Coding experts agree that ASCs should conduct regular audits of their coding processes to ensure the ASC is not upcoding, a possible fraud issue, or downcoding, leading to a loss of owed reimbursement. Coding consultant Lolita M. Jones, RHIA, CCS, discusses five steps to audit your coding process.
1. Concentrate on high-volume, high-complexity procedures. When conducting regular coding audits, Ms. Jones recommends concentrating on high-volume, high-complexity cases that are most likely to have errors. "If the center does a lot of cataracts and some of them are complex cataracts, it might be worth it to look at those," she says. "If all the cataracts are simple, they should probably focus on something else." She says the center should audit as many coded procedures as possible, but in the interest of time and resources, the most important ones are those that necessitate strong anatomy and physiology knowledge from the coder.
2. Focus on cases that present multiple code choices. Some cases, such as bunion repair, will present multiple codes to choose from, Ms. Jones says. "I would focus on GI/endoscopy, where they physically perform multiple procedures during one GI session," she says. "There's a good chance they'll have missed a code there." She says cases that present different codes for different approaches and techniques are often a hot bed of coding errors, and therefore the most appropriate for an audit.
3. Bring in an outsider to review cases. Whether you use an external consultant or a staff member within your facility to review your coding, the person should not have been responsible for any of the coding that needs to be reviewed. "If you're lucky enough to have at least two coders in the facility, you can do peer review," Ms. Jones says. "That way, the coders aren't looking at the same record [they] coded." She says ASCs can also use a facility manager with a coding background or hire an outside consultant.
4. Provide useful feedback. Ms. Jones says when she audits a center's coding process, she writes down the official guideline regarding the coding error and types it into the report. "That way, the report is educational," she says. "They're not just hearing it's wrong, and they're much more likely to remember the rule if they're given the guideline and the source."
5. Follow up on problem areas within 90 days. If auditors notice coding problems, Ms. Jones says the center should follow up on those cases within 90 days. If the center notices a problem but does not follow up in a relatively short time period, the coder will likely forget the feedback and make the mistake again.
Contact Lolita Jones for more advice on coding.
1. Concentrate on high-volume, high-complexity procedures. When conducting regular coding audits, Ms. Jones recommends concentrating on high-volume, high-complexity cases that are most likely to have errors. "If the center does a lot of cataracts and some of them are complex cataracts, it might be worth it to look at those," she says. "If all the cataracts are simple, they should probably focus on something else." She says the center should audit as many coded procedures as possible, but in the interest of time and resources, the most important ones are those that necessitate strong anatomy and physiology knowledge from the coder.
2. Focus on cases that present multiple code choices. Some cases, such as bunion repair, will present multiple codes to choose from, Ms. Jones says. "I would focus on GI/endoscopy, where they physically perform multiple procedures during one GI session," she says. "There's a good chance they'll have missed a code there." She says cases that present different codes for different approaches and techniques are often a hot bed of coding errors, and therefore the most appropriate for an audit.
3. Bring in an outsider to review cases. Whether you use an external consultant or a staff member within your facility to review your coding, the person should not have been responsible for any of the coding that needs to be reviewed. "If you're lucky enough to have at least two coders in the facility, you can do peer review," Ms. Jones says. "That way, the coders aren't looking at the same record [they] coded." She says ASCs can also use a facility manager with a coding background or hire an outside consultant.
4. Provide useful feedback. Ms. Jones says when she audits a center's coding process, she writes down the official guideline regarding the coding error and types it into the report. "That way, the report is educational," she says. "They're not just hearing it's wrong, and they're much more likely to remember the rule if they're given the guideline and the source."
5. Follow up on problem areas within 90 days. If auditors notice coding problems, Ms. Jones says the center should follow up on those cases within 90 days. If the center notices a problem but does not follow up in a relatively short time period, the coder will likely forget the feedback and make the mistake again.
Contact Lolita Jones for more advice on coding.