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Culturally Competent Coding Managing and Measuring Data Capture

Culturally Competent Coding Managing and Measuring Data Capture. Cross Cultural Health Care Conference February 11-12, 2010 Jeri Leong, R.N., CPC, CPC-H, CPMA Healthcare Coding Consultants of Hawaii, LLC. Objectives. Explain the coding process – how data is captured for reporting purposes

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Culturally Competent Coding Managing and Measuring Data Capture

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  1. Culturally Competent CodingManaging and Measuring Data Capture Cross Cultural Health Care Conference February 11-12, 2010 Jeri Leong, R.N., CPC, CPC-H, CPMA Healthcare Coding Consultants of Hawaii, LLC

  2. Objectives • Explain the coding process – how data is captured for reporting purposes • Identify culturally sensitive issues that affect the accuracy of information collected • Provide examples of non-traditional support services • Describe barriers that affect recognition of codes • Discuss potential solutions that may enact change

  3. The Coding Process • Current Procedural Terminology – ‘CPT’® • International Classification of Diseases, 9th Edition, Clinical Modification – ‘ICD-9-CM’ • Health Care Procedural Coding System Level II – ‘HCPCS’ • Code sets assist in reporting clinical data, processing third party claims, and data capture for research and statistical purposes

  4. Barriers • Current coding systems do not effectively address alternative or complimentary medicine circumstances • Culturally sensitive issues such as language interpretive services are not seen as a priority for third party reimbursement • Enabling services which are critical to delivery of health care are not well represented in conventional code sets

  5. Examples • Advance Directive Preparation • S0257 Counseling and discussion regarding AD’s and EOL care planning • Language and Communication Needs • T1013 Sign language or oral interpretive services, per 15 minutes • Transportation • T2001 Non-emergency transportation; patient attendant/escort

  6. Examples • Outreach and Case Management • T1017 Targeted case management, each 15 min • Medical Home, Care Coordination • S0280, S0281 Medical Home program, comprehensive care coordination & planning (initial and maintenance) • Telehealth • Q3014 originating site; use CPT® codes for destination

  7. Barriers to Change • Diversity within a culture can affect the provision and utilization of care • Changing demographics of population groups • Cultural values, assumptions and beliefs affect patient care and third party reimbursement • Existing reimbursement methodologies do not recognize complementary medicine • Conventional and alternative updates must be based on data to effect change

  8. Solutions • Expand the list of codes to accurately capture non-conventional services • Educate healthcare professionals on ways to map specialized services to potential reimbursement sources or quality measure reporting • Work with health plans and government entities to expand coverage

  9. Questions and DiscussionMahalo! Jeri Leong, R.N., CPC, CPC-H, CPMA Healthcare Coding Consultants of Hawaii, LLC Visit us on the web: www.hcchhawaii.com

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