Get Back to the Basics to Produce Competent ASC Coding in the Future
ASC coders experience rapid changes in their work requirements. Faced with frequent code set revisions and additions, along with ongoing rule changes, successful ASC medical coders require a high level of flexibility, desire to learn, and willingness to do what's required to understand proper implementation of these changes. While coders are often pressured to allocate much of their time to ensuring they remain current on and adhere to the numerous changes, it's important to remember the principles of coding that create the foundation for complete, accurate, and compliant code capture.
In the face of the everchanging world of ASC medical coding, remember the following fundamentals to help achieve maximum success and lessen the chance of incorrect coding and lost revenue.
1. Brush up on the basics. The vastness of available information on coding can be overwhelming. One of the trademarks of a successful coder is their ability to know the guidelines that determine how this information should be assessed and applied. Don't be afraid to take a trip back to your CPT book. Make notes of when the code sets are published annually and any subsequent dates established for updates.
It's also important to refresh your memory on the purpose and location of the guidelines and how they pertain to the separate sections of CPT coding. Even if you don't code a certain specialty, reading the guidelines for that section can help broaden your understanding of their purpose and how they may possibly apply to your work now or in the future.
2. Estimation is for mathematicians, not medical coders. Estimation and rounding are some of the earliest taught fundamental concepts for school-aged children, and rightfully so. Imagine how often you use these concepts in your day-to-day lives. For example, you probably estimate how much time it takes to get your kids to school or you round a total up to the nearest dollar to decide how much money you can spend on groceries.
It's no wonder one of the most common and costly errors a medical coder can make is following that natural tendency to estimate and assume. CPT instructions for use require the medical coder to capture the code that accurately identifies the service performed rather than assume the physician's intent. This requires extensive knowledge on the coder's behalf and self-control to avoid falling into the estimation trap.
For example, if a coder estimated the size of a lesion excision without clear documentation in the operative report, this could lead to the documenting of an incorrect CPT code and lost revenue. If incorrect coding capture occurs multiple times without correction, this could raise red flags and prompt an audit.
3. Unlisted isn't synonymous with uncommon. There's a common misconception that unlisted codes are synonymous with uncommon usage. Unlisted codes have often been the vehicles that pave the way to new specific CPT code creation and publication. This means that even when the tendency is to steer away from unlisted procedure codes, coders must follow the strict guidelines of unlisted code reporting.
We often see unlisted codes misused with joint manipulations under anesthesia. There are guidelines and rules that state when it is appropriate to capture a specific CPT code versus the unlisted CPT code based upon the type of anesthesia used during the procedure.
4. The "add-on" reminder. Coders often get caught up in capturing the same codes day after day, which can lead to avoidable errors. For example, do not make the costly mistake of reporting an add-on code without an appropriately reportable primary code. Create a bulleted list, check your coding book, and remind yourself to look for that little (+) in your encoder. Don't get lost in the monotony and submit an add-on code where they are not supported.
Coders must remain vigilant in watching for these scenarios. By making it a customary practice to review the requirements for add-on codes, common errors can be eliminated.
5. Anatomically speaking. Medical jargon and lingo can be confusing. A seasoned ASC medical coder will likely have seen the same procedure or service described at least 10 different ways over the course of their career. Thus, it's always good practice to educate or even reeducate yourself on common and uncommon anatomical terms and procedure descriptions to help stay current on the language to watch for.
*Note, while this article generally focuses on CPT coding capture, the same processes apply for diagnosis coding as outlined in ICD-10's own specific guidelines and conventions.