a quick overview...example: a chest x-ray reveals a primary lung cancer in the left lower lobe. the...
TRANSCRIPT
A Quick Overview
© RadPayor 2010
What is Computer Assisted Coding
History of Computer Assisted Coding
Computer Assisted Coding today
How does it work?
Computer Assisted Coding tomorrow
Embracing the change
© RadPayor 2010
The newest computer assisted coding programs operate entirely different than those developed even 1 or 2 years earlier
The CAC coder acts primarily as a final reviewer and administrator of the document prior to electronic filing
© RadPayor 2010
General coders
Specialty coders
Billers
Managers of coding and billing departments
Owners and managers of billing companies
© RadPayor 2010
CAC systems emerged in the late 1990’s along with the growth of Information Technology ◦ Systems required installation and maintenance of
cumbersome computer hardware
◦ IT staff required for system maintenance
◦ High Cost of Systems limited adoption to only largest institutions
Data security concerns
© RadPayor 2010
Few medical specialties using electronic systems
Why Radiology? ◦ Radiology was one of the first medical specialties to
embrace electronic communications
◦ Diagnostic Radiology maintained common language
◦ Diagnostic reports contained similar formats
© RadPayor 2010
Legal precedence ◦ CAC is NOT new ◦ Medicare interpretations have supported Computer
Assisted Coding cases
Functioning as a CAC Coder ◦ Work better, not harder
Embracing the new CAC Systems ◦ Increasing value to your organization ◦ Protection from outsourcing/off-shoring ◦ Preparation for ICD-10 ◦ Stress reduction
© RadPayor 2010
© RadPayor 2010
In the event the individual responsible for reporting the codes for the testing facility of the physician’s office does not have the report of the physician interpretation at the time of billing, that individual should code what they know at the time of billing.
Sometimes reports of the physician’s interpretation of diagnostic tests may not be available until
several days later, which could result in delay of
billing, in such instances, the individual responsible
for reporting the codes for the testing facility or
the physician’s office should code based on the
information/reports available to them or what they know at the time of
billing
© RadPayor 2010
10.1.5 – Diagnostic Tests Ordered in the Absence of Signs and/or Symptoms (Rev. 1, 10-01-03). ◦ When a diagnostic test is ordered in the absence of
signs/symptoms or other evidence of illness or injury, the testing facility or the physician interpreting the diagnostic test should report the screening code as the primary diagnosis code. Any condition discovered during the screening should be reported as a secondary diagnosis.
Example: A chest x-ray reveals a primary lung cancer in the left lower lobe. The interpreting physician should report the
ICD-9-CM code as 162.5 for malignancy of “other parts of the bronchus or lung” (162.8)
or the code for “bronchus and lung unspecified”(162.9).
© RadPayor 2010
10.1.6 – Use of ICD-9-CM to the Greatest Degree of Accuracy and Completeness (Rev.1, 10-01-03). ◦ The following longstanding coding guidelines are part of the “Official ICD-
9-CM Guidelines for Coding and Reporting”. The testing facility or the interpreting physician should code the ICD-9-CM code that provides the highest degree of accuracy and completeness for the diagnosis resulting from the test, or for the sign(s)/symptom(s) that prompted the ordering of the test. The “highest degree of specificity means assigning the most precise ICD-9-CM code that most fully explains the narrative description of the medical chart of the symptom or diagnosis.
Example: If a sputum specimen is sent to a pathologist and the pathologist confirms growth of “streptococcus, type B” which is indicated in the patient’s medical record, the pathologist should report a primary diagnosis as 482.32 (Pneumonia due to streptococcus, Group B). However, if the pathologist is unable to specify the organism, then the pathologist should report the primary diagnosis as 486 (Pneumonia, organism unspecified).
Each CAC system has its own proprietary processing system, which allows the computer to “read” the physician’s report.
In general, the system looks for specific words and phrases in specific parts of a report.
Most modern systems use a form “Natural Language Processing (NLP)” technology to account for differences in speech. ◦ Physicians do NOT have to use a specific structured
language. ◦ For Example: “Evidence of cancer” is read differently than
“No Evidence of cancer.”
© RadPayor 2010
Artificial Intelligence is the ability of the system to “learn” from previous experiences
Systems can be taught how to read specific phrases or look for combinations that may not be eligible for payment
© RadPayor 2010
Minimal up-front costs for hardware or maintenance
Coding up to 8x faster with improved skill and accuracy
Auto coding of standard modifiers
Auto checks for LCD, NCD, CCI, PQRI, and RAC compliancy
© RadPayor 2010
Immediate archive deposit, search, and retrieval.
No scanning, faxing, copying, OCR, shredding, sorting, etc.
Cost reduction.
EHR Connections.
© RadPayor 2010
© RadPayor 2010
Information Flow
Data retrieved from hospital, outpatient facility or physician office
◦ Paper ◦ PDF ◦ XML ◦ .txt ◦ .doc ◦ .csv ◦ ASCII ◦ HL7
© RadPayor 2010
Auto Data Collection
© RadPayor 2010
Incoming Data
RAC LCD NCD PQRI
CCI Edits Custom
Coding of Modifiers
(26, 52, 59, 76, 77, etc.)
Computer Coding
© RadPayor 2010
Computer check of Demo
Computer Codes Report
(ICD-9, CPT, quick code,
etc.)
Computer Recheck
Human Coder (CPC)
Reviews
To Billing Software
© RadPayor 2010
© RadPayor 2010
© RadPayor 2010
Down Code = BAD ◦ Lost revenue
Up Coding = BAD ◦ Fraud
© RadPayor 2010
Coder
Reviewer
Manager
Assist
PACS
Assist/RPA/Doctor
© RadPayor 2010
Auditor
TestAuditor
Consultant
Clerk
Keyer
Outsource
Support
© RadPayor 2010
Anonymous Users. ◦ Users who cannot see any PHI, yet can fully use the
system.
◦ Examples include: Coders, Reviewers, Auditors, TestAuditors, Outsources, or Consults.
Specialty Coders.
© RadPayor 2010
Who are Specialty Coders ◦ Coders with advanced knowledge in a specific
specialty
◦ Coders who possess exceptional skills and experience coding specific procedures
Why do Specialty Coders Exist ◦ Incredible Accuracy
◦ Incredible Performance
© RadPayor 2010
GenCoder – General coder, non-specialized ◦ Coder – Codes any Radiology studies
Specialist – codes only select procedure class
Diagnostic – codes only diagnostic studies
PlainFilms – codes only plain films
PlainFilmsUE – codes only upper extremities
PlainFilmsShoulder – codes only shoulders
PlainFilmsHumerous – codes only humorous
PlainFilmsElbow – codes only elbows
PlainFilmsForearm – codes only forearms
PlainFilmsWrist – codes only wrist
73100 (2 views)
73110 (3 views)
PlainFilmsFingers – codes only fingers
© RadPayor 2010
Accuracy ◦ Dramatic reduction in common entry errors either
due to omission or improper entry ◦ One instance showed reduction in demographic
error rates improve from 18% to <2% with implementation of CAC system
Traceability ◦ No need to search through cumbersome paper files
to locate missing or incomplete information
Quality Improvement ◦ Continuous quality improvement metrics can be
added and monitored to improve profitability
© RadPayor 2010
Reporting on Coder’s performance
Reporting on Clerk’s performance
Reporting on Physician’s performance
Financial reporting for Owners and Managers
© RadPayor 2010
2013 is NOT far away
Implementation of ICD-10 is not YOUR choice
Learning 140,000+ new diagnosis codes
© RadPayor 2010
Learn 30 new codes with computer’s assistance
Retain quality and performance
© RadPayor 2010
Encryption software ensures HIPAA, HITECH, and Red Flag compliance
PHI ◦ Certain systems can “clean” records of personal
identifiers and private health information
© RadPayor 2010
CAC is already expanding into Emergency Medicine, Cardiology, and Pathology
Expect expansion across all specialties as providers and hospitals transition to EHR
© RadPayor 2010
© RadPayor 2010
© RadPayor 2010
NCEB Practice Management Solutions ◦ Sue Irwin, CHBME, MCS-P, President Tel: (440) 934-6135
Email: [email protected]
◦ Cathy Czarney, CPC Tel: (440) 934-6135
Email: [email protected]
RadPayor Tom Henslee, President
Tel: (800) 550-1933
Email: [email protected]