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As access managers work to get their departments up to speed on their role — however small or large it may be at present — in fulfilling the new outpatient coding requirements, it appears that the devil is in the details.
What may appear to be insignificant omissions in the coding of an account can result in a hospital either being denied reimbursement for a service, or receiving less than it is due, cautions Eileen DeFeo, CPC, president of the Southern Jersey Chapter of the American Association of Professional Coders (AAPC), which is based in Somers Point, NJ.
Access departments that are not monitoring their accounts as they make their way to the billing system may be unaware of errors that are costing their hospitals money, she suggests.
"Modifiers" — indicators added to the CPT (procedure) code — provide the complete description that is now required for payment by the hospital’s Medicare fiscal intermediary, DeFeo explains. Without the full description — indicating that the procedure is on the left side, for example — reimbursement may be denied, or be incomplete, she notes.
The account for a patient who has an electrocardiogram and whose condition then warrants a second one must have a modifier appended to the CPT code on the second charge for the same day, DeFeo says. "If you don’t put 76,’ which indicates a repeat procedure, you have a good chance of getting a line-item rejection for duplication."
If the bill for an X-ray of the hand doesn’t indicate whether it’s the left or the right hand, she points out, it’s in danger of being rejected. "That seems like a very simple example, but if you’re not monitoring these things and how they get to your billing system, there may be a problem."
That route to billing might begin, DeFeo notes, with the registrar looking at the physician’s order and keying in that information, which then goes through an interface to the clinical system. It is accessed by a technician in radiology, for example, who performs the procedure, completes the order, and then sends it to the billing system, she adds.
DeFeo recommends that access managers do a daily auditing log of the charges being sent to billing, in order to catch those that are not fully coded.
With the increased emphasis on upfront accuracy prompted by the new outpatient prospective payment system, hospitals are becoming more aware of the need to have access employees with a knowledge of coding, she notes. "Right now, coding for outpatient procedures is becoming crucial," says DeFeo, who recently was hired to provide coding expertise for a hospital access department. "I am seeing more access personnel who are going to seminars on coding, and some who are taking courses on CPT and ICD-9 coding to enhance their skill level."
The AAPC offers national certifications, DeFeo points out, including certified professional coder (CPC), which emphasizes coding used in physicians’ offices, and CPC-H, which is geared to coders who work in hospital outpatient services and thus focuses on diagnosis (ICD-9) codes. Both certifications cover diagnosis coding and CPT coding and so are useful for access personnel, she notes.
The organization has an independent study program, and sites throughout the country where people may sit for the exams, DeFeo says. Those sites include the local AAPC chapters, she adds, which can be reached through the national office. Attending local chapter meetings, she adds, is also a good way to keep up with changes in coding and reimbursement requirements.
Laureen Jandroep, OTR, CPC, CCS-P, owner and consultant of A+ Medical Management and Education in Egg Harbor City, NJ, says her Web site, www.codingandreimbursement.net, is receiving increasing numbers of inquiries from access personnel regarding certification.
"More people are interested in becoming certified to show they have the level of knowledge to survive in this industry," adds Jandroep, who is an approved instructor for AAPC’s professional medical coding curriculum. "Many times, people get certified as a coder but work as a biller or an accounts manager."
"Coder," she points out, is a relatively new job title, even in medical records departments, where until recently that job was blended with other health information management duties. Now, she notes, coding expertise is a highly desirable addition to the resumes of applicants for access services and other hospital departments. "I just visited a hospital that is interested in having me conduct a coding seminar for its employees, including some in the access department," Jandroep says. "Facilities like that are getting well prepared for the future."
Even for staff who are not going to be certified coders, she suggests, "training in coding helps develop skills in problem solving and critical thinking and how to do the research when they have a question."
[Editor’s note: The American Association of Professional Coders, W. 700 South, Salt Lake City, UT 84101, may be reached at (800) 626-2633, and has a Web site at www.aapcnatl.org. Jandroep may be reached at A+ Medical Management and Education, 330 N. Genoa Ave., Egg Harbor City, NJ 08215; (609) 965-9585. Web site: www.codingandreimbursement.net.]