Coding Accuracy: 4 Question Providers Should Ask Before Each Patient Encounter

Pre-visit planning by providers is now considered a standard of care. From arranging for advanced lab testing to tracking previous screenings and gathering needed information, as well as planning for future appointments before patients leave the office – pre-visit planning means the difference between a mediocre or high quality patient visit.  The planning time is also critical for providers to close needed care gaps with patients and ensure coding accuracy.

During the planning process, providers should ask the following 4 questions and discuss with medical staff to make sure every patient receives needed screenings that are coded appropriately:

  1. What are the insurer/payer coding requirements for this patient?
  2. Persistent Condition Validation (PCV): Have you reported on each chronic condition for this patient this year? (i.e., amputation must be documented every year)
  3. Have you appropriately assessed this patient for next year’s baseline payment through proper use of HCC Coding (Hierarchical Condition Category)?
  4. Have you properly coded this patient’s diagnoses using appropriate ICD-10 ?

These questions were central to learnings from the Dixie Highway Project reported earlier this year. The project resulted in a 90-day improvement for several key metrics –most notably, increased Annual Wellness Exams, gap closure on HEDIS measures, and coding improvements on chronic conditions.

For more information on the Dixie Highway Project, view the whitepaper.