Transitioning to Itemized Billing in the Military Healthcare System: Are We Ready. Evaluating Outpatient Coding Accuracy in the Walter Reed Army Medical Center General Internal Medicine Clinic

摘要

In a major step towards meeting Health Insurance Potability and Accountability Act (HIPAA) standards, the Military Healthcare System (MHS)plans to implement an outpatient itemized billing system by October 2002. Over the last four years, there have been many different methods and systems used to collect and code outpatient encounter data. The purpose of this project is to evaluate and assess various methods of performing coding in the Walter Reed Army Medical Center (WRAMC) General Internal Medicine Clinic (GIMC)and determine whether current outpatient coding practice and data quality is sufficient for supporting itemized billing. The first part of this study involved a comparison on coding accuracy between providers in 1998 using a bubble sheet to code diagnoses and procedures (Gall, 1998), and the current study using an automated coding system. The results showed a decrease in International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis coding correctness from 66% to 51% and a decrease in the average number of diagnoses recorded per encounter from 2.24 to 1.81. Evaluation and management (E&M) complexity coding accuracy worsened, showing a higher propensity towards over coding, increasing from 37% to 83% over coded. The second part of this study evaluated coding accuracy of a clinic initiative using medical clerks to code directly from provider written documentation. Evaluating and comparing the results using these and other methods of coding is essential to developing the best practices for accurate coding in the MHS. This study provides suggested interventions and process improvements to assist the organization in improving coding accuracy and overall data quality. More importantly, these interventions will help leadership reduce billing risk and remain focused on the core mission of providing quality care to military beneficiaries.