Paving the way for single path coding

March 28, 2022 / By Courtney Crozier, RHIA, CCS

According to the American College of Healthcare Executives, for more than 15 years (2004-2020), the number one issue confronting hospitals was financial challenges. In 2021, financial challenges dipped to the number two spot, but continues to be a top concern today.  

As facilities search for more efficient processes to address financial challenges, the old adage of “work smarter, not harder” comes to mind. With regulations constantly changing, the expansion of outpatient services and increasing denials, one option that allows facilities to “work smarter, not harder” is single path coding.

Facility and professional coding

Depending on how an organization is structured, many different coding roles may exist. For simplification purposes, most coding roles can be defined as either facility or professional. Each coding role is different and requires a specific background, separate certifications, specialized training and coding experience. 

Facility and professional coders tend to use different coding platforms, and their coding rules, regulations and guidelines often differ as well. Facility coding captures the patient’s risk of mortality, severity of illness and the facility’s volume and intensity of resources that were used to deliver care.  Professional coding captures the complexity of the physician’s care that was provided during treatment. 

While their coding roles are quite different, there is some overlap when it comes to outpatient facility and professional coders. For example, an outpatient facility coder that codes surgeries will look at the same documentation (history and physical (H&P), operative report, progress note, etc.) as the professional coder. The difference is that the facility coder is coding for the facility and the professional coder is coding for the physician. Duplicate review of documentation for the same patient from two separate coders; could these two workflows possibly be combined to make the process more efficient?

Tying the two together

The answer is yes, and this is where single path coding comes in. 

Single path coding is mainly performed on the outpatient facility side when physicians and facilities work together under the same umbrella. Single path coding combines facility coding and professional coding. It allows one coder to code both facility codes and professional codes for the same patient utilizing a single coding platform. In terms of workflow, single path coding achieves two goals with a single effort which increases coder efficiency, lowers the duplication of coding and optimizes productivity. 

How to prepare for single path coding

Before implementing a single path coding workflow, there are some things to consider:

  • Education and knowledge of coding staff
  • Available technology
  • Current processes in place

It is important that a coder be cross trained in both facility and professional coding and possess the ability to accurately code based on the different coding rules, regulations, guidelines and reimbursement methodologies. 

Implementing single path coding has never been easier. Utilizing a single coding platform gives coders visibility into each other’s workflows, places current clinical and regulatory updates at the coder’s fingertips and features a rich set of coding functions that assist coders with correct coding and billing decisions. 

Reviewing current processes for the facility coder and the professional coder is imperative to determine where the overlap occurs and how single path coding can streamline that process. Utilizing the process improvement model of “Plan, Do, Study, Act” provides the framework needed to determine the best course for single path coding.

Paving the way

By marrying facility coding and professional coding through single path coding, organizations can increase their coding accuracy and compliance, decrease coding duplication and optimize productivity. 

Courtney Crozier is a clinical development analyst 3M Health Information Systems.

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