Improving CPT compliance requires HIM initiative
October 1, 2002 4 minutes read
Develop coding responsibility matrix
If your HIM department does not take outpatient coding seriously, now is the time to start, because coders working with CPT codes will need to have as much and perhaps even more training than inpatient coders, according to an HIM expert.
"There has been a change in the way we think of outpatient coding," says Melinda Stegman, MBA, CCS, manager of Clinical HIM Services for HSS Inc. in Germantown, MD. HSS Inc., based in Hamden, CT, is a health care consulting company.
"It used to be that outpatient coding wasn’t thought to be as important as inpatient coding, so we’d take the newest, least experienced coders and put them on outpatient," Stegman says. "But while the outpatient cases aren’t as long as inpatient, CPT is an entirely different animal than ICD-9 codes, so we need to make sure all coding staff have the training they need, plus additional resources."
Another consideration is that while coders can learn a great deal from ICD-9 coding clinics and books, with CPT coding they likely will need other types of resources to help them understand the different terms and guidelines, Stegman says.
And it would be a mistake for HIM directors to assume that the smaller the hospital, the less attention needs to be paid to CPT coding, Stegman says.
"What we’re finding is that the smaller hospitals may be driving a greater percentage of the total reimbursement on the outpatient side than on the inpatient side," Stegman explains. "They may not have very complex services on the inpatient side, because they transfer these patients right away to a bigger facility."
Outpatient procedures growing more complex
On the other hand, these same small hospitals might be the biggest providers of outpatient services for their region, she adds.
Add to this trend the fact that health care providers are continuing to see more complex outpatient procedures, even in smaller hospital settings, and it’s clear that CPT coding should be a top priority in training and continuing education of HIM staff, Stegman says.
"I was at a tiny hospital in the Midwest, and I thought I’d see typical procedures for treating cataracts," Stegman recalls. "Instead there was an eye surgeon doing state-of-the-art types of things, so even at a small hospital HIM staff need to make sure they’re aware of the services their hospital provides."
Stegman spoke recently about CPT coding compliance at the recent 74th National Convention and Exhibit of the Chicago-based American Health Information Management Association (AHIMA), held Sept. 21-26 in San Francisco.
Here are some of Stegman’s suggestions for improving CPT coding compliance:
• Develop a coding responsibility matrix.
HIM departments need to develop a coding responsibility matrix that will show every outpatient coding or outpatient service area in a facility, along with who has the responsibility for assigning these diagnosis, CPT, and level two codes, Stegman says.
"Typically, no one person has answers to all of it," Stegman says.
So the matrix will force HIM departments to be disciplined about seeing who really is responsible for coding services and who is responsible for different service areas.
• Review the chargemaster.
"There are a lot of hospitals out there that haven’t had their chargemaster reviewed since the inception of APCs, or they think if they have someone come in to review it every couple of years that’s good enough," Stegman says.
"But with regulatory changes, that probably isn’t good enough," she adds.
HIM departments should have a streamlined revision policy in place so that it doesn’t take two to three months to make revisions or changes, she says.
"I went to a small hospital a couple of weeks ago, and it was practically impossible to make changes," Stegman recalls. "They showed me the form, and the form required six signatures."
Just keep in mind that the rules about updating chargemasters have changed, and there needs to be a much more flexible, ongoing process rather than a once-a-year check-up of the charge description master, Stegman advises.
What services does your facility offer?
• Know your top procedures by CPT code.
"One thing we do at HSS is build some tools and database programs to help facilities look at their own internal data and benchmark themselves against other providers," Stegman says.
"Before you can benchmark yourself against better outpatient providers, you need to get a good idea of all of the types of services your facility offers," she adds. "I think there still is a lag in the reporting capabilities that hospitals have on the outpatient side compared with the inpatient side."
For instance, Stegman says she sometimes will go to a hospital and ask for outpatient reports only to find that the hospital cannot run the report that day. Obtaining a report probably wouldn’t be a problem for inpatient data, which is why HIM staff need to make sure that their reporting capabilities are as up to date on the outpatient side as on the inpatient side, she says.
HIM departments need to be able to pull up reports based on volume, as well as other factors, she adds.
"I want to be able to run a report that will tell me by month what are my top 10 or 25 procedures by CPT codes," Stegman says. "Then I’ll want to make sure the coding staff is very comfortable with those top services."
Also, HIM directors could make certain that clinical staff and other departments are aware of any coding changes or clarifications that might affect those top services, she says.
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