Practice Management Alert

CAC is computer software that generates a set of medical codes based on practitioner-provided clinical documentation. CAC provides ICD-10-CM/PCS, CPT^®, and HCPCS Level II codes intended to receive review by a human coder. The software uses natural language processing (NLP), similar to the spell check tool.

CAC can save coders a lot of time. Hall noted that studies show coders can increase their productivity up to 80 percent when working with CAC, especially due to the software’s ability to “learn” from coder input.

However, the “learning” can be a double-edged sword. “The computer software only knows what it’s taught, so it doesn’t have the ability to understand certain things like the difference between unspecified asthma or persistent asthma, and then persistent asthma — is it mild, moderate, or severe?” Hall said.

“If the providers aren’t reporting those specific words, then we could have codes that are mapped to unspecified codes because they can’t pull any other additional information.”

The NLP software doesn’t have the ability to evaluate or apply guidelines, select a principal diagnosis or procedure, or decipher when a condition is changing, Hall explained.

Also, if you have trouble reading a provider’s handwriting, a computer isn’t going to fare any better.

Help CAC Work for Your Team

While coders’ knowledge is crucial for checking the accuracy of CAC’s suggestions, providers’ knowledge and documentation constitutes the foundation for any coder or coding. CAC is dependent on content, so the more specific the input, the better the results.

In fact, some CAC software options can be used at the point of care, eliminating the need — and the associated costs — for dictation or transcription during an encounter. CAC also is easily integrated with electronic health record (EHR) systems.

Improved content can change code assignments and therefore reimbursement, enhancing payment and improving clinical data quality, Hall notes.

If you’re working with CAC as a coder, it’s in everyone’s best interest to make sure providers understand the strengths and limitations of the system. The quality and specificity of providers’ documentation will make the coding much more efficient now and down the road.

Providers need to document manifestations and etiology and convey more disease specificity. Every time the software gets that information, it gets better, and the code recommendations get better, Hall said.

Beware of These Compliance Issues

Hall noted that the Centers for Medicare & Medicaid Services (CMS) has identified some potential compliance issues with CAC, and coders should take note.

The same aspects of technology that can simplify and assist in documentation and coding, generally, can be misused, even to the point of fraud.

Cloning notes can be an issue in situations where autofill and autoprompts populate notes. A patient’s medical record should show that individual patient’s condition and needs during each visit or encounter.

The same technology can help facilitate and improve documentation, coding, and billing, but can also suggest a higher billing code and payment than the services furnished, aka upcoding, Hall warned.