will help the coding team avoid the shark lurking in the waters and keep your pathology coding in a safe swim zone.

TIP: Ensure that all addenda issued are coded and routed completely through the billing process.  These are critical pieces of a patient’s care that need to be captured appropriately.

Education & Training

Coding is a highly specific process that requires a great deal of knowledge.  As we just explored, pathology and radiology coding can be even more detailed than other specialties.  To ensure your processes are up to par, quality training and education for your coding team is a necessity.  There can be no vacation from learning.  Sunscreen is an important part of any outdoor activity, especially a day on the beach, and reapplication is always necessary.  Much the same, ongoing training and CEUs are required for certified coders to maintain their credentials and keep out of harm’s way.

As critical as education is for the coding team, it is also vital for the radiology and pathology teams.  Understanding the rules and changes to the coding regulations is a must in our ever-changing industry. Set up routine, ongoing meetings and opportunities for coding, radiology and laboratory staff, and providers to share knowledge and improve outcomes for your documentation.

TIP: Verify coding credentials with reputable sources such as AAPC, AHIMA, RCC, etc.

Review/Audit

There are many opportunities for a stray thundercloud to ruin a day at the coding beach.  Make sure to keep a keen eye open for issues as they may start to arise.  Routine review of code application, CMS regulations and industry guidance is key to maintaining compliance with a strong coding process.

Establish processes to regularly review and audit the coding for your practice.  This will allow you to lift your sunglasses and get a good look at the activity happening daily.  A review process should cover all aspects of coding including CPTs, ICD10, HCPCS, modifiers and even denials.

TIP: Internal audits are great.  Consider an external audit periodically to see what you may be missing.

Take the time to ensure that your coding process is prepared for anything that may come up.  Coding doesn’t have to be a dreaded task. With proper attention, you can avoid a sunburn of the third degree, ICD-10 L55.2, and enjoy your day at the beach. With proper protection from the sun and common coding errors, a provider can truly relax and enjoy a day at the beach knowing coding has been well prepared for and reviewed thoroughly.