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Computer-assisted coding software in the bigger picture of health IT

authored by added December 31, 2010 19:27 by Matt Sluzinski

In the past few weeks, we’ve looked at several code sets (ICD, ICD-CM, HCPCS, and CPT) that are significant in the medical coding arena. Now, let’s explore computer-assisted coding (CAC) applications and how they fit within the health care information technology environment.

As you know, code sets form the foundation of medical coding. If you don’t know which code represents a specific medical diagnosis or procedure, you can look it up in the appropriate code set — much like you’d look up an unfamiliar word in the dictionary.

Simple enough — if you are looking up a code or two. But medical centers may see hundreds, or even thousands, of patients each day. Every diagnosis made — and every procedure performed — by a clinician must be coded using one of the above code sets. (That is, if the medical center wants to be paid for services provided!)

Even if we assume that to some degree the Pareto principle is in effect — that the majority of cases seen at a medical center can be coded using a reasonably small number of codes — we’re still talking about human coders becoming intimately familiar with hundreds of codes (out of the 15,000 or so codes in ICD-9-CM).

So it’s no surprise that health care organizations are seeking out companies like pmFAQtory to help them implement CAC applications such as CodeRyte. These software tools do the initial assigning of codes, meaning you need fewer human coders — and those coders only have to “audit” the software’s decisions, and perhaps dissect and code the really complex cases.

Within a health care organization’s information technology landscape, CAC applications sit among many other software systems. Various systems feed information into the CAC application; once processed by CAC software, data is fed into more systems.

These other systems include:

  • A phone/dictation system into which physicians dictate their patient notes

  • A transcription application to convert audio dictations into text

  • A routing interface to bring transcribed notes together with relevant patient information, such as a patient number, demographic data, and insurance information

  • A billing system to match procedures with charges and generate a bill for third-party payers and/or the patient

  • An electronic medical record to house each patient’s individual health record

The CAC application generally sits between the routing interface and billing system. As you might guess, there are various checks and balances, and lines of communication, between these systems to ensure data integrity. For example, if a human coder is checking the output from a CAC application and realizes more specificity about a diagnosis is needed from the physician, there’s an avenue for him or her to connect with that doctor.

When managing a CAC software implementation, pmFAQtory’s job — among other things — is to take a holistic look at the organization’s IT environment, determine the interrelationships among the myriad systems, and ultimately ensure that all necessary data flows to and from the new CAC software.

How can pmFAQtory add value to your health care IT project? Contact us.

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