With some 8,500 CPT codes, 16,000 or so diagnosis codes, untold numbers of supply codes, and endless rules about medical necessity and bundling, it’s no wonder practices find coding confusing.
“The complexity of coding has been steadily increasing,” explains Bill Dacey, a certified coder who makes a living auditing charts and training physicians on coding.
How tough has it become? When a group of highly trained coders was asked to code, then code again, the same set of notes four weeks apart, they agreed with their own CPT choices only 85 percent of the time, and with their own ICD-9 codes barely more than half the time, according to Perspectives in Health Information Management (Fall 2006).
And of course, payers make matters even worse, with each throwing in its own coding and billing regulations.
Clearly some help would be appreciated. That’s where computer-assisted coding applications come in. These tools aim to make coding more of a science than an art — and keep you in the money and out of hot water.
They come in several flavors. Some can be used together; some vendors offer several kinds. If you are ready to throw away your paper codebooks, it’ll be useful to understand the general categories of products out there and how they work. Here’s our guide.
Making research easy
The most basic coding software is the encoder. Encoders put your CPT, ICD-9, and HCPCS book — plus many other resources — in an electronic format so it’s easy to look up codes. You can type in the name for a procedure or problem — say, ankle fracture — and get a list of possible codes. Or if you get a denial, you can use an encoder to try and figure out why.
You could use paper instead, but why would you? “Once upon a time they trained me to get square roots without a calculator, too, but why would anyone do that now?” asks Dacey.
CodeCorrect is one example of an encoder. In addition to its database of codes, the online service gives easy access to relevant transmittals and bulletins from Medicare, advice from the AMA’s CPT Assistant, correct coding initiative (CCI) edits, and details from national coverage decisions (NCDs), all of them keyword-searchable.
“We have some people with very thick glasses, and they just peruse what’s going on with [Medicare] and what’s going on with various payers on a state-by-state basis, and [they] incorporate that into the site,” says Jim Keleher, vice president, partner solutions, of Accuro Healthcare Solutions, the company that creates CodeCorrect. “It’s meant to be the authoritative content. It’s not somebody’s opinion about coding. When I go into that knowledge base, I’m going to find articles that … I could use to defend something.”
The product, like most encoders, focuses on Medicare and some rules generally used by other major payers, but users who have the time and knowledge (that may not include very many) can also add rules from local payers.
Ingenix, long a leader in printed coding reference materials, has a similar Web-based product called EncoderPro, which also includes a bevy of research tools. “It’s all the things a coder would have to reference,” explains Ralph Wankier, vice president of physician solutions for Ingenix.
While Ingenix’s paper products still provide more revenue than its electronic products, the software is growing faster, says Wankier. “It’s growing very robustly. It’s double-digit growth.”
Want to check out other encoders? Try FlashCode or EncoderPro.