Q&A: Reviewing CC/MCC capture

Q: What are the benefits to having coders review charts for appropriate capture of complications and comorbidities (CC) and major CCs (MCC)?

A: At the time of coding, coders can flag charts for which they were not able to identify a CC/MCC and send them back to the coding manager for review. Alternatively, the organization can build pre-bill edits that will route inpatient claims without a CC/MCC into a work queue for further review by the coding manager or CDI staff.

“This process will also serve as a way to audit your coders’ and CDI staff members’ performance,” Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, FAHIMA, CHPS, chief operating officer of First Class Solutions, Inc., in St. Louis, Missouri saya. “If we find a number of cases hitting that queue where a coder missed a condition or the CDI didn’t query on a condition, we have a way to trend that performance and address any deficiencies that our staff may have.”

If CC/MCC capture is improved, that will also increase the organization’s case-mix index and, therefore, its reimbursement, Dunn adds.

“I’ve seen this process produce $40,000 a month on the DRG reimbursement—not what we charge, but the actual DRG reimbursement in a hospital with fewer than 300 beds. That’s nearly a half a million dollars a year,” she says. “So even if you have a person spending two hours a day looking at this queue, that will cost far less than the return of a half a million dollars.”

For more information, see "Gaining ground: Enhancing HIM integration in the revenue cycle" in the November 2020 issue of HIM Briefings.