COVID-19 Workflows Improve Medical Coding Efficiency Beyond Pandemic

Getting shots into arms has been a top priority for healthcare providers since the federal government gave the green light to several COVID-19 vaccines. But while speed was key for immunizers, medical coding efficiency has taken a major hit.

At the heart of the issue is the way two major COVID-19 vaccines were created, Amber Epperson, RHIA, CHDA, COC, recently told RevCycleIntelligence.

“[Some] COVID-19 vaccines are two-dose vaccines,” said Epperson, who is the director of health information management services and the physician central business office at LMH Health, a system with a 174-bed hospital in Lawrence, Kansas, and 35 affiliated physician practices.

While the second dose of these vaccines ensures maximum efficacy for patients, coding that follow-up encounter creates extra paperwork for health information management and revenue cycle teams. And that administrative burden is coming at the wrong time: providers all over the country are already facing a return to pre-pandemic volumes after patients delayed care at the height of COVID-19. Additionally, many providers are seeing new surges in COVID-19 hospitalizations as the Delta variant takes hold in the US.

For LMH Health, a solution to this medical coding efficiency problem rested with an existing strategy used by another department.

“At the time, we were only planning having to code [vaccinations] at one time,” Epperson stated. “But we were also thinking through with the revenue cycle team how we could increase our efficiency while still coding the rest of the accounts coming in for the inpatients being seen for COVID-19 and other things. We went to our patient accounts team because we know they have certain rules that they have built in their system for claim edits and things of that nature.”

LMH Health partnered with Cerner, which provides the system’s EHR and now revenue cycle management platforms, to apply this rule-based coding to vaccination efforts.

“What we were able to do was to use the recurring encounter that we have set up with Cerner so that the patient would only have to be registered once for each of the vaccines,” Epperson explained. “So what happens is the patient registers once, we collect that data one time instead of twice, and that encounter stays open until the patient comes in to receive their second dose.”

With some tweaks to rule-based coding for these new vaccines, LMH Health has been able to ensure that a coder did not have to touch any of the thousands of accounts that the system has as part of its large-scale immunization efforts. This is thanks to a discharge rule for recurring patients with an order and a charge for a two-dose COVID-19 vaccine, which automatically assigns the appropriate ICD-10-CM code and changes it to final coded status.

“It ended up being about a hundred hours of coding time that would have taken away from all of the other coding that we still had to do,” Epperson added. “So, we were able to just monitor to make sure that the accounts were hitting our revenue cycle and patient accounts the appropriate way.”

The new medical coding strategy has also been beneficial for coders who are “already working overtime to try and accomplish the rest of the work,” Epperson stated. “In their eyes, it was a way to continue doing what was valuable and not a repetitive task—assigning the same code to thousands of accounts.”

On top of the medical coding efficiency gains, the strategy has also enabled LMH Health to meet turnaround demands and keep the revenue cycle running, according to Epperson.