EHR Coding Dreams Shattered by the Evidence

The automated E&M coding feature of most EHRs has traditionally been highly valued by physicians in search of the Holy Grail. But, apparently this key EHR selling point is a myth! According to a report released by the Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS), absolutely no one actually uses this highly touted feature.
EHR Coding Dreams Shattered by the Evidence
The survey concluded that physicians do not trust their EHRs to assign billing codes. Of the 2,000 physicians surveyed, 88% manually assign the codes for E&M services and the remaining 12% use professional billers to do so.

Perhaps the message has finally gotten out! As part of its 2012 work plan, OIG has specifically targeted billing fraud perpetuated by reliance on EHR coding/documentation. Physicians are scared. But the caution regarding automated coding should not come as news to anyone. It has long been known that EHR coding—along with templated notes—does not stand up well in an audit. An article in the well-regarded Medical Economics journal exposed these dangers several years ago.

Yet EHR sales reps continue to entice physicians by appealing to their desperate search for the Holy Grail of coding, offering an easy way to ensure that they will maximize reimbursement. I hope that the results of this study will redirect physicians to search for an EHR based instead on the potential to deliver improved practice productivity and efficiency and enhanced levels of patient care.

3 thoughts on “EHR Coding Dreams Shattered by the Evidence

  1. You state above that the OIG survey found that “absolutely no one” uses automated EHR-based coding. Yet the OIG is targeting billing fraud perpetuated by reliance on EHR coding and physicians are scared? Do you see the disconnect here? If no one is using it, why is the OIG targeting it? If physicians are not using it, why are they scared?

    In your related post linked above, you state that between 20-95% of EHR-generated claims failed Medicare audits.

    I guess there are surveys out there that can support just about any point of view one wishes to promote.

    [from Evan Steele:]

    OIG is not auditing the automated coding, but rather the documentation behind the codes that the physicians select. The underlying problem that is being investigated is the templated note produced by EHRs that physicians are using to justify the codes they submit. That is the problem discussed in the Medical Economics article. From OIG’s report: OIG will conduct “subsequent evaluations [to] determine the appropriateness of Medicare payments for E/M services and the extent of documentation vulnerabilities of E/M services using EHR systems.”

  2. I don’t know if it’s the fact the physicians don’t trust the EHR to do the coding, rather I’m of the belief that most physicians don’t know how to properly utilize the E&M coding feature in their EHRs. Additionally, for the E&M coding functionality to provide accurate coding suggestions, it requires the physician to document into different areas of the progress note in the e-chart that many physicians don’t utilize. So for an accurate coding suggestion, physicians would have to have fully implemented the EHR and be documenting discrete data into all the places in the progress note that the system knows to pull from when considering a level of service. I would think that many if not most providers are not doing that.

  3. Frankly, since we don’t know how the question was phrased, I wonder if the physicians surveyed thought that “manual” vs “automated” referred to whether the charges were written on a superbill for their billing staff to manually enter into the billing system as opposed to using the automated “charge passing” feature (for E/M and other billable service) that were performed during the encounter. If truly only 12% of the physicians on EHRs ignore the “automated E/M coding feature” of EMRs, I think I’ve personally met every one of those physicians. A good portion of my business involves doing E/M audits — and of my clients on EMRs, the vast majority of the physicians in those practice rely very heavily on the “automated” function to tell them what code has been calculated based on how much information was recorded.

    The other possible explanation for this surprising statistic in the OIG report is that most of the physicians who responded to that question didn’t do it honestly. After all, for the past 10+ years the OIG has made no secret of the fact upcoding of E/M services is pretty high on their radar screen for physicians. What physician in his right mind would tell the OIG that he/she doesn’t know enough about E/M coding to be able to select the right level of service without computerized “help”? After all, E/M codes have been around for more than 20 years. Although I know that most doctors are still befuddled about how to connect the dots between the Documentation Guidelines and the AMA’s description of these services, it would be pretty hard to admit that after 20 years, you still haven’t mastered these codes.

    Or even more likely, what actually happens is that the physician tells himself….”Hmm.don’t really know if this is 99213 or a 99214 (or a 99214 and 99215). I’ll see what that calculator says. Oh, it says 99215? Well, the sales rep tells me that their calculator is the most accurate in the business. So I’ll decide to go with that code.” In other words, it’s still the physician’s decision — it’s just heavily influenced by the automated coding software.

    I’m not usually such a cynic. But when I read that part of the OIG’s report, I had to grab some paper towels to wipe the coffee off my computer screen……

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