how to teach coding concepts to your...

How to Teach Coding Concepts to Your Provider

Nancy Clark, COC, CPC, CPB, CPMA, CPC-I

Judy A. Wilson, COC, CPC, CPCO, CPC-P, CPB, CPPM, CPC-I, CANPC

Objectives

• Learn how to converse with practitioners in relatable terms

• Understand and address providers’ documentation concerns

• Recognize important concepts for providers to understand

• Identify possible uncollected revenue from insufficient documentation

The Business of Medicine Today

• Delivery of medical services is no longer limited to the provider and the patient alone

• A multi-faceted, educated staff is necessary to run and support the medical office

• Staff responsibilities and contributions

• Coders’ and providers’ differences

The Conflict

Coder Vs. Physician

Obstacles to Effective Communication

• Differing perspectives– Clinical, patient treatment vs. documentation-based, revenue

collection and compliance– Do we speak the same language?

• Mutual respect– Do physicians respect the work that coders do and the

intelligence/education required?– Do Coders respect the difficulty of practicing medicine for the

physician when the focus no longer is on the patient?– Does it exist?

• Fear of conflict– Do coders feel that their physician is “approachable”?– Do physicians take the time to discuss concerns with coders—or do

they feel this is a sign of weakness?

Understand Physicians’ Approach to Patient Care

• Physician’s goal is to treat patient– If this is successful, then I should be reimbursed for it

• Years of schooling, studying, education, practical application are being applied---but we were not taught about coding and documentation

• Numerous confusing legislative implementations require so much more of the physician today –PQRS, MACRA, MIPS

• Not trained to be managers• How can we work together to allow the physician to

focus on patient care while still providing the documentation and tools that the coder needs?

Understand Coders’ Needs & Goals

• CPC’s are not just “clerical personnel”– Compliance with guidelines and regulations– Certification depends on integrity

• Documentation drives coding– Cannot presume or guess – The medical necessity must be documented

• Not simply “submitting a claim”– The revenue cycle is complex– Other factors apply, such as carrier and clearinghouse

• Some things are out of coders’ control , much like a doctor advising a patient to quit smoking or lose weight

• Entire revenue cycle and staff affects payment

Utilize Skill Sets to Increase Communication

• Verbal communication– Regular, informal meetings

• When is the last time the physician and coder sat down for a cup of coffee?

– Don’t judge each other• Listen and try to understand the other’s point of view

– Importance of how we address and respond to each other

– Offer positive feedback• Even if the situation is not resolved, work on possible

future enhancements.

Continued...

Utilize Skill Sets to Increase Communication

• Body language

• Sometimes, you can say all the right things, but your body does not communicate agreement

• Let’s review some common stances:– Negative: Arms folded, back turned, facial

expressions/body posture

– Indifferent: Texting while listening, facial expressions/body posture

– Positive: Eye contact, smiles, open arms, relaxed posture

Continued...

Utilize Skill Sets to Increase Communication

• Written reports – Seeing examples in writing can solidify understanding– Monthly reports of coding progress, identifying issues

• Note the potential adverse effects if audited (revenue loss, additional audits)

• Improvement noted on reports

– Improvement noted on reports• Show areas of improvement

– Discuss formats that would be best utilized by each party• Excel, word or PPT graphics? • What works best?• The coder could learn or update a skill set if effective

communication results

Applying These Concepts

• E&M under documentation– HPI

• Understand importance of writing it down

• Written documentation needs to support level of E/M

– Exam• Just because it is on the template doesn’t mean it was

medically necessary

– MDM• Not simply how sick the patient is

• Multiple diagnoses alone do not increase the level

Applying These Concepts

• ICD-10 and diagnosis coding– Importance of diagnosis coding.

• Even though physicians are paid on CPT, diagnoses support the medical necessity of the visit

– Value-based health care• Overall health of the patient as documented in the

medical record will affect reimbursement

– Importance of accurate patient records• Many patients cannot appropriately relay findings and

diagnoses to other health care providers

Applying These Concepts

• Concerns about templates

– Examples of actual documentation

• Male patient presents “status post hysterectomy”

• Importance of reviewing records prior to authenticating them

– And the importance of authenticating records

• Use of free text

Identify Revenue Opportunities from Accurate Documentation

Original Documentation

• HPI:

– Reason for visit: sick visit

Suggested improvements• HPI:

– Patient C/O coughing, associated with congestion, sneezing, itchy hives and headache for 3 days, worse in the morning. Some relief with acetaminophen and decongestant. Patient notes that symptoms began when her daughter adopted a pet cat.

– Indicates that she has been feeling as though her heart is “racing”.

– Patient previously diagnosed with HTN.

Identify Revenue Opportunities from Accurate Documentation

Original documentation

• Exam

– Templated review of 12 Organ Systems

– Including a rectal exam

– And a psychiatric exam

Suggested Improvements

• Exam– Pertinent areas of exam are

identified as the physician deems clinically relevant

– Constitutional, Eyes, ENMT, Respiratory, Skin, CV, Hem/Lymph• Of note, indication of

elevated BP

– Other organ systems based on physician’s judgment and patient’s overall health

Identify Revenue Opportunities from Accurate Documentation

Original Documentation

• MDM:

• Benadryl 25 mg. BID

Suggested Improvements• MDM:

• Allergic rhinitis due to cat dander

• Allergic contact dermatitis due to cat

• For allergy relief, take Benadryl 25 mg. BID

• For dermatitis relief, apply OTC 1% hydrocortisone cream as needed every 3 to 4 hours

• D/C decongestant due to elevated BP and associated symptoms. Patient has had HTN for multiple years. We will monitor HTN.

• Patient is told to contact office if no improvement in 3 days

• Patient is advised of likely allergic reaction to cat and to avoid direct contact. May need to remove cat from the household in the future. Can refer for allergy testing to confirm.

• Follow up for HTN in 6 months.

Identify Revenue Opportunities from Accurate Documentation

Original Diagnosis

• Allergy

• ICD-10-CM

– T78.40XA Allergy, unspecified, initial encounter

Suggested Improvements

• Allergy, cat dander

• Allergic dermatitis, cat dander

• Essential HTN

• ICD-10-CM– J30.81 Allergic rhinitis due to

animal (cat) (dog) hair and dander

– L23.81 Allergic contact dermatitis due to animal (cat) (dog) dander

– I10 Essential (primary) hypertension

Next Steps:Improve Communication

• Schedule monthly preset meetings

– Set up a schedule before an issue arises

– Identify positives first, then issues to be worked on

– Allow each side to speak while the other party listens

• Keep all questions for the preset meeting so you will have the attention of your provider

• In large practices, work with same provider

– Builds relationship

– Provider is responsible to update others in practice

Next Steps:Understand Different Views And

Responsibilities

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Next Steps:Communicate with Everyone in the Revenue

CyclePatient Scheduling

Eligibility & Benefits Verification

Patient Registration

Data Entry & Patient Demographics

Provider Documentation

CodingClaim Submission

Secondary Filing

Charge Posting

Accounts Receivable

Denial Management

Next Step:Tools We All Can Use

• Creation of custom “Cheat Sheets”

– Not to replace coding

– Assist in documentation reminders to provider

• Ongoing education and feedback

– Share the knowledge

• Coder to provider and staff

• Provider to coder and staff

• Staff to provider and coder

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Next Steps:How Can We Help Each Other?

• Open lines of communication

• Ask for help when needed

• Understand different viewpoints

• Work together, not apart

• Reap the benefits!

Questions?• Judy A. Wilson, COC, CPC, CPCO, CPC-P, CPB, CPPM,

CPC-I, CANPC • Nancy Clark, COC, CPC, CPB, CPMA, CPC-I

NancyClarkCPC@gmail.com