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Facility Coding

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Facility Coding

Facility Coding

The Coding Network is a premier provider of accurate coding for all types of hospital outpatient departments and clinics, ambulatory surgical centers, emergency departments, cardiac catheterization labs, and both diagnostic-and-interventional radiology departments. Whether you have a temporary backlog or want to explore the cost efficiencies and quality of either temporary or long-term coverage for all or part of your coding, we can help.

 

Facility coding important?

Our focus is on outpatient facility coding and reimbursement, but facility coders and pro-fee coders need to be aware that the facility is not the only entity that can submit claims for services performed in facilities. Physicians and other providers also report the services they perform in facilities to be reimbursed for their work.

For instance, suppose a specialist, such as a cardiologist or gastroenterologist, provides a consultation for a patient in the emergency department of a hospital. The specialist then bills the professional fee using the appropriate outpatient consultation CPT® code (99241-99245) or other appropriate E/M code based on payer guidelines. (Medicare, for instance, no longer accepts the consult codes, and providers and coders should check with their individual payers to determine the appropriate codes for billing consultations.)

Physician Coding in a Facility Setting

It’s worth noting that this outpatient scenario is similar to how the physician would bill for a service they performed in an inpatient setting. Although physician services are often provided in an outpatient setting (such as a physician office, ED, ASC, or diagnostic department), physicians aren’t limited to billing from these settings to capture their professional work. Many private practice physicians have admitting privileges with hospitals and can admit their patients for more acute care when warranted. During the hospital stay, the admitting physician typically makes frequent visits to the hospital and performs an inpatient E/M service at each visit. This is a billable service for the physician. Therefore, each E/M service performed is coded using the appropriate CPT® code(s) to capture the professional work (pro-fee). The outpatient and inpatient scenarios above discuss capturing the professional work of the physician. However, the facility coders also would submit claims to bring in reimbursement for the facility resources used (such as the room cost, nursing personnel, drugs, supplies, etc.), which is separate from the professional fee. The inpatient and outpatient hospital facilities bill using the UB-04 institutional claim form (also called the CMS-1450), shown in Figure 1. The electronic version of this form is called the 837I (Institutional), the ANSI ASC X 12N 837I, or the American National Standards Institute Accredited Standards Committee X12N 837I (Institutional) Version 5010A2.

Hospital Facility Coding

Some hospitals, particularly smaller community facilities in limited labor markets and specialty hospitals, have a rough time finding experienced hospital coders. You can tell by the very substantial sign-on bonuses they have to offer, the legions of “headhunters” that exhibit at every conference, and the existence of an entire industry subset of itinerant traveling coders. Most traveling coders are “generalists” and don’t have specialty coding skills. What these solutions don’t offer is continuity and quality control. If you can lure a coder to your hospital with a sign-on bonus, will that person move again as soon as the check clears? The “headhunters” solution to continuity is “I’ll find you another (for another fee.)” Itinerant coders have no concern for continuity of service or productivity and can cause dissent among the hospital’s permanent staff. Do you need another Human Resources headache? Are you at the cusp of burning-out your staff with mandatory overtime? Providing up-and-comers within your hospital with training, mentoring, and a career path can be a time consuming and expensive solution that does not answer an immediate need. Poaching staff from a nearby competitor only serves to increase the salary range that both hospitals must pay. These choices are effectively treadmills; at the end of a run, you are at the same place where you started.

The Coding Network’s solution offers hospitals an opportunity to get off the treadmill and on with your business. We become an integral part of your HIM staff. Our work can be limited to just the ED, or just Outpatient Radiology, or just Outpatient Clinics, or we can support your staff of inpatient coders. Individual coders will be made available to you, and TCN coders become part of your team. They follow your coding policies and procedures. Since they work remotely and are paid using a totally different paradigm, there is no employee friction with your staff. Plus, with no required minimums, your management has much greater decision-making flexibility. With our accuracy guaranteed, you can try us for a while to see if TCN is a suitable solution for your hospital. If not, you can revise your staffing plan and recuruit coders without creating a human resources nightmare.

If you are offering your HIM staff training, mentoring, and a coding career path, what is to prevent misunderstandings and mistakes from being passed down from one coder to the next? Our coding accuracy audits address this issue as well as compliance and revenue optimization. Your staff will get an outside expert peer review with a complete and educational analysis of our findings. These audits can be the nidus of a Continuous Quality Assurance plan for your coders’ output and your staff mentoring efforts.

Facility Coding

Some hospitals, particularly smaller community facilities in limited labor markets and specialty hospitals, have a rough time finding experienced hospital coders.