Experienced coders help ED create excellence

Consider increasing compensation

(Editor's note: This is the third in a three-part series on innovative approaches to documentation that can significantly enhance your department's revenues without making any changes in patient flow and throughput processes. This article discusses the use of experienced coders and improved documentation. In the previous two articles, we discussed effective documentation tools, proper staffing to optimize their use, and incentive programs for improved documentation.)

It might seem like common sense, but it doesn't happen enough. One of the keys to achieving excellence in ED billing and coding is enlisting the help of coders with specific experience in this area.

"EDs should use certified coders who are experienced [in ED coding], and who keep up with their profession and national education," says Sandy Steele, CPC, manager of coding and billing for Midwest Emergency Services, a billing, coding, and practice management company in Fraser, MI. Steele explains that all of her company's coders are certified professional coders (CPCs), and many hold a special certification in ED coding. In addition, they are all required to attend a seminar once a year that provides information specific to ED coding. The important issue for EDs is that they use certified coders, this being personnel that have passed an extensive test and are required to maintain their coding education, she adds.

Robert B. Takla, MD, MBA, FACEP, medical director and chair, Department of Emergency Medicine, St. John Hospital and Medical Center, Detroit, agrees. "We will only use coders and billers that are certified" and have experience in ED coding, he says. His department's administrators selected coders and billers based on their reputation and because all of them are certified."

Takla says there is no substitute for ED experience. "I have worked with billing companies that try to be all-inclusive rather than specializing, and I saw a big difference," he asserts. "Those coders and billers need expertise in emergency medicine."

In the end, Takla says, you don't really pay any more for that expertise. In fact, it can save you money. For example, while he now works with Midwest, he says that every firm he has worked with was paid a percentage of what they collected.

Takla says he has found that companies that are paid a higher percentage will tend to perform at a higher level. "If I offer you 9% [of what you collect], and the going rate is 10%-12%, it's possible I'm not going to get as good work from you," he advises.

Midwest works with his facility on a "tiered system," which pays a certain percentage up to a designated level, and then a higher percentage after that point. Collections went up an average of $10-$15 per chart, says Takla, adding, "I'd much rather pay them a higher percentage and collect more." The firm he worked with previously did not charge as high a percentage, Takla says, "but I'm much happier now."

Coding staff don't work in a vacuum

Even if you have the finest coders available working for your ED, there is a limit to what they can accomplish if your staff has not been trained to be productive as possible, Takla says.

"Let's say somebody comes in who has sustained a trauma in a motorcycle accident and has leg pain," he suggests. "When you select 'leg pain' as a chief complaint, and the doctor focuses around the extremities, that give us limited information for coding."

In actuality, he notes, that physician is performing a head-to-toe assessment. "The correct chief complaint and template is 'trauma complaint,'" Takla says.

Without the proper documentation, the coder will be limited, Steele says. "They will not actually be able to code for all the services the doctor provided," she says. Complete documentation by the physician and nursing staff will determine the most appropriate facility code, Steele says.

By working with Midwest and Steele, says Takla, his staff learned about opportunities they were missing. "She gave us relatively short-term feedback," he says. "She was able to say, for example, 'You missed an opportunity here because you only included three or four body parts, and the most I could [bill for] was Level III, when I could have done a Level V.'"

Steele explains that she does "backward coding." "I first look at all the doctor did, and from that I determine the level of care that he provided," she says. If the documentation requirements were not met for that level of care, Steele finds the doctor deficient in coding in that area, and reviews those deficiencies with them.