EHRs and Coding Errors - What Every Practice Should Know

Why Should You Attend:

A substantial percentage of Electronic Health Record (EHR) applications have features that assist providers with determining evaluation and management, diagnosis, device and procedure codes. When designed, implemented and used correctly they can improve coding accuracy and supporting documentation. However, inaccuracies in assisted coding platforms can place healthcare organizations at risk for lost revenue, denials, rejections, and in some instances substantial penalties. At this time there is no regulatory body that ensures that software applications and/or their implementations are accurate or validated.

This session will review common problems associated with coding applications, their implementations and their monitoring in clinical practice.

Areas Covered in the Webinar:

• E/M coding and documentation
• ICD-10-CM and HCC coding and documentation
• CPT procedure coding and documentation
• EHR coding design issues and potential errors and how to avoid them
• Best practices in coding and documentation
• EHR content (e.g., template) issues and their impact on coding
• Knowledge of EHR coding deficiencies can prevent negative audits
• Improvements in documentation and coding based on medical necessity may result in significant increases in revenue

Who Will Benefit:

• Coding and compliance professionals
• Auditing professionals
• Healthcare legal professionals
• Healthcare insurance professionals

Instructor Profile:

Topic Background:

Evaluation and management (E/M) codes are CPT codes reported by most healthcare professionals and are used to compensate providers for work performed in the care of patients other than procedures. Payments to clinicians tied to E/M codes represent the majority of provider income in the U.S. Selecting an E/M code following a patient encounter requires knowledge of complex rules related to the level of history obtained, the level of exam performed, the complexity of medical decision making, modifiers that may be needed and in some instances the amount of time spent with the patient. Multiple EHR vendors have created software tools that assist providers with selecting the most accurate code. However, the use of these tools may result in coding inaccuracies. In some instances they are the root cause or repeated coding errors. Providers and billing/coding professionals need to not only understand coding and documentation requirements, but also how this information is use by their EHR platform prior to accepting the codes suggested by these applications.

International Classification of Diseases – Clinical Modification (ICD-10-CM) codes are used to determine diagnoses that are then used to in part to justify an encounter, test, procedure or other form of care. Some EHR platforms assist providers with selecting the most specific ICD-10-CM codes and prompt them to include as many applicable ICD-10-CM codes as possible. This may increase the medical necessity/complexity of medical decision-making component of an encounter and impact E/M codes or the justification for a surgical or other procedure. ICD-10-CM codes are also used with Hierarchical Condition Category (HCC) codes to determine risk-adjusted factor scores that are tied to reimbursement in Medicare Advantage, ACOs, MIPS and other programs. Some EHR vendors offer support for clinicians in selecting the most specific codes that increase the level of severity of illness though Hierarchical Condition Category (HCC) coding. Inaccurate ICD-10-CM coding may adversely impact E/M coding, justifications for procedures, treatment options, and the determination of risk-adjusted factor scores.

CPT coding (in addition to E/M coding) for procedures is also supported by EHR applications that may or may not ensure that one or more required ICD-10-CM codes is documented during the encounter, and that there is supporting documentation in the record to justify the use of the ICD-10-CM code(s).

Errors in independently designed software applications that automated and support the process of selecting E/M codes, ICD-10-CM codes and CPT procedure codes may lead to denials, rejections, penalties and/or revenue loss.