Proper coding key to quality outcomes


The ability of health information exchanges to sustain themselves is questionable, so they must show that their data is worthy enough to outweigh the costs.

Medical records coding feeds the information flow that is the lifeblood of the healthcare system.

"Coding affects such critical factors as outcomes, care pathways, cost, reimbursement and quality," says David Hochheiser, vice president, data analytics solutions, Ingenix. "Without proper coding, these decisions may be made on faulty data, and that helps no one."

Executives can look to top-ranked hospitals to identify best practices for accurate and complete coding. Ingenix's "Top 200 Coding Hospitals in the U.S." ranks hospitals according to the completeness and accuracy of their medical coding practices used to bill Medicare for inpatient medical services.

"In particular, they would be least likely to be subject to particular RAC recovery areas when compared with their counterparts within their benchmark grouping," Hochheiser says.

To promote accurate and complete medical coding practices, it is important to engage the touch points along the way: physicians, documentation, medical records coders and IT.

The current state of healthcare is still focused around reimbursement, believes Penny Osmon, CHC, CPC, coding and reimbursement educator at the Wisconsin Medical Society, in Madison. "but Medicare and commercial payers are beginning to tie reimbursement to quality," Osmon says.

CMS pays an incentive to physicians who successfully report the Physician Quality Reporting Initiative (PQRI) measures, while HEDIS measures may be used for contracting purposes to pay differentially based on quality performance.

"There is no denying that CMS's move to value-based purchasing eventually will have a significant impact on reimbursement," Osmon says.


The future of medical coding will continue to be driven by quality reporting, as evidenced by the push for ICD-10 implementation.

"The specificity and granularity of ICD-10 will enable us to capture even more detail," Osmon says. "It will not necessarily affect how physicians practice, but will impact our reporting, data, etc. The role of the coder may evolve more toward analyst or auditor, as physicians will most likely have the clinical knowledge necessary to appropriately apply these codes.

"Take a serious look at your quality programs . . . to assure they are growing with the times and are able to report quality measures accurately," Osmon says.

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