Coding Reviews Improve the Accuracy of Coding by Nephrologists

Coding Reviews Improve the Accuracy of Coding by Nephrologists

Coding reviews, continuous education and continued monitoring are factors that are proven to improve medical coding and billing by nephrologists.

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Navigating nephrology coding and billing can be quite complex and requires an in-depth understanding

of

federal

guidelines

and

requirements.

Coding

accuracy

and

clear

documentation are critical for any practice to be accurately reimbursed for services provided. A researchstudyrecently published in Nephrology News & Issues prove that nephrology medical billing as well as coding can be improved by providing coding review and application education for nephrologists.

Nephrologists, like any other specialists depend on their practice’s billing experts for medical claim documentation purposes. However, it happens often that even the best practice staffs are not able to provide the level of expertise necessary in today’s changing and challenging practice environment.Confusion

regarding payment-related

regulations can

also put

nephrologistsat legal risk.

Getting the coding and billing “right” the first time can save the medical practice time, resources, and money. At the same time, it is critical to adhere to the Centers for Medicare & Medicaid Services’ (CMS) fraud and abuse regulations concerning physician billing, coding and documentation. Over-documentation as well as under-documentation are considered equally fraudulent and may increase the practice’s risk.

Nephrologists’ Coding Accuracy Can Be Improved – How? Researchers analyzed the coding accuracy of nephrologists that had signed up for education classes from May 1, 2014 to February 28, 2017. Physician vintage (years of experience), coding accuracy (based on physician documentation), and risk were all reviewed.The analysis focused on comparing how each nephrologist coded prior to receiving education and their coding accuracy following continuous education.

Data of 97 physicians with different years of practice experience, working in general nephrology practices across the United States were evaluated. Based on the years of experience, physicians were grouped into categories such as 1-5 years, 6-9 years, and 10+ years of experience respectively.

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The most common E/M codes used for nephrology were: Office

Hospital

New Visit

Initial visit

99203

99221

99204

99222

99205

99223

Established visit

Subsequent

99213

visit

99214

99231

99215

99232 99233

Nephrologistswere educated via a web-ex and phone conferences, reviewing both areas where coding was accurate and inaccurate, based on the nephrologist’s documentation.

They were shown specifically where the errors occurred either in their documentation and/or in their coding of an appropriate E/M level.

Most

common

coding errors that

were

noted

include over documentation, under

documentation, over coding, and other errors due to purposefully coding at a lower level to audit risk.

Based on the results of initial coding review, a follow-up coding review is performed either at 30, 60, 90, or 120 days later. After each coding review, education is provided again, focusing on where each nephrologist’s errors occurred and what was needed to document and code correctly.

Continuous education following coding reviews improved the accuracy of coding by nephrologists. Improvements in coding accuracy were noted for all physician experience cohorts and for all codes. •

1-5 years of experience - a small difference was noted between their initial coding accuracy pre-education and following continuous education, but even this group demonstrated an improvement of 6%.

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•

6-9 years of experience – they showed the greatest improvement, moving from a 67% initial coding accuracy to 85% following education—a 27% improvement.

•

10+ years of experience – these nephrologists had an improvement of 12% in their coding accuracy following education.

Overall across all levels of experience, the initial accuracy on coding review averaged 73% vs. a post-education average of 85% resulting in an improvement, on average, of 16%.

Coding accuracy comparison for the first 6 months showed that nephrologists with least years of experience (1-5) showed the best initial coding review results. Physicians with 6-9 years experience, who are at the peak of their practice productivity,have the worst initial coding review results. This cohort is excessively busy and/or distracted and is expected to have formed bad coding habits, resulting in lower score on initial coding review accuracy.Professional medical billing and coding companies can be of great help for these physicians. Meanwhile those with >10 years experience had initial coding review results in between the before mentioned two groups.This cohort may have a combination of the luxury of being somewhat less busy with clinical activities, have more overall experience and understanding of appropriate documentation, coding and billing, and value its importance to the business success of their practice.

The study concludes that coding reviews as well ascontinued monitoring can help nephrologists toassess the accuracy and completeness of the documentation of services provided and to determine if that documentation supports the claims ultimately submitted for payment.

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