Q&A: Reviewing charts for CCs/MCCs

Q: What are the benefits to having coders review charts for appropriate capture of CCs and MCCs, and how can our coding team get started in this process?

A: At the time of reporting, 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 is beneficial because it can serve as a way to audit your coders’ and CDI staff members’ performance. 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.

I’ve seen this process produce $40,000 a month in MS-DRG reimbursement—not what we charge, but the actual MS-DRG reimbursement in a hospital with fewer than 300 beds. That’s nearly a half a million dollars a year. 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 half a million dollars.

Editor’s note: Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, FAHIMA, CHPS, chief operating officer of First Class Solutions Inc., in St. Louis, Missouri answered this question in HIM Briefings.

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.