MDNews - Central New York

SPECIAL FEATURE Writing the of Medical Education A CCORDING TO BETH SASSANO, CPC, CPMA, CCS-P, cod- ing instructor at Bryant & Stratton College and Chief Operating Officer at Syracuse's North Medical Cardiovascular Group, today's world of coding is dictated by the need for specifics. Simply providing a code and diagnosis is no longer sufficient. Each diagnostic code must be sup- ported by substantial documentation, which must not only match the specific diagnostic code in order to be considered for reimbursement, but also be in line with the patient's coverage determina- tions. Coding a simple otitis media is not just a matter of selecting the unilateral code for a middle ear infection. As Sassano explains, the sophistication of payer systems requires coders and providers to answer one root question before receiving reimbursement: Was the service medically necessary based on the presenting complaints? The Evolution of Coding A hospital- or practice-based coder is no longer relegated to the billing world, but is now an integral link on the front desk — in scheduling and communicat- ing with patients and in educating office and medical staff about how their individual jobs relate to coding require- ments. Coders have become responsible for compliance programs, assuring adher- ence to coding, documentation, and billing rules and regulations. In some cases, coders physically view procedures Code OVER THE PAST FOUR DECADES, THE ROLE OF A MEDICAL CODER IN THE HOSPITAL AND PRACTICE SETTINGS HAS TRANSFORMED FROM PERFORMING LARGELY SECRETARIAL DUTIES TO HELPING ASSURE THE PROVIDER OF SERVICES RECEIVES REIMBURSEMENT FOR HIS OR HER WORK EFFORTS. AT BRYANT & STRATTON COLLEGE, THE CERTIFIED PROFESSIONAL CODER PROGRAM IS STRUCTURED TO DEVELOP AND SUPPORT MEDICAL CODERS AT ANY LEVEL. to better understand the services to which they assign codes and ensure the provider is being properly compensated for his or her work effort. Incorrect coding or an overlooked notification can put a physician at risk for penalties. For example, should a practice perform an echocardiogram (ECHO) on a patient referred from a primary care physi- cian and whose insurance policy does not cover the diagnostic test reflected in the code attached to the ECHO, the practice is required to have the Medicare patient sign an Advance Beneficiary Notice (ABN) before the test is performed. The ABN form explains that the Professional Skills Center Staff, L-R: Brian Curtis, Director; Heather Bessette, administrative assistant; Devin Butler, administrative assistant; Brian Zalick, Healthcare Account Executive 16 | Central New York MD NEWS ■ MDNEWS.COM patient's insurance policy may not cover the ECHO, how much the patient may be responsible for financially and why the ordering physician recommended the test. If the final test results change the diagnosis code to one under which the ECHO is covered, the payer will reimburse the practice. However, if the ECHO results do not alter the code and the practice neglected to provide the patient with an ABN, the financial burden of the diagnostic test falls on the physician, and the patient cannot be billed. In these situations, a coder's new role as educator — from teaching the front desk staff to be aware of the required correspondence to teaching the ECHO technologist how to serve as a check and balance within the system before performing a test — is crucial. Photos courtesy of Bryant & Stratton College

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