Radiology Coding Alert

Check out these tips for more effective clinician communication.

Coding education is an ongoing effort in healthcare, which is why Samuel “Le” Church, MD, MPH, CPC, CRC, FAAFP, core faculty family medicine residency at Northeast Georgia Health System and Crystal Tompkins, CDEO, CPMA, CPC, CRC, COBGC, auditor/coding educator at Northeast Georgia Health System went into helpful detail about the topic during their 2024 HEALTHCON session titled “Tag Team Coding Education for Family Medicine Residents.”

Whether you work closely with resident physicians, are looking to improve your onboarding process, or simply need fresh insights into how to better educate your practice’s physicians on coding and documentation, read on to learn what our experts have to say.

Recognize the Common Challenges with Coding Education

Resident physicians hardly ever receive coding education during their schooling. This means they’re starting at square one. But before you begin to exchange coding expertise and information, you’ll need to address certain barriers or blocks to the education process.

For example, doctors, like anyone else, have different learning styles. What’s easy for one doctor to understand with a simple explanation might be difficult for another doctor to understand unless you use a case study. Additionally, establishing a trusting relationship is essential in any learning environment. It’s easy for coders and teaching doctors to come at this from an overly aggressive standpoint. “You never want to approach anyone as an educator to put them in their place. These are areas of opportunity to help the physician,” said Tompkins.

Here are a few other things to keep in mind when you’re trying to establish this kind of relationship:

• Interest: Doctors did not go to school to learn documentation and coding. They went to school to treat patients. Their interest generally lies in patient care. Creating notes around billing requirements is not their priority.
• Language barriers: Doctors have a specialized, clinical skillset and knowledge base. This often makes it hard for coders and even other doctors in different specialties to connect to them.
• Focus: Doctors have several things going on, often that literally have to do with life and death, so it can be difficult to truly hold a doctor’s attention. Educators often have to say the same thing multiple times, which can cause frustration on both sides.
• Interpretation: Many coding rules and guidelines are open to interpretation. Clinical documentation disputes are incredibly common as coders, physicians, and payers can all have legitimate arguments in favor of their points of view.

Consider the “Why” to Help Motivate Doctors

Like anyone else, if doctors don’t understand how good coding and thorough documentation directly affects them or their patients’ care, you won’t have their attention. “Coding touches every patient encounter. Treat it that way,” said Church.

Whether it’s compliance, contractual obligation, revenue optimization, resources to pay staff better or give more bonuses, morale, or more resources to expand care, there are a plethora of reasons to care about better documentation and accurate coding. Sometimes, the biggest motivation is simply better pay and more reimbursement. “Remember, pay shouldn’t be what drives the work, but lack of pay can prevent great work,” Church said.

Consider Teaching These Concepts First…

We think of doctors as smart, and with good reason. They are. But coding is not easy, and there is plenty of nuance. Doctors need to start off with easier coding concepts that are relevant to their everyday workload. Give them the opportunities to have successes they can then build on.

Evaluation and management (E/M): A good place to start is with the office/outpatient E/M codes. Start with a discussion of what constitutes a medically appropriate history/exam, then break down the medical decision making (MDM) chart into small pieces, one column at a time. E/M isn’t straightforward, but it does affect every encounter. So, begin by giving your providers bite sized concepts they can apply right away, and use techniques such as mnemonics, white boards, notes, and the like.

Diagnosis codes: The ways doctors learn about diagnoses in medical school don’t always translate to ICD-10-CM. A lot of what’s in the code book simply doesn’t match up with the doctor’s language. “Start with the most common codes and conditions,” said Church.

Common procedures: Just as you would start diagnosis coding education with commonly used codes, begin procedure code education with your provider’s bread-and-butter procedures and build their knowledge base from there.

… And Teaching These Concepts Later

Modifiers: Modifiers can get tricky, so it’s best not to introduce them right out of the gate. However, it’s good to work on these as you go along. It opens your providers’ eyes to show them how to bill atypical situations or more than one service at once. Most pertinent is modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to justify a same day E/M service as a procedure and modifier 59 (Distinct procedural service) to report multiple procedures that otherwise can’t be reported on the same day.

Risk adjustment: “Risk adjustment is like an advanced primer on diagnosis coding,” explained Church, so start on this around the end of the first year. Think of it like this, he continued. “You don’t teach to the adjustment factor. You need to teach to the accurate diagnosis coding. The rest works itself out.”

New relevant code releases: As new codes come out, be sure to keep everyone up to date on the changes that will have the greatest impact on them, such as the recent split/shared visit update or changes to how time is calculated for E/M visits.

Take In These Onboarding Recommendations

When making coding education part of your onboarding process, ease your provider into it in a logical way. Mix it up, incorporate active recall, easy-incentive quizzes, and show real examples. Use the following timeline as a template:

• First meeting: Revenue cycle process and the basics of CPT^® and ICD-10-CM codes
• Second meeting: Documentation requirements in the note
• Third meeting: How to level service and time-based billing
• Fourth meeting: Review notes and show how to level services
• Fifth meeting: Review of redacted notes that residents have billed and any areas of opportunity

Remember, you are building relationships and trust. Emphasize how difficult and confusing coding is. “Think of a grocery store,” explained Church. “There is an agreement between the grocer and patron. It’s the same with coding. You can’t leave items in the cart and walk out. You also can’t scan things twice,” he continued.

Lara Kline, AS, BS, AAPC