Book excerpt: The pros and cons of CAC

By Adrienne Commeree, CPMA, CCS, CEMC, CPIC

Due to the intricacy of healthcare records, clinical documentation, and the complexity of medical terms and abbreviations, many hospitals use computer-assisted coding (CAC) together with intervention by human coders. However, the latest CAC software technology employs a type of natural language and syntax processing to compare, contrast, and extract specific medical terms from electronic data or typed text so CAC stand-alone technology does exist. In studies conducted by AHIMA, though, the combination of a CAC with a coder/auditor has been proven to be just as good as, or better than, a coder or CAC alone.

The biggest challenge CAC poses might be getting buy-in from the hospital coding and HIM staff. The HIM, coding, and clinical staff must all be part of the change and be on board with learning how to use the technology. In the past, there has been some uncertainty and fear related to CAC eliminating coders’ jobs. However, a good CAC solution in conjunction with HIM management allows coders to apply their critical-thinking and analytical skills to create well-coded documentation of patients’ care. This, in turn, results in more accurate DRG assignment and reimbursement for the facility.

HIM and coding staff responsibilities and roles in the fiscal revenue stream will change as a result of CAC and similar technology. With this change must come the acceptance that it takes both a human and a computer to successfully transform a CAC product into positive financial outcomes and better documentation.

As coders will surely agree, the final code selection for inpatient records should be based on coders’ knowledge of coding guidelines, clinical concepts, and compliance regulations. When working with CAC, the coder has the ability to agree with or to override codes that the software selects. Coders have the education to understand why a diagnosis or procedure should, or should not, be coded in a specific situation, and by using CAC, they can help the software learn to identify the importance of specific documentation and its relation to ICD-10-CM/PCS codes.

Many CAC vendors promise the following list of features and benefits:

• Better medical coding accuracy
• Faster medical billing
• Greater coder satisfaction
• Identification of clinical documentation gaps
• Increased coder productivity
• Improved revenue due to more detailed bills

A coder’s productivity could stay the same, as a coder might have to audit the information to determine whether the code generated by the software is correct. But in regard to the other CAC benefits on the above list, coder satisfaction should not be overlooked.

During AHIMA’s pilot testing of CAC software, the organization weighed in on some of the potential issues with using CAC software alone (with no human intervention). AHIMA noted that within specific areas of the pilot CAC testing in ICD-10, the coders did not accept 75% of the diagnosis codes presented, and they did not accept 90% of the procedure codes presented within the code sets. However, the information that the CAC software presented did give the coders a good starting reference from which to drill down to a more comprehensive diagnosis or procedure code.

Coders and CDI personnel still need to be in charge of the following:

• Ensuring that clinical documentation is complete and querying when appropriate
• Ensuring complete coding (e.g., for specificity)
• Ensuring correct sequencing of diagnosis and procedures
• Reviewing CCs/MCCs and DRG assignments with case complexity and severity

Editor’s note: This article is an excerpt from The Coder’s Guide to Physician Queries.