South Shore Hospital in Weymouth, Mass., a 284-bed acute care teaching medical center, "has the second busiest ED in the state of Massachusetts," says Jeanne Dugas, the outpatient coding manager.
"It was a very manual process," says Dugas
."Coders had to physically go down to the department, bring the records back, sort them and then abstract the information."Tracking down transcribed reports and matching them to ED records also took time and gave the coders another layer of clerical duties to wade through, resulting in a high level of frustration.
Compounding the problem is the fact that ERs traditionally generate two sets of bills: one for physician services, also known as E&M (evaluation and management) "pro fee," and another for the use of the facility and supplies.There are three components to E&M emergency pro fees, Dugas
explains: history, exam and medical decision making."Each of these has guidelines that coders need to consider," she
Prior to rolling out CodeRunner
by Mt. Laurel, N.J.-based MedQuist Inc.
, South Shore had used a different electronic coding system.But in 2002, about the same time Dugas and other members of a new management team came on board, the Web-based CodeRunner
became the solution of choice for the ED.Rolling out the new software went well, she
says.Trainers from MedQuist
were on-site for a couple of days, and the company has a responsive tech-support team, she
In the beginning, though, the ER was only using CodeRunner
for physician services, but after examining its potential, the organization decided in 2003 to also utilize the system for facilities coding.That wasn't the only coding change South Shore made.In the fall of 2003, the hospital allowed its coders to work from home, a strategy that has consistently shown to increase productivity.After relying on MedQuist
for pro fee coding, South Shore
decided in July 2004 to bring it in-house for both coding and billing.Dugas
admits that productivity levels by coders have see-sawed as a result of these changes and the complexity of abstracting professional E&M levels, but still extols the virtues of CodeRunner
, citing a 20 percent improvement in productivity.
Beside the fact that coders can now access CodeRunner
from home via the Internet, Dugas
is impressed with the system's natural language processing (NLP) optional feature.This technology both "reads" and "understands" naturally-spoken language, then analyzes the meaning of text at three levels: the definition of individual words (lexicon), the way words are put together to form sentences (syntax) and the meaning (semantics).This is possible because a built-in knowledge of medicine in the NLP engine allows it to recognize statements of medical fact, even if it is unable to fully understand them.
Workflow Improvements"Dictation from the ED goes to a transcriptionist at MedQuist
, then directly into CodeRunner
explains.Once the physician signs off, it can be accessed by coders.The NLP engine "reads the dictation and, from the key words, recommends certain codes.The coder becomes more like an auditor who can delete unwanted or irrelevant codes."Dugas
says using NLP in this manner requires a 24-hour hold, after which the dictation is available to the coders.Records are usually coded within 48 to 72 hours after the physician dictates his
encounter notes.The technology has an accuracy rate of between 75 percent and 80 percent, she
The system also improves workflow because it uses a split screen with the dictation on one side and the baseline codes on the other.The coding screen provides input for ICD-9 (with E-codes and V-codes), HCPCS and CPT coding, along with E/M level of service for both facility and professional reporting and billing.When one record is finished and "Ready to Bill" is clicked, the next record automatically pops up.This allows the three full-time and one part-time ED coders to handle between 12 and 15 records per hour, she
It's easier for Dugas
to keep track of all ED records with CodeRunner
."The system has reporting capabilities," she