Revenue streams are in a state of flux in today’s changing healthcare landscape. However, at least one constant remains: quality medical coding is a critical factor in maintaining a healthy revenue stream.
Around 42% of claims are denied because of coding issues, emphasizing the importance of precise coding practices. It is important to ensure your coding fully and accurately reflects your patients’ diagnoses and the care they receive to meet revenue performance goals. Medical coding is especially challenging in specialties. Coders must stay on top of a vast numbers of new codes, revisions to existing codes and increasing complex clinical documentation requirements.
Below are two examples of complex conditions that challenge medical coders:
Chronic Obstructive Pulmonary Disease (COPD)
COPD is the fourth leading cause of death in men and seventh in terms of global health issues. Coders must recognize associated symptoms such as shortness of breath, wheezing, chest tightness, chronic cough, diminished energy, and more, and remember that these symptoms are not coded separately but categorized under ICD-10-CM’s category J44.
This category encompasses various conditions, including asthma with chronic obstructive pulmonary disease, chronic asthmatic bronchitis, bronchitis with airway obstruction or emphysema, chronic emphysematous obstructive bronchitis, asthma, and chronic obstructive tracheobronchitis. Furthermore, J44 is subdivided to specify the presence of an acute lower respiratory infection and exacerbation, requiring a comprehensive understanding of these further categorizations. In some cases, category J45 is employed to specify the type of asthma.
More information about the intricacies of coding for COPD, can be found in our recent Medical Coding Academy Monthly Newsletter.
Prostate Disease
Men are assailed by the diseases that can affect anyone such as heart disease, stroke, diabetes and cancer, but they also have unique issues such as prostate cancer and benign prostate enlargement. Coding for prostate disease falls within categories N40 to N42, with neoplasms of the prostate identified separately. Additional codes are designated for specifying associated symptoms such as urinary frequency, obstruction, retention, urgency, and incontinence. Accurate coding of both the procedure and diagnosis is crucial to ensuring correct claims submission and reimbursement, given how frequently prostate screening is performed in urology practices.
Prostate-specific antigen (PSA) tests are representative of the complexities around coding. There are two types of tests: screening and diagnostic. Screenings for PSA are conducted when there are no signs or symptoms of prostate cancer, while diagnostic tests are performed when the patient does present with indicators of the disease. Coding these tests must be meticulous because of varying requirements among payers, including Medicare. Codes are often based on elevated PSA or benign prostatic hyperplasia for diagnostic tests, with or without lower urinary tract symptoms. In some cases, Medicare may consider payment for urological signs or symptoms like gross hematuria, benign essential microscopic hematuria, frequency of micturition, or nocturia.
More information about the intricacies of coding for Prostate Disease can be found in the Medical Coding Academy Monthly Newsletter.
What to Look for in Medical Coding Staff
A highly trained and experienced coding staff is essential to ensure accurate medical coding and avoid backlogs. Effective coders:
- maintain an accuracy level of 95% or higher
- have certification from AAPC or AHIMA
What to Look for in a Strategic Partner
When outsourcing coding services, partnering with a reliable partner like Shearwater Health is a prudent choice. Shearwater offers a dedicated team of coders and clinical documentation improvement (CDI) specialists, along with Six Sigma experts who streamline the entire process.
Shearwater coders are also clinicians, making them particularly equipped to handle complex cases. Shearwater’s track record is impressive, with over 600 certified coders reviewing approximately 7,000,000 charts annually, boasting an accuracy rate of 96% as confirmed by third-party audits. Client satisfaction remains consistently high at 97%, making Shearwater a thoroughly vetted, and trusted, medical coding partner.
