Trendspotter: Computer-Assisted Coding Is Coming

Are you ready for computer-assisted coding (CAC)? So far, it’s being used mainly in hospital outpatient departments, emergency rooms, imaging centers, and ambulatory surgery centers. But it’s starting to move into inpatient settings and ambulatory-care clinics, as well. So you might soon be receiving solicitations from CAC vendors such as CodeRyte, A-Life Medical, AMI and 3M Healthcare Solutions. Whether or not your practice can benefit may depend on such factors as EHR adoption, the types of work you and your colleagues do, and whether you employ professional coders.

There are at least two different forms of CAC. One is similar to the E&M code checkers found in many EHRs. Products from companies like IMO are integrated with EHRs and map the medical terms used in those records to diagnosis and procedure codes. So if you use drop-downs and pick lists for most of your documentation, the program can identify many of the codes you should be using, based on the discrete data in the EHR.

A more common approach to CAC uses what is known as “natural language processing” to identify relevant terms in electronic text and analyze them in the context of coding logic. By using this kind of software, some radiology departments have been able to code up to 60 percent of their claims automatically and send them directly to the billing system. Radiology and a few other specialties are especially suited to CAC because they have so many repetitive cases. Because these are easy to code, CAC is fairly accurate in these areas.

In more complex care settings, CAC helps increase productivity by doing some of the basic coding work, while allowing human coders to make the final decisions. These programs reduce the amount of time that coders have to spend searching through documents to find relevant information. CAC software does not work with paper or scanned documents; it’s designed for electronic text, such as transcribed notes or reports. But since that’s all that the majority of practices have online right now, CAC might be useful to some groups in which physicians don’t code their own claims.CodeRyte, which has been around for a decade, claims that it “automates medical coding for leading multi-specialty clinics around the country.” It also automates coding for about 70 single-specialty, hospital-based practices. Most of them are radiology, pathology and ER groups, but their customers also include some cardiology practices. CodeRyte avers that its product can increase coder productivity by up to 200-300 percent.

A-Life Medical, another CAC leader, also says that it improves coder productivity and integrates with hundreds of billing, hospital and document management systems. According to the company, it assists coding operations for more than 40,000 physicians.

There are a few reasons why CAC is likely to become more prevalent. First, experienced coders are in short supply, which means that practices need to maximize the productivity of those who are available. Second, hospitals are using these products, and more and more physicians are working for hospitals. And third, the industry is on the verge of moving to ICD-10 diagnostic coding. When that happens, there will be a big expansion of codes, with an accompanying rise in the complexity of coding. Some observers believe that computer-assisted coding can help physicians and hospitals cope with this challenge.

One thing is for certain: physicians and their staffs spend far too much time on administrative tasks that take time away from patient care. If CAC can remove some of that burden, while helping practices code more appropriately, it will be welcomed in physician groups of all kinds.