Best Practices: Why Your Practice Needs a Master Coder - By: Judy Capko

Medical practices are faced with a number of changes each year, some of them unexpected. But one change that comes each year are the changes in the annual revision of current procedure terminology (CPT) codes. In 2011 there are 212 new codes, 106 revisions and 110 deleted CPT codes. Are you ready? If not, there’s a chance your payments will be stalled and some services may go unpaid if you don’t apply these changes.

It’s important for every practice to examine CPT coding modifications each year and revise those that affect their specialty and the services they offer. The updated codes must be changed in the billing system’s charge master and on the encounter form. One of the best ways to make sure this happens is to assign one person in the practice to be the coding expert and hold him or her accountable for implementing these changes.

The Master Coder (MC) may be a new concept for some practices, but embracing this can ensure the practice is compliant. Here are some tips on how to succeed with executing the role of an MC in your practice so that you get paid accurately and timely for what you do.

First, define the role. This means determining responsibilities the MC will assume. Typically this includes:

1.Monitor coding application, ensuring it accurately represents the services performed and services are coded appropriately to get you paid correctly.
2.Required to monitor coding and billing performance.
3.Expected to obtain updated CPT and HCPX procedural coding books each year and ICD-9/ICD-10 (diagnostic coding) and implement changes.
4.Required to attend formal coding continuing education courses each year with close attention paid to changes affecting your specialty.
5.Expected to provide entire staff with an annual coding update based on changes that emerge each year.
6.Responsible for conducting formal coding training sessions for new providers and new billing staff members within 30 days of hire.
Next, identify the person on staff best suited for this position and discuss the role with him or her. Clarify the responsibilities and accountabilities, and what education and support will be provided. To begin with, don’t assume the person you have in mind is an expert. If he is not a certified coder get him trained and certified. The AAPC coding certification is acquired through gaining expertise and passing the test provided by the American Academy of Professional Coders. Certified coders are required to obtain continuing education credits to maintain their certification. You will receive the benefits of providing this training for your MC. She will be the one who keeps the entire practice on course with coding properly.

The MC should also monitor coding performance and variances between providers each month and graph them, presenting the reports to the management team with any explanation she may have to explain variances. In other words is there a reasonable explanation why Dr. Able is providing more low level E & M services, and Dr. Code is coding all level 4 and 5 CPT codes? It may be reasonable if Dr. Able sees patients with minor problems and Dr. Code sees more patients with multiple chronic problems.

What about those ICD-9 diagnostic codes being used for those chronic visits? Do they support the medical necessity for the level of service? If not, you might be getting claims rejected or down-coded. On the other hand, if a number of discrepancies are seen, it may be time for a coding audit to clarify the validity of the variance and determine if additional provider training in either coding or documentation of services is needed.

ICD-10 implementation is slated for October 2013. APC is already offering training on this complex code-set that will require far more specificity in diagnostic coding. This is reason enough for medical practices to create the role of Master Coder now, so you have a skilled expert on board before ICD-10 takes effect.

Finally, use available resources to stay updated. There are many sources to keep your MC in tune with coding updates and billing regulations, including seminars, webinars, podcasts and other on-line sources that can provide needed support on coding matters such as http://www.findacode.com. This subscription service can save you time and pinpoint coding changes that are relevant to the practice. Another source is Codapedia, which is a free service that offers an open dialogue for coders to share information and offer tips on coding application.

Coding, documentation and billing is the lifeline of the revenue flow for the practice. With physicians typically charging at least $500,000 a year (and double that for some specialties) it’s worth protecting the revenue. There’s a big upside to having a MC that knows her stuff and helps the entire office understand coding requirements so that you get paid what you deserve!

Judy Capko is the founder of Capko & Company and author of the popular book “Secrets of the Best-Run Practices,” Greenbranch Publishing, September 2005. Judy has specialized in medical practice operations and marketing for more than 20 years, and is a certified risk management specialist.

About the Author

Trusted by thousands of doctors, Kareo is the web-based practice management and medical billing software with integrated electronic claims processing that’s the most user-friendly, easy-to-buy, and easy-to-set-up solution on the market (http://www.kareo.com/).

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