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)

Compliance Billing: Power Mobility Devices
December 27th, 2022 - Chris Woolstenhulme
In May of 2022, the OIG conducted a nationwide audit of Power Mobility Device (PMD) repairs for Medicare beneficiaries. The findings were not favorable; the audit revealed CMS paid 20% of durable medical suppliers incorrectly during the audit period of October 01, 2018- September 30, 2019. This was a total of $8 million in device repairs out of $40 million paid by CMS. We gathered information in this article to assist providers and suppliers in keeping the payments received, protecting beneficiaries, and assisting you in ensuring compliance.
Leveraging Hierarchical Condition Category (HCC) Coding to Improve Overall Healthcare
December 27th, 2022 - Kem Tolliver
Diagnosis code usage is a major component of optimizing HCCs to improve overall healthcare. Readers will gain insight into how accurate diagnosis code usage and selection impacts reimbursement and overall healthcare.
Accurately Reporting Diabetic Medication Use in 2023
December 20th, 2022 - Aimee Wilcox
Along with the ICD-10-CM coding updates, effective as of October 1st, the guidelines were also updated to provide additional information on reporting diabetic medications in both the general diabetic population and pregnant diabetics. Accurate reporting is vital to ensure not only maximum funding for risk adjusted health plans, but also to ensure medical necessity for the services provided to this patient population.
REMINDER: CMS Discontinuing the use of CMNs and DIFs- Eff Jan 2023 Claims will be DENIED!
December 19th, 2022 - Chris Woolstenhulme
Updated Article - REMINDER! This is important news for durable medical suppliers! Effective January 1, 2023, CMS is discontinuing the use of Certificates of Medical Necessity (CMNs) and DME information forms (DIFs). We knew this was coming as the MLN sent out an article on May 23, 2022, but it is time to make sure your staff knows about these changes.
How Automation Could Impact the Future of Medical Coding
December 15th, 2022 - Find-A-Code
Automation is a fact of life in the modern world. As digital systems expand and mature, the creators of those systems are bringing more automation to more industries. Medical coding isn't the exception.
CPT Codes and Medicare's Relative Value Unit
December 13th, 2022 - Find-A-Code
A recently published study looking to explain income differences between male and female plastic surgeons suggests that billing and coding practices may be part of the equation. The study focused primarily on Medicare's relative value units (RVU) as applied to surgeon pay. But what exactly is an RVU?
Identifying the MEAT to Support Reporting Chronic Conditions in the Computer-Assisted-Coding (CAC) World
December 13th, 2022 - Aimee Wilcox
The benefits of computer-assisted-coding (CAC) are great and understanding how to engage with the engine to ensure maximum coding efficiency is vital to the program's success for your organization. But how do you know when to accept an autosuggested code and when to ignore it, especially when it has to do with historical patient data?

Home About Contact Terms Privacy

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

Copyright © 2000-2023 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association