Wiki Professional coding processes

[tswanson@ehr.org]

Hi Everyone,
We are trying to come up with process improvements and solutions to some common coding problems we run into daily (professional side). I was wondering if you could share the processes you use to code and enter charges at your practices? Is it common practice to scrub each note and how is incomplete documentation handled?
Thank you!

 

[Pam Warren]

It really depends on the organization and perhaps also the specialty.

Our primary care and consultative specialty providers' E&M codes are automatically dropped from the EHR without any coder intervention. We do audit retrospectivly both internally and externally several times a year to meet our own organization's compliance plan and to provide documentation improvement assistance to providers. The only exception to this rule is with brand new providers who must meet 90% accuracy prior to claim drop, as evidenced by audit once they begin seeing patients. After coder/auditor training, and when they meet that metric, they are able to drop their E&Ms electronically. This has been very successful.

Office procedures, diagnostic tests and all surgeries are coded by a coder prior to charge entry. We do have a coder reveiw TCM and CCM because of the documentation guidelines and date parameters. They also code and post all facility-based physician services such as nursing home visits, hosptial admissions/discharges/rounds.

 

[marandee]

Post Op TCM

Hi Pam,
You seem experienced and knowledgeable so I am seeking your opinion regarding appropriate modifier for a TCM within the global surgery period. Claim denied due to document request as well as modifier missing. Services were verified, so now just a question of appropriate modifier. Industry notes I've gathered recommend surgical code with appended modifier -55 but TCM are services I need to bill and I would like to append modifier -24. Does this make sense? The TCM was for Rehab discharge but still within postop period.

Truly appreciate your response - and anyone else who may advise.

-Deirdre