To code, or not to code: that is the question: Whether 'tis nobler in the mind to suffer (786.5) The calls and emails of outrageous fortune,Or to take arms against a sea of uncoded T’cons,And by opposing end them? To be denied leave, and sleep (307.41)No more; and by taking leave we temporarily endThe heart-ache (419.9) and the thousand emailsThat my in-box is heir to, 'tis a consumption (011.9)Devoutly to be wish'd against.

Jim Cox, in his year of discontent 2005

Coding Overview and the Commander’s Statement

Ms Sharon Taylor

June 2006

DQMC

Goal

• Quality data on which to base sound decisions

Data Goal Corollary

• You give me bad data, I’ll make bad decisions

Suggested Coding “Solution”

• Have each new provider, prior to receiving privileges to practice at your MTF, spend 4 hours with a good coding trainer– Option to “test out” of the class by passing

test composed of examples of quality documentation which the provider will enter the correct diagnoses/external causes of injury, evaluation and management code(s) with modifiers, procedure code(s) and any other applicable HCPCS code(s)

One-on-one Training Overview

• Each training is specific to the specialty involved (e.g., training is different for obstetrics, orthopedics and occupational therapy)

• 1 hour documentation/diagnoses• 1 hour evaluation and

management/modifiers• 1 hour procedures/supplies/training• 1 hour practice

Training Goals

• Learn basics of good documentation

• Learn basics of ICD/E&M/CPT/HCPCS coding

• Learn when to ask for coding assistance

• Become comfortable asking coder questions (it also gets the coder comfortable working with the provider)

Measure Success of Training

• Random audit of provider’s first week of documentation/coding and provide immediate feedback

• Random audit of provider’s first month and provide immediate feedback

• Continue to audit/provide one-on-one feedback until documentation and coding are consistently at acceptable level

Professional Staff

• Arrange to have coder auditor have maximum of 5 minutes at professional staff to review issues common to the facility

• Arrange to have coders permitted to attend professional staff as – This will permit a non-threatening environment

for providers and coders to interact– Coders need continuing education too

• Now back to the beginning of this briefing

Objectives

• Understand Data Application

• Understand What the Data Are and Are Not Indicating

• Understand “Random” When Applied to Audits

Running a Business

• Would you like to know– Your customers– How much it costs to make your product– For how much you can sell your product

Running a Business

• Would you like to know– Your customers

• ICD-9-CM diagnosis data (6c)• Demographic data• Patient categories (PATCATs)

– How much it costs to make your product• Medical Expense Performance and Reporting System

(MEPRS)

– For how much you can sell your product• Relative Value Units (RVUs) and Relative Weighted Products

(RWPs) (6b and 6e)

Data Quality = $$$

• Patient Registration– PATCATS - $$$ -

• $180.8M last year (get your Coast Guard, VA, DoD civilians, and civilian emergencies correct…)

– Identifying injuries (Medical Affirmative Claims) - $$$ • $16.5M last year – demonstrates how poorly we identify

these cases

– Other Health Insurance (DD 2569) - $$$• $106.3M last year

• Documentation - $$$– Must have document filed in record– Coding - $$$

Close

• Close counts in atomic bombs

• Close counts in horseshoes

• Close does not count in coding– If there is no code, then there is no code

• Yes, we do bill for Active Duty services (in MSA we bill Coast Guard, in MAC will bill)

5a. Outcome of monthly inpatient coding audit: NAVY

Inpatient Records (DRG) (C.5)Reporting Month Apr-06Data Month Feb-06Navy 98%

NAVY MEDICINE EAST 98%NH PENSACOLA 97%NH JACKSONVILLE 100%NH GREAT LAKES 100%NH CAMP LEJEUNE 94%NH CHERRY POINT 100%NH CHARLESTONNH BEAUFORT 100%NH CORPUS CHRISTINMC PORTSMOUTH 97%NH GUANTANAMO BAY 100%NH NAPLES 95%NH ROTA 100%NH KEFLAVIK 96%NH SIGONELLA 97%NHC NEW ENGLAND

NATIONAL CAPITAL REGION 85%NHC ANNAPOLISNNMC BETHESDA 85%NHC QUANTICONHC PAX RIVER

NAVY MEDICINE WEST 100%NH CAMP PENDLETON 100%NH LEMOORE 100%NMC SAN DIEGO 100%NH TWENTY NINE PALMS 100%NH BREMERTON 100%NH OAK HARBOR 100%NHC PEARL HARBORNH GUAM 100%NH OKINAWA 100%NH YOKOSUKA 100%

5a. Outcome of monthly inpatient coding audit: ARMY

Reporting Month Apr-06Data Month Feb-06

SEOUL 90%

*HEIDELBERG 100%*LANDSTUHL 93%*WUERZBURG 100%

*FT. BLISS 97%*FT. CARSON 100%*FT. HOOD 100%*FT. HUACHUCA FT. LEAVENWORTH*FT. LEONARD WOOD 100%*FT. POLK 100%*FT. RILEY 100%*FT. SAM HOUSTON 80%*FT. SILL 100%

*FT. BELVOIR 100%*FT. BRAGG 97%*FT. DRUM

*FT. EUSTIS 100% FT. KNOX 100%*FT. LEE*FT. MEADE FT. MONMOUTH*WALTER REED 97% WEST POINT 100%

*TAMC 93% JAPAN

*FT. BENNING 100%*FT. CAMPBELL 100%*FT. GORDON 100%*FT. JACKSON 100%*FT. RUCKER*FT. STEWART 100%*REDSTONE ARSENAL

FT. IRWIN 100%*FT. LEWIS 97%*FT. WAINWRIGHT 100%

5a. Outcome of monthly inpatient coding audit: AIR FORCE

5b. Outcome of monthly inpatient coding audit: Inpatient Professional services audited and

deemed correct (C.5) NAVYReporting Month Apr-06Data Month Feb-06Navy 85%

NAVY MEDICINE EAST 85%NH PENSACOLA 34%NH JACKSONVILLE 77%NH GREAT LAKES 100%NH CAMP LEJEUNE 98%NH CHERRY POINT 100%NH CHARLESTONNH BEAUFORT 96%NH CORPUS CHRISTINMC PORTSMOUTH 73%NH GUANTANAMO BAY 100%NH NAPLES 97%NH ROTA 93%NH KEFLAVIK 97%NH SIGONELLA 70%NHC NEW ENGLAND 64%

NATIONAL CAPITAL REGION 45%NHC ANNAPOLISNNMC BETHESDA 45%NHC QUANTICONHC PAX RIVER

NAVY MEDICINE WEST 90%NH CAMP PENDLETON 93%NH LEMOORE 100%NMC SAN DIEGO 96%NH TWENTY NINE PALMS 83%NH BREMERTON 85%NH OAK HARBOR 100%NHC PEARL HARBORNH GUAM 100%NH OKINAWA 66%NH YOKOSUKA 88%

5b. Outcome of monthly inpatient coding audit: Inpatient Professional Services encounters

audited/deemed correct ARMYReporting Month Apr-06Data Month Feb-06

SEOUL 93%

*HEIDELBERG 92%*LANDSTUHL 81%*WUERZBURG 0%

*FT. BLISS 90%*FT. CARSON 91%*FT. HOOD 100%*FT. HUACHUCA FT. LEAVENWORTH*FT. LEONARD WOOD 100%*FT. POLK 90%*FT. RILEY 100%*FT. SAM HOUSTON 89%*FT. SILL 100%

*FT. BELVOIR 47%*FT. BRAGG 80%*FT. DRUM

*FT. EUSTIS 100% FT. KNOX 97%*FT. LEE*FT. MEADE FT. MONMOUTH*WALTER REED 99% WEST POINT 44%

*TAMC 97% JAPAN

*FT. BENNING 93%*FT. CAMPBELL 53%*FT. GORDON 95%*FT. JACKSON 100%*FT. RUCKER*FT. STEWART 43%*REDSTONE ARSENAL

FT. IRWIN 23%*FT. LEWIS 87%*FT. WAINWRIGHT 47%

5b. Outcome of monthly inpatient coding audit: Inpatient Professional Services encounters

audited/deemed correct: AIR FORCE

6a. Percentage of outpatient medical records on-hand containing the documentation and/or the loose

documentation of the encounter selected to be audited or documented as checked out? (C.6) NAVY

Reporting Month Apr-06Data Month Feb-06Navy 96%

NAVY MEDICINE EAST 93%NH PENSACOLA 94%NH JACKSONVILLE 100%NH GREAT LAKES 100%NH CAMP LEJEUNE 100%NH CHERRY POINT 96%NH CHARLESTON 97%NH BEAUFORT 94%NH CORPUS CHRISTI 100%NMC PORTSMOUTH 78%NH GUANTANAMO BAY 100%NH NAPLES 100%NH ROTA 100%NH KEFLAVIK 100%NH SIGONELLA 41%NHC NEW ENGLAND 98%

NATIONAL CAPITAL REGION 99%NHC ANNAPOLIS 100%NNMC BETHESDA 95%NHC QUANTICO 100%NHC PAX RIVER 100%

NAVY MEDICINE WEST 99%NH CAMP PENDLETON 100%NH LEMOORE 100%NMC SAN DIEGO 100%NH TWENTY NINE PALMS 100%NH BREMERTON 100%NH OAK HARBOR 99%NHC PEARL HARBOR 89%NH GUAM 100%NH OKINAWA 100%NH YOKOSUKA 100%

6a. % of outpatient medical records on-hand or documented as checked out? ARMY

Reporting Month Apr-06Data Month Feb-06

SEOUL 90%

*HEIDELBERG 100%*LANDSTUHL 97%*WUERZBURG 100%

*FT. BLISS 100%*FT. CARSON 100%*FT. HOOD 91%*FT. HUACHUCA 100% FT. LEAVENWORTH 98%*FT. LEONARD WOOD 100%*FT. POLK 100%*FT. RILEY 100%*FT. SAM HOUSTON 98%*FT. SILL 100%*FT. BELVOIR 100%*FT. BRAGG 100%*FT. DRUM 100%

*FT. EUSTIS 100% FT. KNOX 100%*FT. LEE 96%*FT. MEADE 100% FT. MONMOUTH 100%*WALTER REED 60% WEST POINT 100%

*TAMC 100% JAPAN 100%

*FT. BENNING 100%*FT. CAMPBELL 100%*FT. GORDON 100%*FT. JACKSON 100%*FT. RUCKER 100%*FT. STEWART 100%*REDSTONE ARSENAL 100%

FT. IRWIN 100%*FT. LEWIS 100%*FT. WAINWRIGHT 100%

6a. % of outpt medical records on-hand: AIR FORCE

More AF 6a

6a

• Why the variation– Is this a random audit?– Are ALL SADRs for the MTF included

• Technicians/nurses• Telephone calls• ALL MEPRS (include FBI)

– What qualifies as “checked-out” – in the past week, past month, past year, past decade?

• What do the data tell us?

6b. % of E&M codes deemed correct? NAVY

Reporting Month Apr-06Data Month Feb-06Navy 79%

NAVY MEDICINE EAST 78%NH PENSACOLA 72%NH JACKSONVILLE 97%NH GREAT LAKES 90%NH CAMP LEJEUNE 55%NH CHERRY POINT 57%NH CHARLESTON 78%NH BEAUFORT 80%NH CORPUS CHRISTI 91%NMC PORTSMOUTH 67%NH GUANTANAMO BAY 99%NH NAPLES 84%NH ROTA 83%NH KEFLAVIK 98%NH SIGONELLA 36%NHC NEW ENGLAND 79%

NATIONAL CAPITAL REGION 79%NHC ANNAPOLIS 80%NNMC BETHESDA 77%NHC QUANTICO 81%NHC PAX RIVER 79%

NAVY MEDICINE WEST 82%NH CAMP PENDLETON 65%NH LEMOORE 88%NMC SAN DIEGO 69%NH TWENTY NINE PALMS 80%NH BREMERTON 77%NH OAK HARBOR 93%NHC PEARL HARBOR 80%NH GUAM 100%NH OKINAWA 63%NH YOKOSUKA 100%

6b. % of E&M codes deemed correct? ARMY

Reporting Month Apr-06Data Month Feb-06

SEOUL 98%

*HEIDELBERG 78%*LANDSTUHL 64%*WUERZBURG 92%

*FT. BLISS 98%*FT. CARSON 95%*FT. HOOD 73%*FT. HUACHUCA 90% FT. LEAVENWORTH 98%*FT. LEONARD WOOD 100%*FT. POLK 71%*FT. RILEY 100%*FT. SAM HOUSTON 91%*FT. SILL 90%

*FT. BELVOIR 91%*FT. BRAGG 80%*FT. DRUM 90%

*FT. EUSTIS 92% FT. KNOX 100%*FT. LEE 79%*FT. MEADE 98% FT. MONMOUTH 99%*WALTER REED 63% WEST POINT 90%

*TAMC 40% JAPAN 90%

*FT. BENNING 78%*FT. CAMPBELL 78%*FT. GORDON 96%*FT. JACKSON 94%*FT. RUCKER 83%*FT. STEWART 57%*REDSTONE ARSENAL 97%

FT. IRWIN 54%*FT. LEWIS 65%*FT. WAINWRIGHT 80%

6c. What is the percentage of ICD-9 codes deemed correct? ARMY

Reporting Month Apr-06Data Month Feb-06

SEOUL 100%

*HEIDELBERG 80%*LANDSTUHL 93%*WUERZBURG 96%

*FT. BLISS 94%*FT. CARSON 91%*FT. HOOD 98%*FT. HUACHUCA 83% FT. LEAVENWORTH 98%*FT. LEONARD WOOD 100%*FT. POLK 87%*FT. RILEY 100%*FT. SAM HOUSTON 91%*FT. SILL 90%

*FT. BELVOIR 79%*FT. BRAGG 90%*FT. DRUM 95%

*FT. EUSTIS 93% FT. KNOX 100%*FT. LEE 90%*FT. MEADE 98% FT. MONMOUTH 100%*WALTER REED 66% WEST POINT 71%

*TAMC 60% JAPAN 90%

*FT. BENNING 97%*FT. CAMPBELL 70%*FT. GORDON 98%*FT. JACKSON 97%*FT. RUCKER 97%*FT. STEWART 80%*REDSTONE ARSENAL 93%

FT. IRWIN 46%*FT. LEWIS 62%*FT. WAINWRIGHT 20%

6d. Percentage of CPT codes deemed correct? ARMY

Reporting Month Apr-06Data Month Feb-06

SEOUL 100%

*HEIDELBERG 98%*LANDSTUHL 88%*WUERZBURG 98%

*FT. BLISS 98%*FT. CARSON 96%*FT. HOOD 97%*FT. HUACHUCA 83% FT. LEAVENWORTH 98%*FT. LEONARD WOOD 100%*FT. POLK 81%*FT. RILEY 100%*FT. SAM HOUSTON 93%*FT. SILL 98%

*FT. BELVOIR 42%*FT. BRAGG 86%*FT. DRUM 92%

*FT. EUSTIS 96% FT. KNOX 100%*FT. LEE 98%*FT. MEADE 99% FT. MONMOUTH 100%*WALTER REED 91% WEST POINT 74%

*TAMC 67% JAPAN 98%

*FT. BENNING 93%*FT. CAMPBELL 92%*FT. GORDON 98%*FT. JACKSON 96%*FT. RUCKER 89%*FT. STEWART 93%*REDSTONE ARSENAL 100%

FT. IRWIN 100%*FT. LEWIS 86%*FT. WAINWRIGHT 30%

6e. % DD Form 2569s (current/complete)? NAVYReporting Month Apr-06Data Month Feb-06Navy 56%

NAVY MEDICINE EAST 47%NH PENSACOLA 21%NH JACKSONVILLE 0%NH GREAT LAKES 0%NH CAMP LEJEUNE 72%NH CHERRY POINT 100%NH CHARLESTON 75%NH BEAUFORT 80%NH CORPUS CHRISTI 36%NMC PORTSMOUTH 16%NH GUANTANAMO BAYNH NAPLESNH ROTANH KEFLAVIKNH SIGONELLANHC NEW ENGLAND 71%

NATIONAL CAPITAL REGION 47%NHC ANNAPOLIS 63%NNMC BETHESDA 35%NHC QUANTICO 37%NHC PAX RIVER 54%

NAVY MEDICINE WEST 72%NH CAMP PENDLETON 100%NH LEMOORE 100%NMC SAN DIEGO 14%NH TWENTY NINE PALMS 75%NH BREMERTON 60%NH OAK HARBOR 57%NHC PEARL HARBOR 73%NH GUAM 100%NH OKINAWANH YOKOSUKA

6e. % DD Form 2569s (current/complete)? ARMYReporting Month Apr-06Data Month Feb-06

SEOUL 40%

*HEIDELBERG 54%*LANDSTUHL 52%*WUERZBURG 94%

*FT. BLISS 52%*FT. CARSON 96%*FT. HOOD 57%*FT. HUACHUCA 100% FT. LEAVENWORTH 28%*FT. LEONARD WOOD 70%*FT. POLK 74%*FT. RILEY 90%*FT. SAM HOUSTON 9%*FT. SILL 53%

*FT. BELVOIR 65%*FT. BRAGG 83%*FT. DRUM 92%

*FT. EUSTIS 99% FT. KNOX 95%*FT. LEE 96%*FT. MEADE 94% FT. MONMOUTH 98%*WALTER REED 27% WEST POINT 95%

*TAMC 47% JAPAN 30%

*FT. BENNING 58%*FT. CAMPBELL 79%*FT. GORDON 97%*FT. JACKSON 77%*FT. RUCKER 90%*FT. STEWART 73%*REDSTONE ARSENAL 100%

FT. IRWIN 90%*FT. LEWIS 76%*FT. WAINWRIGHT 94%

Audits

• All data included population– Each encounter equally likely to be selected

• Random selection of sample from entire population

• A person will continue to code in the same manner he has coded unless acted upon by an outside source

Your Commander Signs:

9. I am aware of data quality issues identified by the DQMC Review List and when needed, have taken action to improve the data from my facility.

Objectives

• Understand Data Application

• Understand What the Data Are and Are Not Indicating

• Understand “Random” When Applied to Audits

Questions