The document discusses the importance of well-managed coding programs in radiology, highlighting tools and strategies for tracking performance, accuracy, and compliance. It covers the definitions and distinctions between ICD-9 and HCPCS codes, the benefits of certification, and the factors affecting coding accuracy and reimbursements. Finally, it addresses common challenges in coding, including documentation requirements and audit processes, while providing insights on improving coding practices.

1. Coding for Radiology Practice Managers Brigette LaBar October 12, 2009

2. Disclosure: Nothing to disclose I’m not a coder, but I play one on T.V.!

3. The value of a well-managed coding program What to track Tools Session Learning Objectives

4. 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.

5. 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

6. Types of CPT Codes Level I: CPT-4 codes Level II: DME, Ambulance, Drugs Level III: Local & temporary codes

7. Bonus Staff for Certification! Types of Certification CPC – AAPC CCS – AHIMA RCC – RBMA Internal/Proprietary Computer-assisted coding tools Certification

8. Benefits of a well-managed coding program Maximize reimbursement Reduce compliance risk Ensure charge capture Identify and manage costs Minimize write-offs

9. “ 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.”

10. What to Track Throughput & Output Accuracy based on internal audit TAT Denials

11. 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

12. Output Track by coder, identify outliers Create internal standards Evaluate learning curve of new staff Encourage team to excel

13. Throughput External benchmark comparisons – will vary by: Procedure mix Utilization of technology – CAC Quality of electronic report

14. Throughput Should be one of your KPIs Analyze trends Hour of day Day of week Identify faulty facility interface New rad, new coder Post group results in common area

15. Accuracy QA audit process Frequency Internal: Quarterly, rotate coders audited monthly Annual external audit Sample size

16. 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

17. 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

18. Non-Specific Finding Guideline to Improve Specific Clinical Indications MVA Document 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 Dates Specify 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

19. Compliance What’s the “magic” number? Reporting coding errors to payers RACs Creating Coding Guidelines LCDs, NCDs, Payer-specific rules ACR documentation requirements

20. 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

21. 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%

22. Common Coding Denials Not medically necessary Missed 5 th digit Age inappropriate – The “Golden Rule” Modifier errors Payer non-compliance with CCI Payer insists on medical documentation – coding isn’t “enough”

23. Interfaces Risks associated with accepting codes Load errors CPT extracted from the title 15% error rate 8% discrepancy rate Compare performed procedure to coded procedure

24. Education Support continuing education for coders A/R follow-up staff Clinical staff Yourself! Keep resources current: CPT and ICD books NCD/LCD information Coding & Dictation guidelines

25. ICD-10 When is it coming? Oct. 1, 2012 What will change? 155K+ codes alpha-numeric codes

26. Questions?