Track Your Coding Process Effectiveness with Six Easy Indicators
Published on Thu Oct 01, 1998
Other than noting [claim] rejection reasons and rates many practices dont have a good estimate of how theyre doing, observes Jan Rasmussen, CPC, coding consultant and instructor for Med Learn, a medical practice management training and consulting firm in Minneapolis/St. Paul, MN. Reviewing these six key indicators can help determine how effective your coding process is.
1) Produce a Statistical Overview of Your Codes. Statistics give you the big picture, Rasmussen states. While some practices do not take the time to run these overall summary reports, Sandra Darrow, office manager for Womens Health Care Associates, of Annapolis, MD, says her practice runs them monthly. This gives an overview of what services they are providing and the mix in the types and levels of codes being used. One can see whether there are patterns of up or down coding taking place. Both CPT and diagnosis codes should be evaluated.
CPT: Within CPT codes, review the mix of E&M codes. Are all levels of services represented? Is a certain level of E&M office visit being used more than others? Some red flags may be a tendency toward the higher end or lower end of office visits or the consistent use of only one level. Other danger signs are an imbalance of consultation codes verses new patient codes, an obvious lack of preventive medicine services or the absence of Medicares new breast and pelvic exam code G0101. Many physicians only bill preventive medicine services for patients under age 65, whereas they actually are billable for older women as well.
ICD-9: Diagnosis codes should be evaluated by examining the top 20-25 codes used for the year. Evaluate their specificity. A high use of .8 and .9 codes indicates the diagnoses could be more specific. Also, look for missing 5th digits, and whether or not the codes are being carried out to the appropriate digit.
2) Review Explanations of Benefits (EOB) and Rejections. The next important indicator is whether there is a process for reviewing EOBs, says Rasmussen, who obviously feels they should be. Next to your statistics, EOBs can give you the most information about the coding process, she says. Your rate of rejections will depend a lot on your payor mix. Rejection rate is really not the defining factor, although it can help identify trends or a specific problem in the manner in which certain procedures are coded. But the review process should extend to encompass of the reasons for the rejections. This analysis should look closely for reasons such as unbundling, whether or not the diagnosis codes support the claim, modifier usage and if an explanation is being requested. It is important to note that repeated unbundling of services can [...]
