Coders, ensure compliance with continuing education

By Annetta Slover, MHA, CPC, CPC-I, CPCO, COC, CPCD

In my 30-plus years in the healthcare industry, I have always been intrigued by coding. Healthcare coding is like a puzzle—all the pieces have to fit together correctly for accurate, compliant coding to happen. It’s a challenging field, and attracts some of the most intelligent healthcare professionals I’ve had the privilege of working with.

But here’s the truth: intelligence alone does not ensure quality coding that complies with current regulations. 

Health systems and providers need to prioritize certification and continuing education for their coders in order to safeguard accuracy, compliance, and revenue integrity for their organizations.

Hire certified coders.

There are a lot of people out there doing coding work who are not certified coders. This may be more expedient in the hiring process, but it puts health organizations at risk. To be clear, this has nothing to do with the intelligence or integrity of the employee. If they are dedicated to accuracy, an uncertified coder can read the CPT book and understand what each individual code means. But coding logic is so incredibly in-depth that without certification to teach you the inner workings of how and when to use a specific code, coders can bill inaccurately and get their organizations in regulatory trouble.

For example, a person goes into his physician’s office because his ears are popping frequently, and he has been experiencing ear pain. The physician talks to him about his symptoms and checks his ears, immediately deciding he needs to flush the patient’s ears out. The physician flushes his ears out at that visit, and the patient goes on his way.

The coder sees that the patient visited his provider and got his ears flushed. In reality, though, all the provider did was clean the patient’s ears out. Therefore, that’s all the coder should bill for—the procedure only, not the office visit. This logic is nuanced and takes education and practice. Without certification, you cannot understand the complex logic to determine the most appropriate way of billing.  

Offer continuing education for coders and providers.

Certification training for coders is rigorous, but once you land a position in a billing office, the education doesn’t stop. The healthcare landscape is rapidly changing, and with that comes changes to coding, both from governmental regulations and payers revising their policies on how they want the coding to look and feel. Even something you learned just five years ago could be outdated today.

For example, coders often put themselves in compliance trouble by not having diagnoses in the proper hierarchy. If a sick patient with multiple diagnoses comes in to see their provider frequently, I see coders select “associate all” on the diagnosis coding, whether it’s pertinent to that day’s visit or not. You may have a patient who struggles with an eye disease and hypertension, but if they visit their doctor to get relief for cold symptoms, coders must discern which ongoing diagnoses are related to that day’s visit.

So why do so many coders automatically select “associate all?” Because this was the recommended course of action for a long time. Only in the last couple of years have the regulations changed to prevent providers from abusing the coding system by billing all diagnoses in order to bill a higher level of service. Even a highly intelligent certified professional coder with a decade of experience but no continuing education could miss this important change and put their organization in a state of non-compliance.

I also recommend that practitioners occasionally brush up on coding changes. For healthcare practices to prioritize compliance, a culture of continuing education must be established in every part of the organization.

If you would like to learn more about the benefits of certification and continuing education in professional coding, or if you have questions about the certification process, please reach out.