PHS Reveals What We’re Seeing from Computer-Assisted Coding

The ICD-10 standards have increased coding specificity and complexity, requiring more attention to detail and causing longer throughput times for coders. The shift to EHR, value-based care, increased denials from payers, dealing with the pandemic, and keeping up with rapidly changing coding guidelines have all hit hospitals that are trying to manage the revenue cycle while meeting the healthcare needs of their markets.

A common means of coping with all of these factors is implementing CAC (computer-assisted coding) systems to increase coder productivity. But if not used appropriately, CAC can impact accuracy, which affects billing and reimbursement, quality metrics and compliance.

Casey Monahan, CCS, CCDS, Director of Coding Audit and Education at Paramount Health Solutions, has been a coder since 2005. As part of the PHS team, she reviews and audits between 25 to 60 charts daily for client facilities. With the increased reliance on CAC, she has observed a marked drop in coding accuracy.

“From my experience, CAC has really muddied the waters for coding,” Monahan said. “CAC has made coding accuracy much, much lower because it picks up on things that aren’t relevant in the chart that can’t be billed. It picks up things from patient histories, radiological findings, previous hospitalizations – things we can’t code. I’m finding multiple codes that have nothing to do with the current admission that I have to remove.”

When coding staff use CAC on a chart without also reviewing it carefully themselves, too many errors end up in the chart, Monahan said. “I see some charts so badly coded that I immediately know it was a CAC chart. A lot of coding staff who use CAC don’t check on where the documentation is coming from. It has made coding easier for coders, but the results aren’t as accurate.”

“Technology is a good supplement in many ways,” said Bilal Mushtaq, M.D., the Paramount Health Solutions COO. “At the end of the day, it comes down to how well the coders are actually using it. Even with those sophisticated programs, there needs to be accountability for someone to still review the case and make sure that everything is done appropriately.”

A study by the AHIMA Foundation found that CAC alone without the intervention of a credentialed coder had a lower precision rate.

The Paramount Health Solutions team takes pride in leveraging our experience and skills to find any and all potential problems and opportunities in the charts.

“We look at every code, every procedure, and medical necessity,” explained Monahan. “We look for absolute changes, such as changing the coding or the DRG, and whether it’s an upgrade for an increased reimbursement or a change for a decreased reimbursement. We find things coded incorrectly, and we remove things that shouldn’t be there. The result is a clean and accurate chart that is coded correctly and is compliant,” she said. “About 95 percent of the time, the clients accept our recommendations and they bill it out.”

“Our yield has been very positive,” Monahan summarized. “We’re yielding a higher reimbursement rate for our clients. Those higher reimbursement rates are translating into client profits.”

For more information about CDI/DRGV services offered by Paramount Health Solutions, go to this page.