Getting shots into arms has been a top priority for healthcare providers since the federal government gave the green light to several COVID-19 vaccines. But while speed was key for immunizers, medical coding efficiency has taken a major hit.
At the heart of the issue is the way two major COVID-19 vaccines were created, Amber Epperson, RHIA, CHDA, COC, recently told RevCycleIntelligence.
“[Some] COVID-19 vaccines are two-dose vaccines,” said Epperson, who is the director of health information management services and the physician central business office at LMH Health, a system with a 174-bed hospital in Lawrence, Kansas, and 35 affiliated physician practices.
While the second dose of these vaccines ensures maximum efficacy for patients, coding that follow-up encounter creates extra paperwork for health information management and revenue cycle teams. And that administrative burden is coming at the wrong time: providers all over the country are already facing a return to pre-pandemic volumes after patients delayed care at the height of COVID-19. Additionally, many providers are seeing new surges in COVID-19 hospitalizations as the Delta variant takes hold in the US.
For LMH Health, a solution to this medical coding efficiency problem rested with an existing strategy used by another department.
“At the time, we were only planning having to code [vaccinations] at one time,” Epperson stated. “But we were also thinking through with the revenue cycle team how we could increase our efficiency while still coding the rest of the accounts coming in for the inpatients being seen for COVID-19 and other things. We went to our patient accounts team because we know they have certain rules that they have built in their system for claim edits and things of that nature.”
LMH Health partnered with Cerner, which provides the system’s EHR and now revenue cycle management platforms, to apply this rule-based coding to vaccination efforts.
“What we were able to do was to use the recurring encounter that we have set up with Cerner so that the patient would only have to be registered once for each of the vaccines,” Epperson explained. “So what happens is the patient registers once, we collect that data one time instead of twice, and that encounter stays open until the patient comes in to receive their second dose.”
With some tweaks to rule-based coding for these new vaccines, LMH Health has been able to ensure that a coder did not have to touch any of the thousands of accounts that the system has as part of its large-scale immunization efforts. This is thanks to a discharge rule for recurring patients with an order and a charge for a two-dose COVID-19 vaccine, which automatically assigns the appropriate ICD-10-CM code and changes it to final coded status.
“It ended up being about a hundred hours of coding time that would have taken away from all of the other coding that we still had to do,” Epperson added. “So, we were able to just monitor to make sure that the accounts were hitting our revenue cycle and patient accounts the appropriate way.”
The new medical coding strategy has also been beneficial for coders who are “already working overtime to try and accomplish the rest of the work,” Epperson stated. “In their eyes, it was a way to continue doing what was valuable and not a repetitive task—assigning the same code to thousands of accounts.”
On top of the medical coding efficiency gains, the strategy has also enabled LMH Health to meet turnaround demands and keep the revenue cycle running, according to Epperson.
RULE-BASED CODING BEYOND VACCINATIONS
Epperson believes rule-based coding could help other areas of the health system. One area with an immediate focus is perioperative care.
“For our outpatient surgeries, all patients who are scheduled to come in for surgeries are required to do a COVID test three days prior and before they are able to come in, they have to show a negative result,” Epperson said. “We have been coding those manually. Our plan is to also get those with rule-based coding.”
“What we’re going to have is a report from our LIS system that will show us any of the pre-op tests that were positive. We’ll monitor that report every day and we’ll allow the rule-based coding to code preoperative exam for COVID based on the rules that we’re going to have set up in the system for the pre-op tests. For any that we find that are positive, we will go back in by exception and add the COVID diagnosis to those.”
But the medical coding strategy has even more applications beyond pandemic-related care, Epperson adds. Take mammograms, for instance.
“Mammograms are happening hundreds of times every day, and many of them are negative. But some may require a follow-up,” Epperson explained.
“We know that in our radiology system that we have a discrete field where they can show if a follow-up is needed. We’re going to work next with them to get a report on any of the mammograms that require a follow-up or have some type of a finding and set up this rule-based coding for our mammograms where they will automatically drop when they have the specified charge on it that we’re looking for.”
Epperson expects a wider application of rule-based coding to save the health system even more time. “We’re really excited to be able to keep the momentum of this going,” the health information management leader stated.
COLLABORATION IS KEY
Improvements in medical coding efficiency during this critical time could not have been possible without collaboration across the healthcare industry, Epperson admitted. Not only did several departments from LMH Health team up to develop a strategy for coding immunizations, but the health system partnered with a long-time vendor to innovate.
“The thing that I think has been most valuable in it is just collaborating with our IT department and the Cerner team to really help us get this in place,” Epperson concluded. “My biggest lesson learned in this is don’t be afraid to reach out and ask questions if something is possible to innovate. Have that curiosity about whether something is possible. It has helped us grow and ensure that we’re able to discover new things, new workflows, and make things possible that we didn’t realize were.”