EHRs and Coding Productivity

Vol. 17 •Issue 19 • Page 18
EHRs and Coding Productivity

EHRs can be a dream come true for some physician practices, but they won’t solve all of your problems.

If you’re in a medical practice, you most likely know about EHRs. These products are designed to increase clinical accuracy and reduce your costs, making them a dream come true for busy medical practices and facilities. In addition, EHRs can be invaluable when prescribing medications because these high-tech systems can prevent the physician from prescribing drugs that interact poorly with one another or giving the patient the wrong dosage. But before you jump on the EHR train, consider a few key points essential to a quality EHR program and how it might affect your coding productivity.

EHRs Are Not All Created Equal

An EHR begins as a point-of-care system that collects data from multiple sources for purposes of clinical decision-making. The data may be entered and accessed by all patient caregivers. Beyond that capability, the features of EHRs vary greatly. Scanned paper documents that are stored electronically can be part of an EHR, but by most standards, an EHR contains individual data elements that can be searched and collated. An EHR may contain embedded clinical guidelines for practitioners, and flags or alerts associated with those guidelines. Some EHRs also contain pull-down menus of codes so that the provider can easily click and select procedural or diagnostic codes. Some systems go beyond the clinical side of the practice, integrating into the EHR capabilities around collections, billing, productivity and revenue analysis. The best system for the practice depends on the environment of the practice and the process improvement goals set.

Understanding of EHRs is easier if the relationships among EHRs, computer assisted coding (CAC) and electronic medical records (EMRs) is understood:

  • CAC:Software able to automatically generate codes from an EMR. The results are validated by medical coders. An EMR is required for a CAC.
  • EHR:The EMR plus processes associated with that record, either through validation of clinical issues or expediting of business processes. An EHR may contain a CAC, and must contain an EMR.
  • EMR:A computer-based patient record that consists of data files, scanned files and digitized copies of tests. An EMR is the basis for CAC or EHR.

    Shop Around

    Getting the most out of your EHR system will depend upon the quality of the program that you buy and how much you’ve learned about the system from your vendor.

    The federal government recognizes EHR certification standards created by the Certification Commission for Health Information Technology (CCHIT). The adoption of CCHIT standards is important because certification ensures an EHR has met more than 300 baseline requirements established by national IT experts in the areas of functionality, security and reliability, and interoperability. You can visit the CCHIT Web site at to find out more about CCHIT-certified EHR products. However, keep in mind that CCHIT certification does not guarantee that the EHR will fit the needs of your practice. It is of high importance to note that none of CCHIT requirements address issues of compliance with coding guidelines or regulations. When reviewing EHRs, a practice should always involve its coding experts in the decision-making process. And remember a good EHR developer will always have coders on its staff, too.

    Beware of “Canned” Documentation

    Some analysts say that “canned” documentation is the No. 1 problem with EHRs. In some instances, the practice will program the EHR to enter specific language into a field on the EHR, and the physician will be prompted to change it if necessary. But you should customize each patient record to reflect that specific patient’s problems. If the “canned” language indicates that the patient’s lungs are normal on auscultation and percussion, but the diagnosis is bronchial pneumonia, it’s obvious that the physician forgot to change the pre-filled field.

    In other instances, the record will carry over previous items that the physician reviewed at a prior visit, making it appear as though he addressed those issues again at the new visit. This can be dangerous from a compliance standpoint because you don’t want to document that the physician performed an item when he didn’t actually perform it on that date of service.

    Another form of canned documentation involves the ability of an EHR to prepopulate history fields based on previous office visits. This automated history-taking may be discounted by payers during audits, and care should be taken to ensure coders and payers are on board with coding appropriately for the processes in place.

    Don’t Eliminate Your Coding Staff

    Some software may prompt physicians for missing data. Still others might ask the physicians follow-up questions. Some even perform an auto-coding function by using natural language processing to abstract codes from the electronic record. But human beings will still be an essential part of the coding team for many reasons.

    For instance, the drop-down menus that are essential to EHRs don’t always show the “includes” and “excludes” notes for diagnoses that might lead to a mistake in diagnosis coding choices, so it’s important that your coder review these claims to ensure accuracy.

    Or, consider the case of the health care attorney who recently encountered an EHR system that inserted the phrase “Breast exam normal” on every chart that didn’t flag an abnormal breast exam. The problem was that this primary care physician treated an equal number of male and female patients. This could have counted as an extra “bullet” that the physician reviewed during a male patient’s exam, thus allowing a higher level of E/M service, although not justified by medical necessity.

    Ultimately, human coders are essential to the process because regardless of how an EHR may streamline the medical records or even assist in code selection, the rules and guidelines around coding compliance are too mercurial and too complex to be left to a machine. And no intelligent practice manager would choose to delegate issues of coding compliance to machinery programmed by a third-party—not when non-compliance can lead to fines or even jail time. Coders are necessary and uniquely qualified to ensure that all claims filed follow payer rules and will survive an audit. Physicians are still responsible for the accuracy of their claims.

    The important step will be training your coding and billing staff on your practice’s specialty-specific EHR challenges. For example, in the practice above, the coder would adjust the EHR to eliminate breast exam notations for male patients and then would periodically check to ensure that the software does not insert these on male patients’ charts.

    Torrey Kim is senior editor at the American Academy of Professional Coders (AAPC), an organization that provides certified credentials to medical coders in physician offices, hospitals and outpatient centers.