Apr 08, 2020
It seems to be a topic of interest lately. Single path coding is defined as performing both the facility coding and the professional fee coding for the same patient account by the same coder in the same workflow. It is also called “dual (medical) coding.” As most coders know, facility coding rules and guidelines are quite different than professional fee coding rules and guidelines. While professional fee codes primarily capture the complexity and intensity of physician care or surgery provided during a visit, facility codes detail the volume and intensity of hospital or health system resources used to deliver patient care, such as the use of surgical and medical equipment, medication, and nursing staff. Typically the facility coding flows to the (electronic) UB04 claim form and the physician fee coding flows to the CMS-1500 (electronic) claim form. Single path coding is not necessarily new. However, up until lately, these two types of coding for the most part have been done by separate coders with separate coding backgrounds, training, experience and certifications.
Why is single path coding significant?
The biggest reasons why some hospital systems are moving to “single path coding” is to eliminate duplicative processes and to optimize productivity. In addition, costs are reduced when only one coder “touches” the record and completes both types of coding. This is primarily being done in outpatient setting when the physicians and the facility are under one umbrella.
One big advantage is that with one coder assigning surgical CPT and other codes to both claims, there will not be discrepancies or variances in the codes of both claims. That will decrease the amount of claims rejections and other billing issues. It will also help with meeting demands for AHRQ (Agency for Healthcare research and Quality) and HCC (Hierarchical condition category) data elements.
Challenges to single path coding
Probably the biggest challenge is to have coders that are sufficiently trained in both facility fee and professional fee coding. As stated, things can be different between the two such as modifier use, technical vs professional components, and payor guidelines. The coder will need to know these differences and be able to put on a different hat when coding the same encounter for both. That means more time and expense for training in order for coders to become proficient in both coding
Another challenge is having the technology to accommodate single path coding. Mapping out how the different claims data will flow from coding will take crucial planning. Some systems allow coders to select ‘Single Path Coding” for certain specialties. Starting out with a small amount of specialties and then building out with more specialties as trouble areas are conquered is probably the best way to implement.
So what is the take away for coders?
Coders may want to explore and learn more about the areas of coding they are not familiar with and research. For a hospital outpatient coder, this means exploring the nuances of professional fee coding and its edits. The professional fee coder can begin becoming familiar with hospital facility coding rules and requirements. Entertaining coding certification in both areas is also a good direction to take. As more and more healthcare facilities and practices become consolidated under one umbrella, we will only see single path coding grow. Coding has always been, and always will be an evolving profession.
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The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
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