Ensuring successful migration to ICD-10 will require intensive planning and an integrated, enterprise-wide technology approach that minimizes compliance risk. Parallel to developing new policies and procedures, implementing new workflows and introducing intensive staff training, providers must acquire information technology (IT) resources that address both the financial and compliance challenges presented by the ICD-10 transition. Computer-assisted coding (CAC) software is one type of technology that should be embraced as healthcare organizations adjust to the level of detail and complexity required by the new code set.
There are numerous advantages to CAC, in addition to the obvious one of improved coder productivity. But let’s start there.
Early studies have shown that, for some CAC applications, one result is a net increase in coding speed. This is largely because the key point of CAC is that codes have been preselected by the software, meaning the coding professional need only review the preselected codes and make whatever changes are necessary. Certainly, some medical domains lend themselves to faster coding speeds than others, though. Domains in which documentation tends to be highly repetitive (screens of mammogram radiology reports, for example) or in which procedural techniques are fairly predictable (gastroenterology endoscopies, for example) yield the greatest speeds.
However, these high speeds are offset when a code is found to be incorrect and editing needs to be performed, so there may be a tradeoff between accuracy and speed (which is always the dilemma in coding). Productivity also may be affected by increased efficiency in the coding workflow itself. Using a CAC tool, different categories of medical reports or chart types can be routed to particular work queues so that coding professionals can get into a rhythm, allowing them to code all the reports or charts of one specialty, physician or location (or any other attribute the tool is designed to recognize). An added consideration, unique to the structured, input-based CAC method, is that in the near future, the system may be able to prompt more complete documentation – meaning that delays caused by missing details needed to assign precise codes may be minimized, delivering more compliant and timely coding.
Increased Coding Consistency
It is difficult to make organizational improvements in coding when coding is done inconsistently from one day to the next (or from one coder to the next). CAC is very consistent, even when it is not right. This consistency makes for a compelling argument for its implementation. Under CAC, codes will be assigned in the same manner each time. Using a structured, input-based tool, codes linked to structured input are assigned at the time the input is created. Natural-language processing, rules-based software does not “forget” a rule one day and “remember” it another. Even mistakes would be generated consistently, presenting another advantage, being that problematic coding trends can be identified sooner and resolved faster.
Increased Comprehensive Code Assignment
The use of ICD-10 has great implications for clinical care and global health monitoring. Diseases presenting public-health concerns generally are able to be recorded in a more specific way when using ICD-10. Additionally, in the case of outpatient claims, CMS-1500 forms have a limited number of fields for ICD-9-CM codes. Because of production demands, often only the codes necessary for reimbursement and/or reporting to third-party payers are captured. This typically has to do with minimizing productivity impact more than anything else. An advantage of CAC software is that it can be used to code a chart with 10 diagnoses as quickly and easily as a chart with only two diagnoses. CAC technology can make it easier to capture all relevant diagnoses and procedure codes to foster better reporting, positively affecting patient outcomes and overall global healthcare monitoring.
Increased Coding Accuracy
Coding rules represent something of a moving target, with clarifications offered quarterly in the case of ICD-9-CM and HCPCS Level II codes, and monthly in the case of CPT codes. Revisions to the CPT, HCPCS and ICD-9-CM code sets are made regularly, and payer rules (such as NCCI edits) are updated frequently. Official clarification on proper use of the ICD-9-CM code set comes from the Central Office for ICD-9-CM, either via its quarterly Coding Clinic for ICD-9-CM publication or via questions posed directly to the office Similarly, official clarification on proper use of the CPT code set is issued frequently via various forms of communication from the American Medical Association (AMA).
Even the most skilled coding professional can tend to struggle with keeping up with the rapid and frequent changes. Updated CAC software will ensure consistent compliance. The axiom “If it wasn’t documented, it wasn’t done” may apply to CAC software more than to human coders, in fact. Both NLC-based and structured, input-based CAC applications are incapable of assuming anything, jumping to any conclusions or even “reading between the lines;” simply put, the software automatically assigns codes based on the available documentation. If that documentation is ambiguous or incomplete, the software should not return any assigned codes.
Decrease in Coding Costs
CAC engines can read through documentation at high rates of speed in order to assign relevant codes. As a result, coders only need to focus on the relevant documentation, which should be highlighted by the software and associated with the CAC-assigned code. As with any major change, the return on investment should reflect all relevant factors, including the initial investment in the system, how the tool is implemented, ongoing operational costs and the financial and non-financial benefits of risk avoidance and compliance.
Availability of a Coding Audit Trail
All code assignments made by CAC software and coders are auditable. Furthermore, the reasons a particular code was added, deleted or modified are tracked and made available for future reference. System designers or developers may reconstruct such audit trails as needed. Having these functions is imperative, as they allow you to identify problem areas faster and execute improvement strategies sooner in order to minimize impact on compliance.
Data Query Ability
The use of CAC data for such purposes as the Joint Commission core measures of auditing, quality assurance, performance studies, credentialing and research is another attractive feature of this technology. Many CAC systems offer different ways in which to query data from their systems, including via prewritten “canned” reports, ad-hoc queries and the use of structured query language (SQL). CAC ensures consistency in queries and reporting, as well as increases in staffing efficiencies.
Use of Free Text for Recording Documentation
While using CAC, physicians can continue to document health record information using their preferred means, mitigating the obstacles of system implementation and promoting user acceptance of process and technology changes. This, in turn, will support the production of more accurate and complete documentation.
System Improvements Through Feedback
CAC can “learn” from coder behavior by accepting feedback on actions taken by the coder when assigning each code. This ongoing feedback and learning loop will result in continuous improvements in performance.
ICD-10 promises to provide much-needed improvement to our nation’s healthcare system, but in order to survive the transition, providers must take a strategic, organization-wide approach to preparing. This can be done by thoroughly evaluating readiness from the perspectives of people, process, clinical documentation and technology, areas that must be examined in order to identify gaps and prioritize efforts. The identification of vulnerabilities and opportunities is crucial to planning and implementation. And when these efforts are coupled with the power of CAC technology, organizations not only will mitigate the risks associated with ICD-10, but they perhaps will emerge as even better, more financially sound organizations in the long run.
About the Author
Cindy Doyon, RHIA, is vice president of coding and client audit services with Precyse, a leader in health information management (HIM) technology and services.
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