Computer Assisted Coding – Friend or Foe?

Pulse Check:

Raise your hand if you believe that Computer Assisted Coding (CAC) is your friend. Ok, raise your hand if you believe that CAC creates more trouble than it is worth. Now, how many of you believe that it may be a little bit of both? Good. Keep reading.

Whether you are in the friend or foe camp, we can all agree that CAC continues to evolve, integrate with and certainly change the way we operate in the coding business. In an age of electronic health records, ICD-10 coding and operational changes from healthcare reform, it is imperative that we continue to move and change with technology as it re-shapes our careers.

I have seen CAC software referred to as a coder’s “Spell Check” software – which is an accurate depiction  - as a basic rule. However, where spell check just made us a little less reliant on our own individual spelling skills (and don’t even get me started on auto-correct!), CAC has generated a new direction for our careers. We are now editors, data analysis experts, validators and facilitators to ensure that not only are we doing our jobs, but that the technology is accurately doing its job as well.

With this new direction in mind, we must remember that most technology still operates on a garbage-in-garbage-out rule. Therefore, we have summarized our general thoughts on the “Friend or Foe” relationship.

Benefits

  • Increases productivity for outpatient coding and is evolving in providing this same benefit for inpatient coding.
  • Very helpful for coders new to the field of coding as it provides a good starting point for them in locating codes.
  • Enables CDI staff who may be less familiar with coding to obtain codes to begin their concurrent reviews.
  • Alerts coders to diagnoses and procedures that they may have overlooked due to the amount of data in the records.
  • Extremely helpful in identifying specificity now required in coding with the onset of ICD-10.
  • Alerts coders to diagnoses, which may have otherwise been overlooked.

Limitations

  • The primary function is to provide a code based on documentation.  The codes do not have the ability to provide quality measure information or qualitative data. In its current state, healthcare organizations have not seen the cost benefit to date.  However, as systems mature this will change.
  • Errors can be detrimental to quality measures, profiling and reimbursement for both patient and provider.
  • Often, signs and symptoms are coded from written diagnoses and are not removed from the claim prior to claim submission when a definitive diagnosis has been established.
  • Reports from CAC must be analyzed extensively in order to improve system performance. This takes analytical skills that may not be available in the current staffing environment.
  • Coders may rely too much on CAC generated codes and not verify them as thoroughly as required. This is especially true for new coders who are not as familiar with coding guidelines.

Where do we go from here?

When implementing an effective CAC system, the integration, testing and timing must be approached with careful execution. As with any system implementation, a good relationship with the IT department is critical.  System interfaces must work correctly in order for the CAC to function properly. Be sure to approach outpatient CAC and inpatient CAC with the understanding of coding guidelines.  The correct CAC system set-up is based on the differences in coding these patient types.

What it all comes down to is balance. CAC is not a stand-alone solution. It is a tool that, when implemented and leveraged effectively can improve and even ease elements of the coding process. As this tool evolves gets more sophisticated, so will the role and requirements of the coding profession. So, buckle up and get ready for whatever may come next!