November 26 , 2007

Inpatient Computer-assisted Coding: Imagine the Possibilities
By Dee Lang, RHIT
For The Record
Vol. 19 No. 24 P. 8

When considering the ever-changing pressures in the coding world, it can often be bewildering, especially for coders and coding managers. Assignment of the present on admission (POA) indicators is the first change that comes to mind.

From a coding perspective, this added requirement will have a huge impact on an organization’s reimbursement and profitability. A component of the Deficit Reduction Act, POA assignment began with discharges on October 1 and has a mandatory enforcement of reporting beginning January 1, 2008. This reporting challenge will create havoc in the coding world. Add to this the transition to Medicare severity diagnosis-related groups (MS-DRGs), necessitating coding staff to learn a completely new disease severity ranking system, and you have enough reason to believe that coding productivity will take a plunge.

Step out of the box for a moment and imagine a computer-assisted coding (CAC) technology that could actually be applied in the inpatient coding environment. Imagine using this technology during inpatient encounters to help mitigate coding challenges.

We hear about CAC technology being used in an outpatient setting—many of us have seen it work well in this environment to the extent that some outpatient coding is being automated. Although we don’t hear much about it, CAC technology for inpatient coding does exist.

Inpatient CAC can drive necessary positive changes in the coding workflow, particularly as it relates to productivity and quality. It can automate many tasks associated with inpatient coding, resulting in time-savings for coders and a reduction in discharged not final billed (DNFB).

Inpatient CAC can also decrease chart processing time. For example, imagine coders having all data elements and documentation required for coding in a single format and view. Think about how many documents an inpatient coder has to hunt through to code the record—a minimum 100 pages for an average length of stay. Also, consider the various sources (some electronic, some paper, some scanned images) where this documentation is found. A CAC solution can pull these documents from any source and in any format together in a single view.

Couple this with the fact that machine processing of 100 pages is faster than any coder. Then, add the technology’s ability to read and understand the clinician’s naturally spoken language and the knowledge of when to code and when not to code. CAC technology then assigns diagnoses and procedure codes for the coder to validate and appropriately sequence. The icing on the cake is an inpatient CAC solution that can automatically assign the POA indicator, requiring only validation by the coder. This technology lessens the burden on coders and results in a boost in overall coder performance.

If the technology is smart enough to read and understand the diverse terminology used in various inpatient documents (history and physical, discharge summary, operative report, and consultations), it can assist and automate portions of outpatient coding as well. This type of CAC technology would rely on a data field that distinguishes a record as inpatient or outpatient so it could invoke the appropriate coding guidelines.

What should you expect from an inpatient CAC solution? First and foremost, expect it to streamline the coding process, resulting in increased efficiency (accuracy, consistency, and productivity) for inpatient coders. You also want an inpatient CAC solution that brings together in a single view all the documents a coder needs to code a chart. You want to give coders the ability to work without having to go to multiple locations—not to mention the ability to work remotely.

Furthermore, most would agree that coding is subjective and based on the knowledge and judgment of each individual coder. Knowing that coder variability is a significant challenge to manage, healthcare facilities also want coders to have maximum flexibility to change, alter, or modify the codes and to select the principal and secondary diagnoses and procedures as they deem necessary.

The CAC solution should also be able to learn from your coders over time so the way it codes gradually conforms to the way the coders perform the function. Also, expect a CAC solution that knows when to code and when not to code. Should you expect inpatient CAC to replace your coders? Certainly not—and it won’t. In fact, it’s just the opposite: It relies on coder interaction.

Applying CAC for inpatient coding is a creative way of tackling a common process and one that will continue to change and evolve because of regulatory requirements and other changes established by external forces. Inpatient CAC’s benefits include effective DNFB management, positive financial results, a decrease in chart processing time, improved auditing capabilities, accelerated coder performance, a reduction in costs associated with coding backlogs, and an enabling technology for remote coding. Beyond coding, inpatient CAC can support other areas such as clinical documentation improvement programs, information/data abstraction, auditing, and pay-for-performance data generation.

Inpatient CAC technology is fascinating, and the possibilities for its application are endless.

— Dee Lang, RHIT, is president of Dee-L & Associates, LLC, an information management and technology consulting firm.