Identifying the MEAT to Support Reporting Chronic Conditions in the Computer-Assisted-Coding (CAC) World

December 13th, 2022 - Aimee Wilcox
Categories:   Billing   Claims  

Working with computer-assisted coding (CAC) opens our eyes to the many facets of coding not often considered. When trends are noted on a larger scale due to an engine processing high quantities of the same type of encounter or service, it is easier to see formatting, documentation, and coding issues than if you were evaluating significantly smaller numbers of the same document types. CAC is a process where the engine consumes formatted provider notes and based on programming, recommends specific ICD-10-CM/PCS, CPT, and HCPCS codes for coders to choose from. When coders accept the autosuggested code, the accuracy rate or success rate of engine functionality increases. When the coders reject the autosuggested codes, the accuracy rate is reduced. Analysts review engine performance and metrics to determine how successful and accurate the engine is in identifying and suggesting the correct code. 

The engine is programmed to apply coding rules for successful code suggestions. It consumes the medical report and applies the programmed logic to determine which codes to recommend. Coders can look at the evidence the engine used to determine the suggested code and either accept it or reject it and then can add any codes the engine may have missed. This is a field of artificial intelligence (AI) that is ever expanding and very exciting.

CAC requires analysts to review hundreds of encounters, very quickly to identify coding trends associated with engine functionality, note formatting, provider documentation, and coder behavior, and to then provide feedback to both the engine and the coder about how to continually improve performance outcomes. 

Identifying Coding Trends Improves Engine Performance

Identifying coding trends of correct or incorrect code suggestion and code reporting, are essential to ensuring accurate engine autosuggested codes; however, coder behavior plays a significant role in the process. Here are a few examples: 

  • Issue:  The engine autosuggests ICD-10-CM codes from the history sections within the patient encounter but the coders do not accept the codes. 
  • Trend: After analyzing a percentage of the encounter notes where certain condition codes were rejected, it was noted the patients were often seen in the Emergency Department for an acute, traumatic injury. The suggested codes were correctly autosuggested from the patient’s history (i.e., HPI, ROS, PMFSH) but coders will only accept the suggested codes related to the actual injury and ignore or reject the others. 
  • Resolution: Additional research highlighted an article by the AHA Coding Clinic that recommended that coders only report codes for conditions documented as addressed during the encounter, which aligns with the ICD-10-CM coding guidelines and recommendations are for coders to adhere to these guidelines and choose which codes they’ll accept and which should not be reported.

How To Know Which Conditions Meet Reporting Criteria

A common acronym has been floating around related to identifying reportable conditions. MEAT is an acronym that stands for Monitored, Evaluated, Addressed, and Treated. It indicates that if one of the document supports a condition meets the criteria of MEAT, it is considered a reportable condition. 

The following is a summary of actions that are identifiable for each of these four areas of assessing whether MEAT has been met: 

  • Monitoring: The documentation includes signs, symptoms, disease progression or regression, continued surveillance or observational findings. 
  • Evaluation: The provider documented the current state of the chronic condition (e.g., stable, exacerbated, worsening, uncontrolled). There are examination findings, test results reviewed, discussion of medication or treatment efficacy or notations of the patient’s response to treatment(s). The provider has noted assessment of late effects of a condition or illness. 
  • Assessment: Documentation exists of a discussion of a chronic condition and how it should be monitored, followed up with the recommended specialist. Records and test results are reviewed. Counseling is provided or a discussion noted about additional evaluation or ordering of additional testing to determine the status of the disease, progression, or regression. Patient care or plans are discussed with another provider on the patient’s care team, internally or externally.
  • Treatment: The current treatment is documented, reaffirmed, or changed. There is an increase or decrease in medication dosing. A referral to a specialist is made, additional testing, imaging, studies, or therapies are ordered. Patient education is provided related to a specific condition, recommended or ongoing treatment. Additional treatment options are recommended, discussed, or summarized. The treatment plan is reviewed and updated. 

Understanding what to look for when trying to determine if a historical code should be reported for a specific encounter takes practice and having reference information at your fingertips can ensure coding and auditing success.

 

 

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities? 
Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)
December 19th, 2023 - Aimee Wilcox
Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association