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How to Teach Coding Concepts to Your Provider Nancy Clark, COC, CPC, CPB, CPMA, CPC-I Judy A. Wilson, COC, CPC, CPCO, CPC-P, CPB, CPPM, CPC-I, CANPC
How to Teach Coding Concepts to Your Provider
Nancy Clark, COC, CPC, CPB, CPMA, CPC-I
Judy A. Wilson, COC, CPC, CPCO, CPC-P, CPB, CPPM, CPC-I, CANPC
Objectives
• Learn how to converse with practitioners in relatable terms
• Understand and address providers’ documentation concerns
• Recognize important concepts for providers to understand
• Identify possible uncollected revenue from insufficient documentation
The Business of Medicine Today
• Delivery of medical services is no longer limited to the provider and the patient alone
• A multi-faceted, educated staff is necessary to run and support the medical office
• Staff responsibilities and contributions
• Coders’ and providers’ differences
The Conflict
Coder Vs. Physician
Obstacles to Effective Communication
• Differing perspectives– Clinical, patient treatment vs. documentation-based, revenue
collection and compliance– Do we speak the same language?
• Mutual respect– Do physicians respect the work that coders do and the
intelligence/education required?– Do Coders respect the difficulty of practicing medicine for the
physician when the focus no longer is on the patient?– Does it exist?
• Fear of conflict– Do coders feel that their physician is “approachable”?– Do physicians take the time to discuss concerns with coders—or do
they feel this is a sign of weakness?
Understand Physicians’ Approach to Patient Care
• Physician’s goal is to treat patient– If this is successful, then I should be reimbursed for it
• Years of schooling, studying, education, practical application are being applied---but we were not taught about coding and documentation
• Numerous confusing legislative implementations require so much more of the physician today –PQRS, MACRA, MIPS
• Not trained to be managers• How can we work together to allow the physician to
focus on patient care while still providing the documentation and tools that the coder needs?
Understand Coders’ Needs & Goals
• CPC’s are not just “clerical personnel”– Compliance with guidelines and regulations– Certification depends on integrity
• Documentation drives coding– Cannot presume or guess – The medical necessity must be documented
• Not simply “submitting a claim”– The revenue cycle is complex– Other factors apply, such as carrier and clearinghouse
• Some things are out of coders’ control , much like a doctor advising a patient to quit smoking or lose weight
• Entire revenue cycle and staff affects payment
Utilize Skill Sets to Increase Communication
• Verbal communication– Regular, informal meetings
• When is the last time the physician and coder sat down for a cup of coffee?
– Don’t judge each other• Listen and try to understand the other’s point of view
– Importance of how we address and respond to each other
– Offer positive feedback• Even if the situation is not resolved, work on possible
future enhancements.
Continued...
Utilize Skill Sets to Increase Communication
• Body language
• Sometimes, you can say all the right things, but your body does not communicate agreement
• Let’s review some common stances:– Negative: Arms folded, back turned, facial
expressions/body posture
– Indifferent: Texting while listening, facial expressions/body posture
– Positive: Eye contact, smiles, open arms, relaxed posture
Continued...
Utilize Skill Sets to Increase Communication
• Written reports – Seeing examples in writing can solidify understanding– Monthly reports of coding progress, identifying issues
• Note the potential adverse effects if audited (revenue loss, additional audits)
• Improvement noted on reports
– Improvement noted on reports• Show areas of improvement
– Discuss formats that would be best utilized by each party• Excel, word or PPT graphics? • What works best?• The coder could learn or update a skill set if effective
communication results
Applying These Concepts
• E&M under documentation– HPI
• Understand importance of writing it down
• Written documentation needs to support level of E/M
– Exam• Just because it is on the template doesn’t mean it was
medically necessary
– MDM• Not simply how sick the patient is
• Multiple diagnoses alone do not increase the level
Applying These Concepts
• ICD-10 and diagnosis coding– Importance of diagnosis coding.
• Even though physicians are paid on CPT, diagnoses support the medical necessity of the visit
– Value-based health care• Overall health of the patient as documented in the
medical record will affect reimbursement
– Importance of accurate patient records• Many patients cannot appropriately relay findings and
diagnoses to other health care providers
Applying These Concepts
• Concerns about templates
– Examples of actual documentation
• Male patient presents “status post hysterectomy”
• Importance of reviewing records prior to authenticating them
– And the importance of authenticating records
• Use of free text
Identify Revenue Opportunities from Accurate Documentation
Original Documentation
• HPI:
– Reason for visit: sick visit
Suggested improvements• HPI:
– Patient C/O coughing, associated with congestion, sneezing, itchy hives and headache for 3 days, worse in the morning. Some relief with acetaminophen and decongestant. Patient notes that symptoms began when her daughter adopted a pet cat.
– Indicates that she has been feeling as though her heart is “racing”.
– Patient previously diagnosed with HTN.
Identify Revenue Opportunities from Accurate Documentation
Original documentation
• Exam
– Templated review of 12 Organ Systems
– Including a rectal exam
– And a psychiatric exam
Suggested Improvements
• Exam– Pertinent areas of exam are
identified as the physician deems clinically relevant
– Constitutional, Eyes, ENMT, Respiratory, Skin, CV, Hem/Lymph• Of note, indication of
elevated BP
– Other organ systems based on physician’s judgment and patient’s overall health
Identify Revenue Opportunities from Accurate Documentation
Original Documentation
• MDM:
• Benadryl 25 mg. BID
Suggested Improvements• MDM:
• Allergic rhinitis due to cat dander
• Allergic contact dermatitis due to cat
• For allergy relief, take Benadryl 25 mg. BID
• For dermatitis relief, apply OTC 1% hydrocortisone cream as needed every 3 to 4 hours
• D/C decongestant due to elevated BP and associated symptoms. Patient has had HTN for multiple years. We will monitor HTN.
• Patient is told to contact office if no improvement in 3 days
• Patient is advised of likely allergic reaction to cat and to avoid direct contact. May need to remove cat from the household in the future. Can refer for allergy testing to confirm.
• Follow up for HTN in 6 months.
Identify Revenue Opportunities from Accurate Documentation
Original Diagnosis
• Allergy
• ICD-10-CM
– T78.40XA Allergy, unspecified, initial encounter
Suggested Improvements
• Allergy, cat dander
• Allergic dermatitis, cat dander
• Essential HTN
• ICD-10-CM– J30.81 Allergic rhinitis due to
animal (cat) (dog) hair and dander
– L23.81 Allergic contact dermatitis due to animal (cat) (dog) dander
– I10 Essential (primary) hypertension
Next Steps:Improve Communication
• Schedule monthly preset meetings
– Set up a schedule before an issue arises
– Identify positives first, then issues to be worked on
– Allow each side to speak while the other party listens
• Keep all questions for the preset meeting so you will have the attention of your provider
• In large practices, work with same provider
– Builds relationship
– Provider is responsible to update others in practice
Next Steps:Understand Different Views And
Responsibilities
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Next Steps:Communicate with Everyone in the Revenue
CyclePatient Scheduling
Eligibility & Benefits Verification
Patient Registration
Data Entry & Patient Demographics
Provider Documentation
CodingClaim Submission
Secondary Filing
Charge Posting
Accounts Receivable
Denial Management
Next Step:Tools We All Can Use
• Creation of custom “Cheat Sheets”
– Not to replace coding
– Assist in documentation reminders to provider
• Ongoing education and feedback
– Share the knowledge
• Coder to provider and staff
• Provider to coder and staff
• Staff to provider and coder
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Next Steps:How Can We Help Each Other?
• Open lines of communication
• Ask for help when needed
• Understand different viewpoints
• Work together, not apart
• Reap the benefits!
Questions?• Judy A. Wilson, COC, CPC, CPCO, CPC-P, CPB, CPPM,
CPC-I, CANPC • Nancy Clark, COC, CPC, CPB, CPMA, CPC-I
