Improving Precision of Do Not Contact Codes: Results of a Manual Review to Inform Coding and Case Contact Procedures.

Introduction: Central cancer registries are responsible for managing appropriate research contacts and record releases. Do not contact (DNC) flags are used by some registries to indicate patients who should not be contacted or included in research. Longitudinal changes in DNC coding practices and definitions may result in a lack of code standardization and inaccurately include or exclude individuals from research. Purpose: We performed a comprehensive manual review of DNC cases in the Utah Cancer Registry to inform updates to standardization of DNC code definitions, and use of DNC codes for exclusion/inclusion in research. Methods: We identified 858 cases with a current or prior DNC flag in the SEER Data Management System (SEER*DMS) or a research database, with cancers diagnosed from 1957-2021. We reviewed scanned images of correspondence with cases and physicians, incident forms, and comments in SEER*DMS and research databases. We evaluated whether there was evidence to support the current DNC code, a different DNC code, or insufficient evidence for any code. Results: Of the 755 cases that had a current DNC flag and reason code in SEER*DMS, the distribution was as follows: 58%, Patient requested no contact; 20%, Physician denied; 13%, Patient is not aware they have cancer; 4%, Patient is mentally disabled [sic]; 4%, Other; and 1%, Unknown. In 5% of these cases, we found evidence supporting a different DNC reason code. Among cases included because of a prior DNC flag in SEER*DMS (n = 10) or a DNC flag in a research database (ie, cases with no current DNC flag or reason code in SEER*DMS, n = 93), we found evidence supporting the addition of a SEER*DMS DNC flag and reason code in 50% and 40% of cases, respectively. We identified DNC reason codes with outdated terminology (Patient is mentally disabled) and codes that may not accurately reflect patient research preferences (Physician denied without asking the patient). To address this, we identified new reason codes, retired old reason codes, and updated current reason code definitions and research handlings. Conclusion: The time and resource investment in manual review allowed us to identify and, in most cases, resolve discordance in DNC flags and reason codes, adding reason codes when they were missing. This process was valuable because it informed recommended changes to DNC code definitions and research handlings that will ensure more appropriate inclusion and exclusion of cancer cases in research.

Evaluation and Management Codes for Outpatient Neurology Services in 2021: Changes to 99202-99215.

Medical services can be conceptualized as falling into two categories: procedures and cognitive care. A procedure is defined as a surgical, medical, or diagnostic test performed on a patient, such as an x-ray, wound suture, surgery, or physical therapy treatment. Cognitive care, also known as Evaluation and Management (E/M) services, involves performing a medical history along with a physical examination and possibly ordering or reviewing diagnostic tests before formulating a medical opinion and initiating a care plan. The uniform language and categorization of all medical services is contained in the Current Procedural Terminology (CPT) manual by the American Medical Association, which precisely describes all medical services using non-overlapping definitions and descriptions. The codes defined by CPT are the most commonly accepted set of codes used to file medical claims. In 2000, the US Department of Health and Human Services designated CPT to be the national reporting standard used in conjunction with the Health Insurance Portability and Accountability Act (HIPAA). CPT codes used today for E/M services were established in 1995 and define the components of history, examination, and medical decision making necessary to determine the level of each cognitive care service as delivered by a physician or other qualified health care professionals (eg, advanced practice providers). E/M rules were modified in 1997 and allowed some specialty services, such as neurology, to substitute a single system examination for a general, multisystem physical examination. Although new E/M codes were added over the years, the code descriptions and documentation guidelines for E/M services for outpatient and inpatient care remained essentially unchanged from 1997 through 2020. Most of the work performed by neurologists is E/M services, and the rules for coding outpatient care will change dramatically on January 1, 2021. This article discusses the rationale for these coding changes and explains how they are to be applied in the clinical setting.

Coding in the World of COVID-19: Non-Face-to-Face Evaluation and Management Care.

Almost all medical care in the United States is delivered with the provider and patient in immediate proximity; this model is referred to as face-to-face care. Medical services can be apportioned as procedural care (eg, surgery, radiology, or laboratory testing and others) or cognitive care, also known as Evaluation and Management (E/M) services, in which the provider formulates an assessment and plan after obtaining information from the patient's history, examination, and diagnostic tests.Providing a medical opinion and plan using the telephone as the technology that links the provider and the patient is an example of a non-face-to-face E/M service. Common Procedural Terminology (CPT) codes and the details for how to provide telephone services have been available for decades but have not been reimbursed and therefore were rarely used. In recent years, as new technologies have evolved, there has been slow and steady acceptance that non-face-to-face E/M care can be an adjunct to or replacement for some face-to-face E/M services. These technologies and the descriptors for associated CPT and Healthcare Common Procedure Coding System (HCPCS) codes were introduced over the past few years and have become known by the generic term telehealth. They have been slowly incorporated into medical practice. Most of these services were introduced in the consumer retail market, in which the cost was borne directly by the patient, or as private contract services, in which the cost was borne by the consulting hospital, such as with telestroke services. In both the consumer retail model and private contract model, the care delivered usually did not involve CPT or HCPCS coding. The adoption of telehealth has been slow, in part because of the initial costs and several regulatory constraints, as well as the reluctance of patients, providers, and the insurance industry to change the concept that medical care could only be delivered when the patient and their provider were in physical proximity.After the COVID-19 pandemic reached the United States, the US Department of Health & Human Services issued a public health emergency and declared a Section 1135 Waiver that lifted many of the administrative constraints. With the need for near-absolute social distancing, this perfect storm has resulted in the immediate adoption of telemedicine, at least for the duration of the pandemic, for cognitive care to be delivered using communication technologies that are already in place. This article discusses the most common forms of non-face-to-face E/M care and the proper coding elements necessary to provide these services.

Development and Utility of the Observational Research in Oncology Toolbox: Cancer Medications Enquiry Database-Healthcare Common Procedure Coding System (HCPCS).

PURPOSE: Health-care claims are of increasing utility as a rich, real-world data resource for conducting treatment-related cancer research. However, multiple dynamic coding nomenclatures exist, leading to study variability. To promote increased standardization and reproducibility, the National Cancer Institute (NCI) developed the Cancer Medications Enquiry Database (CanMED)-Healthcare Common Procedure Coding System (HCPCS) within the Observational Research in Oncology Toolbox. METHODS: The CanMED-HCPCS includes codes for oncology medications that a) have a US Food and Drug Administration-approved indication for cancer treatment or treatment-related symptom management; b) are present in National Comprehensive Cancer Network guidelines; or c) carry an orphan drug designation for treatment or management of cancer. Included medications and their HCPCS codes were primarily identified based on Center for Medicare and Medicaid Services annual HCPCS Indices (2012-2018). To demonstrate the utility of the CanMED-HCPCS, use of systemic treatment for stage II-IV colorectal cancer patients included in the Surveillance, Epidemiology, and End Results-Medicare data (2007-2013) was assessed. RESULTS: The CanMED-HCPCS (v2018) includes 332 HCPCS codes for cancer-related medications: chemotherapy (156), immunotherapy (74), hormonal therapy (54), and ancillary therapy (48). Observed treatment trends within the NCI Surveillance, Epidemiology, and End Results-Medicare data were as expected; utilization of each treatment type increased with stage, and immunotherapy was largely confined to use among stage IV patients. CONCLUSION: The CanMED-HCPCS provides a comprehensive resource that can be used by the research community to facilitate systematic identification of medications within claims or electronic health data using the HCPCS nomenclature and greater reproducibility of cancer surveillance and health services research.

Exploratory study of radiology coding in health information management practice.

An exploratory study was undertaken to determine the role and practice issues of radiology coding in health information management (HIM) practice. The study sought to identify the challenges of radiology coding and the solutions implemented to address these challenges. A self-report survey was sent to 828 American Health Information Management Association (AHIMA) members identified as directors, managers, or supervisors of HIM departments and/or coding. Two hundred seventy-eight surveys were used for data analysis purposes. Sites reported that on average they have 3.4 coders devoted to radiology coding who code an average of 4,245 reports per month. Productivity standards varied by exam type ranging from 7 (interventional radiology) to 31 (diagnostic) exams coded per hour. Diagnosis codes were assigned most frequently for diagnostic, ultrasound/nuclear, MRI/CT, and mammography exams, while diagnosis and procedural codes were assigned more frequently for interventional radiology exams. The need for education specifically focused on interventional radiology coding was identified along with other issues affecting the quality of radiology coding. Suggested solutions to challenges of radiology coding such as establishing a good working relationship with physicians, radiology, and charge description master (CDM) departments were suggested.

The devil is in the details: maximizing revenue for daily trauma care.

BACKGROUND: Falling reimbursement rates for trauma care demand a concerted effort of charge capture for the fiscal survival of trauma surgeons. We compared current procedure terminology code distribution and billing patterns for Subsequent Hospital Care (SHC) before and after the institution of standardized documentation. METHODS: Standardized SHC progress notes were created. The note was formulated with an emphasis on efficiency and accuracy. Documentation was completed by residents in conjunction with attendings following standard guidelines of linkage. Year-to-year patient volume, length of stay (LOS), injury severity, bills submitted, coding of service, work relative value units (wRVUs), revenue stream, and collection rate were compared with and without standardized documentation. RESULTS: A 394% average revenue increase was observed with the standardization of SHC documentation. Submitted charges more than doubled in the first year despite a 14% reduction in admissions and no change in length of stay. Significant increases in level II and level III billing and billing volume (P < .05) were sustainable year to year and resulted in an average per patient admission SHC income increase from $91.85 to $362.31. CONCLUSIONS: Use of a standardized daily progress note dramatically increases the accuracy of coding and associated billing of subsequent hospital care for trauma services.

[ICD and OPS. Historical development and current situation]. / ICD und OPS. Historische Entwicklung und aktueller Stand.

This survey describes some general problems of medical classifications and their historical development at international and national levels. The emphasis is on the "International Statistical Classification of Diseases and Related Health Problems (ICD)" of the World Health Organization (WHO). Evolving from an "International List of Causes of Death", initiated more than 100 years ago, particularly since 1948 the ICD has increasingly developed into an internationally essential classification also for all problems of morbidity. In Germany, the implementation for the mandatory coding of diagnoses of inpatients began with ICD-8 in 1968. With the 10th revision (ICD-10) the coding of diagnoses of all inpatient and outpatient cases became mandatory in the year 2000. Since 2004 this specific German version is called ICD-10-GM and revised yearly. No internationally valid classification is available for operations and other medical procedures. "The International Classification of Procedures in Medicine (ICPM)", published by the WHO in 1978, has not been revised since, but served as a model for several national classifications. Also the German "Operationen- und Prozedurenschlüssel (OPS)" (Code of Operations and Procedures), initially published in 1994, derives from the ICPM. Since 2004 both the ICD-10-GM und the OPS are revised yearly. This paper shows historical development, contents and areas of application for ICD-10-GM and OPS. In the case of inpatient treatment, the classifications are mainly used for reimbursement based on the German G-DRG System, in the case of outpatient treatment for the legally required coding of diagnoses and other reasons for medical treatment and of selected surgical procedures for reimbursement purposes.

Efficiency of a semiautomated coding and review process for notification of critical findings in diagnostic imaging.

OBJECTIVE: When a significant unexpected finding such as malignancy is noted on a study, the standard of care generally holds that the radiologist communicate the findings to the referring physician and document the communication in the radiology report. Despite this standard, for a variety of reasons it remains possible that the direct care provider might receive such notification but not initiate an appropriate workup. On the basis of prior root cause analysis, we developed and instituted a semiautomated process for notification of critical diagnostic imaging findings. We now report our 12-month experience with the process. MATERIALS AND METHODS: A diagnostic code was attached to every radiology report. When a significant unexpected finding occurred, our radiologists, in addition to contacting the appropriate clinician, gave the report the designation code 8. On a weekly basis, a list of code 8 cases was passed to the cancer registrar at our institution, who tracked the cases to ensure that they were appropriately followed up. RESULTS: In the 12-month period after initiation of this system, we performed 37,736 radiologic examinations at our institute. Of these, 395 cases were given code 8. All code 8 cases were followed up by the tumor registrar. In 35 cases, no workup was documented after 2 weeks. Of these, eight cases would have been completely lost to follow-up if this safety net had not been in place. CONCLUSION: Failures of communication, documentation errors, and various system failures may lead to an untoward outcome for the patient. We devised a simple system to ensure that significant unexpected findings on imaging received appropriate attention. An additional level of redundancy has increased the probability of optimal patient outcome.

Illustrating the root-cause-analysis process: creation of a safety net with a semiautomated process for the notification of critical findings in diagnostic imaging.

The ACR has set a standard for the communication of critical findings on imaging examinations. Despite this standard, for a variety of reasons, it remains possible that appropriate follow-up is not initiated. The authors review the theory and application of root-cause analysis to such a failure of communication within their institution, including the development and implementation of a semiautomated notification system for critical unexpected findings on imaging examinations.