The Coding Corner

Have you ever wondered who was on the other end of the phone or computer asking you to make coding changes to the patient report you just completed? Or why procedures need to be coded the way that they are? Each month, we will try to solve this issue by addressing common coding errors in our Q & A portion of RadNews. Below are the UMass Memorial coders. 

(Left to Right: Deborah Serafini, Cheryl Chevalier, Penny Ellsworth, Trina Carbonneau, Terry Balzano and Linda Balawender)

Penny Ellsworth, Coding and Clinical Documentation Manager and her team of 5 Certified Professional Coders are located at the Hahnemann Campus, and are in charge of coding for most of the hospitals within the UMass institution. The coding team assigns procedure codes, as well as the diagnosis codes for outpatient studies. Daily, they work with the leads through PeerVue for confirmation of what was performed, while also taking calls for pre-authorizations and questions from the billing office, process research studies, and participate in quality improvement measures within the department.

Every year the number of procedure codes change dramatically. The coders attend webinars and seminars regularly in order to stay up to date with coding changes. The coders reference reputable sources like the AMA, ACR, SIR and SNM and work in conjunction with APS before implementing coding and documentation changes. Penny says that although it may seem like the UMass Memorial coders are being a bit picky, “we follow the instructions from these coding sources to try to help everyone on the professional and hospital side in order to maximize revenue and reduce risk associated with overcoding in the event of a Medicare audit.” The hard work coming from this group has dropped the number of medical necessity denials drastically by almost 90%! 

As of October 1, 2015, ICD-10 will be implemented resulting in major coding changes. ICD-10 will introduce a much higher level of specificity and will significantly increase the number of diagnosis codes.  Penny emphasizes that being prepared for this change calls for a “proactive” approach now, rather than “reactive” later. CMS has recently released LCD/NCDs (medical policies) for ICD-10. The coding staff is currently reviewing orders and documentation to see how this will impact future revenue.  Penny will be working within the department to help educate all staff in regards to what changes will need to be made.

Penny and her team are happy to answer any questions you might have and explain the reasoning behind the guidelines. Below is our first Q & A for “The Coding Corner.”  

Q. Is there a difference between how diagnosis codes are assigned for “cancer” vs. “history of cancer”?

A. Yes! There are different diagnosis codes for these scenarios. According to the AMA, when a primary malignancy has been previously excised or eradicated from its site and there is no further treatment directed to that site and there is no evidence of any existing malignancy, a “history of cancer” code should be used to indicate the former site of the malignancy. It is important that the documentation is clear as to whether the patient is receiving active treatment or if the patient has a history of cancer.