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ICD-10 Intelligence

ICD-10 and Computer-Assisted Coding

Does your CAC enhance coding quality? Five questions to consider.

Q: Our organization implemented computer-assisted coding (CAC) a couple of months after we went live with ICD-10-CM/PCS. Our goals were to improve coding productivity and foster coding accuracy. However, it appears as though we haven't been able to accomplish either of these objectives. What questions should we consider internally so we can more effectively reap the benefits of this technology?

A: Many of our clients have the same concerns regarding CAC. Everyone wants to know how they can get the most out of their CAC solution in ICD-10-CM/PCS. For some facilities, CAC has-in fact-enhanced coding productivity. However, it hasn't necessarily enhanced coding quality. Ultimately, CAC is only as precise as the documentation on which it's based. If documentation isn't as specific as it could be, there's no way coders will be able to use the technology effectively and efficiently.

However, there are also other factors to examine. Consider these five questions to better capitalize on your CAC technology:

1. Is there a feedback loop between coders and CDI specialists?

As mentioned previously, CAC is only truly effective when the documentation is as detailed as possible. If the documentation isn't present-or as specific as ICD-10-CM/PCS requires-the CAC certainly cannot locate the terms and phrases necessary to trigger an appropriate code. Coders and CDI specialists must work together to improve documentation quality. Neither group can do it alone. As coders spot opportunities for physician education, they should pass that information along to CDI specialists. CDI must, in turn, be open to coders' input and expertise. For example, can the two collaboratively develop educational materials for physicians?

2. Are coders 'teaching' the CAC to learn unspecified codes?

If so, it's not surprising that coding quality challenges remain. When coders highlight a diagnosis that maps to an unspecified code, they may be  essentially teaching the CAC to recognize that an unspecified code is acceptable. Instead, coders should use these opportunities to query physicians for more specific documentation. The idea is that over time, documentation will improve-followed closely by productivity and quality.

Why should facilities avoid unspecified codes? There are several reasons. First, they provide limited insight into the clinical scenario. Second, they simply don't convey enough information about a patient's risk. For example, diabetes with neuropathy carries much more weight in a risk-based payment system than unspecified diabetes. Finally, payers may eventually reject unspecified ICD-10 diagnoses entirely.

3. Have you adjusted productivity standards to account for CAC training?

It takes time to train on CAC technology. That's because in addition to reviewing the record, coders may also need to manually highlight diagnoses and procedures in the documentation that is either still in hardcopy or may not have been picked up by the CAC tool, and then link those terms to various codes. In some cases, coders must correct the CAC so it doesn't keep making the same mistakes. This takes time. For example, in one instance, we've heard of a  CAC that flagged  the state abbreviation for Michigan (MI), in this instance the coders had to train the technology that it shouldn't assign a myocardial infarction.

Has your organization adjusted productivity standards accordingly so coders can balance quantity with quality? Make it clear to hospital executives that documentation specificity and coding accuracy are the two most important ingredients for success in a value-based healthcare environment. Reiterate this point: Adjusting coder productivity standards to allow for proper CAC training may increase the discharge-not-final-billed (DNFB) in the short-term, but it will pay dividends in the long-run.

4. Have you created best practice policies for copy-and-paste documentation?

When used inappropriately, the copy-and-paste function within the EHR can result in incredibly voluminous documentation that the CAC must subsequently analyze. This results in an oftentimes overwhelming number of highlighted phrases that coders must review and validate. Much of this EHR documentation may be completely repetitive and irrelevant, causing a drain on coding productivity. In addition, errors in this documentation continue to proliferate throughout the record, making it difficult to assign the correct codes.

Work with your EHR vendor to address this issue. Can your vendor display text differently when a physician has copied and pasted the information from elsewhere? At a minimum, this will help coders differentiate this documentation so they can question it more thoroughly. Also educate physicians about the proper use of copy-and-paste functionality. Do physicians validate documentation before they copy and paste it? Are they allowed to copy and paste information in all circumstances or only specific ones? Do they understand and follow organizational policies?

5. Are you feeding as much documentation as possible through the CAC solution?

To take full advantage of CAC technology, allow it to apply and analyze as much information as possible. This includes the discharge summaries, operative notes, interventional radiology notes, history and physical, and progress notes. Unfortunately, progress notes are typically the last portion of the record that facilities transition into an electronic format. Yet, these notes are incredibly important for CAC. In particular, progress notes provide the following information:

Procedures that may be inadvertently omitted from the discharge summary (e.g., placement of a PICC line)
Diagnoses that resolve quickly and are inadvertently omitted from the discharge summary
Clinical indicators to support various queries, thus helping to make the documentation more accurate for CAC in the future

In some cases, the progress notes are the only source of reliable information. This is particularly true when physicians don't complete the discharge summary until 30 days' post-discharge. Without the progress notes, the CAC would have minimal information on which it could rely.

As you continue to examine the effectiveness of your CAC solution, take the time to review internal processes to identify opportunities for coder and physician education. It may not be a technology problem after all.

Julie Boomershine is an AHIMA-Approved ICD-10 Trainer and Manager of Coding Operations, and Abby Coplan is Director, Client Services, both at HRS.

ICD-10 Intelligence Archives

I can only speak for one system - CAC coding cannot match the findings to the indication. MOst computer assigned codes need to be corrected. not much help

sharon cohenAugust 12, 2016
ne, MS


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