Computer-Assisted Coding Technology & Beyond

1. Computer-Assisted Coding Technology & Beyond Heather Eminger, Dolbey CAC Product Manager

2. What is CAC? Computer-Assisted Coding (CAC) is the use of computer software that automatically generates a set of medical codes from documentation provided by healthcare practitioners and presents the results to the coder for review and validation.

3. What is NLP? • The field of computer science and linguistics focused on the interactions between computers and human language. • NLP is often considered a sub-field of artificial intelligence. • The term “natural language” is used to distinguish human languages from computer languages. • NLP uses computer programming to process human language. • NLP encompasses both text and speech.

4. CAC Powered by NLP • Natural Language Processing (NLP) software for healthcare identifies medical language found within the text of the documented patient encounter. • NLP converts patterns of language and applies the correct ICD or CPT code. • The entire patient record is considered and not just single documents within the chart. • Free form text is processed and does not require structure or changes in physician behavior. • Not all CAC is powered by NLP.

5. How Does NLP Code Charts? • Patient presents with a pressure ulcer due to diabetes. • Patients Family has a history of diabetes.

6. How Does NLP Code Charts? • Patient presents with a pressure ulcer due to diabetes. • Patients Family has a history of diabetes.

7. How Does NLP Code Charts? • Patient presents with a pressureulcerdue to diabetes. • Patients Family has a history of diabetes.

8. CODER JOB SECURITY? • Certain aspects of CAC rely on coder verification, validation, and approval. • Coders roles may change, but will continue to be a precious commodity. • Coders can be freed up from mundane tasks and placed in the most challenging areas of Health Information Management.

9. CODER ROLE CHANGE • Coders will review difficult cases and evaluate suggested codes from CAC. • Advanced coder skills are needed for difficult cases. • Coders will work in partnership with CAC software to provide best coding output.

10. Electronic vs. Hybrid • Electronic: Available through an EMR, Hospital Systems, or Document Repository in text based format. The key is the document itself was typed into a computer system. • Hybrid: Documents are not only physical paper documents but can also be handwritten or text based images represented as pictures, usually scanned.

11. CAC Explained Encoder Chart Documentation CAC Billing

12. CAC -NOTJustforCoders The traditional concurrent review role of the CDI specialist is expanding. Due to increasing demands to demonstrate quality initiatives in “real time,” the role will become even more important in the future.

13. What are CDI Goals? • Identify and clarify missing, conflicting documentation • Support accurate diagnostic and procedural coding, DRG assignment, SOI, and ROM, leading to appropriate reimbursement. • Promote health record completion during the patient’s course of care. • Improve communication • Improve documentation • Improve coders’ clinical knowledge. *Clinical Documentation Improvement Toolkit American Health Information Management Association 2010

14. ImprovingtheBottomLine • Improve the post-discharge query process • Implement real-time clinician education • Obtain complete clinical documentation at the point of care • Ensure documentation reflects the complexity and severity of patients treated

15. CAC With CDI Scenario The RAC has requested a medical record with the following scenario: A patient is admitted to the acute care setting in the hospital. The principal diagnosis is established as an acute myocardial infarction. The physician also documented that the patient has congestive heart failure (CHF). Clinical indicators include chest pain with left arm radiation, troponin levels elevated with shortness of breath, diaphoresis, O2 saturation of 88%, and rales and rhonchi upon auscultation. The treatment plan is IV morphine, non-rebreather O2 mask with Lasix 40 mg IV.

16. CAC Outcome • CAC sees NLP coded the chart as CHF unspecified. Since unspecified CHF this chart gets placed in CDI queue for a specialist to review. • A CDI specialist queries the physician for CHF specificity. The physician responds that the patient’s heart failure is acute and probably systolic in origin. • The CHF specificity allows the coder to provide accurate coding assignment and billing. • This record is no longer at RAC risk due to the collaboration between the CDI specialist, physician, and coder.

17. RAC AUDIT TOOLS • Using CAC to Identify Problem Cases Such as: • Wound Debridement • ER Levels • Blood Transfusions • Inpatient Protocol Charts • Specific MS-DRG’s • Core Quality Indicators/ CHF/CAP etc.

18. Decreasing the RAC Risk The RACs indicate that all MS-DRGs will be open for review eventually. A review was found that 60% of all denials were documentation-driven and denials were primarily in the areas of: • Excisional debridement • Acute respiratory failure • Sepsis • Dehydration • Procedures unrelated to the principal diagnosis • Renal failure • Syncope • Diabetes

19. STREAMLINING WORKFLOW • Coder/Managers • Triggers for Chart to be Coded • Rules for Coder Work Flow • CDI • Notifications • Review of the Suggested Codes and DRG

20. PHYSICIAN BENEFITS • Creation of a Patient Problem List • Current Diagnoses and Procedures • History of Diagnoses and Procedures • Medicine Reconciliation List • Quick Access to the Patient Record • Used for Discharge Summary Creation

21. ABSTRACTION /DATA MINING HITECH Meaningful Use: • 23 proposed Meaningful Use Requirements for hospitals, and 40 Quality Reports • Automatic Data Abstraction using NLP • Quality Reporting Initiatives

22. PREPARING FOR OUR FUTURE • Education with CAC • Coders • Physicians • Administrators • Finance • CDI • Transitioning From ICD-9 to ICD-10 • Beginning in 2011 • Switching from18,000 to155,000 codes will require some software assistance.

23. EXPECTATIONS OF CAC • Unique Results at Each Facility • Electronic vs. Hybrid • Differences in Reporting • Workflow • Unique Hospital Guidelines • Coder Exception • Integrations

24. EXPECTATIONS OF CAC • The range improvement should be 25% or more. • Accounts receivable and coding backlogs and reductions are more noticeable as coders become more comfortable with the technology.

25. CAC BENEFITS • Increased accuracy/quality • Increased productivity/efficiency • Reduced unbilled – increased timeliness of bills • Decreased rejected bills • Elimination of repetitive coding tasks

26. CAC BENEFITS • Consistency-elimination of variability • Automatic processing of certain record types • Reduction or elimination of outsourced coding companies. • Coder productivity should continue increase in about 3 to 4 weeks of using CAC.

27. BEYOND JUST CAC • Streamlining Workflow • Clinical Documentation Improvement Programs (CDI) • Data Mining With Advanced NLP • Creating Problem Lists for Physicians • ICD-10 CM/PCS Education • RAC Audit Trails

28. Questions? More Information?

29. Heather Eminger CAC Product Manager Dolbey heather@dolbey.com PHIMA Annual Meeting