Computer-assisted coding aids radiology practice

Historically, radiologists have been leaders in the adoption of new technologies. The first radiology computer-assisted coding (CAC) product went into commercial production in early 2000. Since that time, hundreds of millions of radiology reports have been coded and audited using CAC.

CAC’s purpose is to assist human coders in deriving and auditing compliant and accurate reimbursement codes based on what services were performed and documented during the patient encounter.

CAC BENEFITS

There are three immediate, positive impacts a CAC product will have when inserted into the revenue cycle. First, manual processes for managing radiology report workflow are eliminated. CAC products can sort, distribute and identify radiology reports by user-defined criteria. CAC products with natural language processing (NLP) read and understand in a manner similar to the way a human being does, therefore the computer knows how to sort, digest, and distribute radiology reports at the time of processing.

Second, CAC is supported by complete transparency and traceability. CAC products identify where in the radiology report the reimbursement codes are derived from by highlighting text within it that corresponds to the chosen ICD-9 and CPT-4 codes.

Once CAC users become comfortable with the CAC coding output, certain code pairs can be identified by the user and sent to the billing systems without human intervention or review. Additionally, CAC products help manage the code-to-bill process by identifying where the radiology reports are within the revenue cycle, status of radiology report processing, identification of report queue distribution, number of reports assigned by coder, and whether the charge information has been submitted for reimbursement to the billing system.

Finally, coder productivity is managed and traced through the CAC system. Radiology coder productivity gains have been observed to increase over 300% when utilizing CAC. Productivity gains can be measured through dashboards and trend reports, which provide a snapshot of the users’ success by combining automated coding and production metrics.

Production metrics gauge the number of reports that have been coded complete, correct, and ready-for-bill with or without coder intervention. Additionally, production metrics should identify the number of reports that have been classified as needing review or coder intervention for documentation weaknesses. Combining the automated coding results with overall production metrics allows meaningful data analysis to maximize CAC efficiency and effectiveness to boost return on investment.

HOW CAC IMPROVES RADIOLOGY

Radiology administrators have adopted CAC products to benefit from the elimination of manual processes, enhance coder productivity, increase coding accuracy and consistency, and improve overall manageability of the coding and auditing process.

One of the greatest benefits of deploying any CAC solution is coding consistency. But how is coding quality measured? CAC products possess auditing tools that allow users to examine several components including the software’s output, the medical coding professional, and coding changes while also identifying documentation weakness trends by physician.

Industry standards show that CAC products are generating CPT coding agreement rates of more than 90% for diagnostic radiology reports. Diagnosis agreement rates are a bit lower due to variability of code choice selection and some gray areas within the guidelines.

Positioning technology to automatically identify deficiencies and strengths in the coding process through user-defined audits allows radiology administrators and billers to use technology to advance their revenue cycle and compliance programs. Coding, auditing, and compliance will become more and more significant as the industry transitions to ICD-10-CM in October 2013.

SUMMARY

In today’s healthcare environment, radiology is continually under pressure to change. CAC can aid in reducing costs, providing data to measure results, and improving coding accuracy. Radiology administrators and coding managers should be thinking now about how they can effectively respond to coding production bottlenecks and audits. A consistent and up-to-date coding process is essential. Furthermore, the process must have the transparency to clearly justify coding and billing decisions. The demand for CAC only stands to grow with the implementation of ICD-10-CM in just a few years.


Mr. Morsch is vice president of technology at A-Life Medical. He directs the company’s linguists and oversees those software engineers engaged in the company’s NLP applications. He can be reached at 858-795-1668 or via e-mail at mmorsch@alifemedical.com.