“We had coding and compliance experts help clean up the dictionary, but even then there were character limitations” and other problems, Sharp reports. She encourages other groups to ask ahead of time if an EMR has a robust database for coding. CodeCorrect, for example, is partnering with some EMRs.
Coder Bill Dacey is less worried about the codes EMRs select than the way they subtly encourage physicians to overdocument to get a higher code than may be appropriate.
“I am frightened by EMRs’ tendency to lead the physician. … It makes it too easy to bump up that record. I see a tremendous potential to overdo it on the history and exam because the machine is doing it for you.”
“I have seen a trend toward higher levels of coding. There was a significant increase of 99214s from 2004 to 2005 for Medicare. It shows a pretty steady uptick. Some of that I agree with, because I think that physicians have been doing a significant amount of undercoding. But on the other hand, is it just machines turning level threes into fours?”
When he audits charts, he sees EMR-produced notes that may technically be a level four or five E&M but “in essence” are level threes.
“It’s a machine and machines like lists and data. If you let it bring you into data-land,” mistakes can happen, Dacey warns. For example, these days he sees a lot of notes documenting that the patient’s pupils are alert to light and accommodation. “How often are physicians actually testing for accommodation? How often do they do it for a kid with a bellyache? I see it ad nauseam. I’ve got 100 charts to do tonight. I’m going to know three charts in if the guy is doing it by machine or not.”
As with any software, EMRs can’t replace the need for human oversight and restraint.
There is a whole new world of gadgetry for coders, billers, and physicians to explore. The keys to success are making sure the solution or combination of solutions you choose solve the coding problems specific to your practice.
Pamela L. Moore, PhD, is senior editor, practice management, for Physicians Practice. She can be reached at [email protected].
This article originally appeared in the July/August 2007 issue of Physicians Practice.