I have heard this countless times over my professional career: "We can't afford to update code books or encoders so we just google the codes". This is a disturbing sentiment especially in the era of ADRs, compliance audits, pre-payment review status, recoupments, and increasingly sophisticated data analytics. Utilizing up-to-date coding and authoritative resources is non-negotiable! Terry's insights about the compliance risks associated with using the internet to code are SPOT ON!
Originally posted on ICD-10 Monitor
Looking for Codes on Facebook
The risks of using the Internet to self-diagnose and code.
A majority of us turn to the Internet for health-related information. According to the Pew Research Center, in 2014, a total of 87 percent of American adults had access to the Internet, and in 2012, a total of 72 percent of survey respondents said that they’d looked online for health-related information within the past year.
Not too long ago, patients were receivers of medical information through traditional means. A physician would take a few minutes to explain a disease and its anticipated course, followed by a description of treatment options.
With the explosion of the Internet – technology that has changed medicine more than any other single invention – the physician-patient dynamic has changed, too. Now, anybody can easily access health-related information, and patients bring this knowledge to their office visits.
With this overload of health data, physicians are voicing their concerns about how their patients will treat all this information, and how it will impact the doctor-patient relationship.
From a clinical perspective, medical information found on the Internet is meant to be supplemental and is best used to inform your medical-decision making – not replace it. The medical information found on the Internet shouldn’t guide self-diagnosis or treatment. This is a statement made by researchers at the U.S. National Institutes of Health (NIH).
Internet Searches by Patients
Based on recent studies, patients typically use the Internet in two ways:
First, patients seek out information before a clinic visit to decide whether they need to see a healthcare professional at all.
Second, patients search the Internet after an appointment, either for reassurance or due to dissatisfaction with the amount of detail provided by the healthcare provider they visited.
Particularly active Internet searchers include people with chronic illnesses who not only seek out more knowledge about their illness, but also turn to others for support. Additionally, people who lack insurance coverage often turn to the Internet to learn more about symptoms and illnesses.
Physicians Respond in Three Ways
According to a 2005 review published in “Patient Education and Counseling,” Miriam McMullan suggests that after a patient presents online health information to a physician or other healthcare provider, the healthcare provider can respond in one of two ways:
Health professional-centered relationship. The healthcare provider can feel that his or her medical authority is being threatened or usurped by the information the patient cites, and will defensively assert “expert opinion,” thus shutting down further discussion. This reaction is common among physicians with poor information technology skills. The physician will then use the remainder of a short patient visit to direct the patient toward the physician’s own desired course of action. This approach often leaves the patient feeling dissatisfied and frustrated, and patients can leave the appointment believing that they themselves are better equipped than the physician at seeking out health information and treatment options online.
Patient-centered relationship. With this scenario, the healthcare provider and the patient collaborate and look at Internet sources together. Although a patient has more time on his or her own to search the web, a physician or other healthcare provider can take some time during the patient encounter to surf the web with the patient and direct them to relevant sources of additional information. Experts suggest that this approach is best; however, many providers complain that there’s not enough time during a lower-level clinical visit to search the Internet with the patient and discuss disease and treatment options.
The review also reported that physicians liked it when patients used the Internet to learn more about their pre-established medical conditions. However, physicians didn’t like it when patients used the information to either diagnose or treat themselves, or test the knowledge of the physician.
The Bottom Line
Health information on the Internet is endless. Some of this information is pretty scary, especially if the reader doesn’t understand everything that’s being described. For example, I searched out a differential diagnosis for headache, and this took me to an Internet offering of a potential diagnosis of stroke. Now, according to most physicians, the chances that any particular incidence of headache is stroke-related are slim, especially if you’re young and healthy. But someone not aware of the full patient profile or factors that may or may not lead into a definitive diagnosis can read themselves into a self-diagnosis, which can be dangerous and upsetting.
Information gathered from the Internet can be wonderfully helpful, as is the case with patients with chronic health conditions who want to learn more about their care. However, it can also be detrimental, as in the case of a person who needlessly frets over a self-diagnosis, or worse, a person who self-treats a self-diagnosis, which could result in bodily harm. It is the job of the healthcare professional to remind patients that it is their physician who can help put the information gleaned from the Internet into context.
CPT and ICD-10 Coding from the Internet
The Internet not only features created sites and an information stream for medical conditions but also for medical coding options. There are sites that are “approved, vetted, and credible,” such as www.ICD10Data.com, which is a verified lookup site for diagnosis (ICD-10-CM) codes for physicians and “the professional coder.” But recently, I have had “coders” come to me, some from offshore employers, asking for my assistance because their codes were denied when reporting to the insurance carrier. After reviewing their reports and the corresponding documentation, I came to realize that many of the codes were not only inaccurate but not even appropriate to report, for the specialty for which they were coding.
When querying some of these healthcare employees, a good number were telling me that they learned to code from the Internet only, or from a social media site. I had to ask again. Where did you learn to code? Same response. I asked if they had any training or certification for coding, and the majority of responses were “no.” This not only concerns me for the employee who contacted me, but for the physician who engaged in the services of the billing company, or the person reporting these inaccuracies to the payors under the physician’s name and national provider number.
As with patients self-diagnosing from the Internet, healthcare personnel in charge of coding who are only using unverified Internet or social media sites to code need to be discouraged from the practice. This can not only lose a vast amount of reimbursement for the physician, but expose them to future audits for non-compliance and errors.
Do you have to be certified to work in medical coding and billing? No. You do not need certification to work as a medical biller and coder. However, getting your Certified Professional Coder certification or other reputable coding credential could help a healthcare professional stand out in the field as an applicant, lending them credibility as someone who has studied the codes, learned the coding systems and compliance rules, and adheres to a coder’s code of ethics.
Make sure you are checking the background, credentials, experience, and resources your coders are using before trusting the information completely. Your practice’s financial health depends on it.