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Module 2 Assignment
April 11, 2011
Computer Assisted Coding (CAC) Pros and Cons
The basic design for Computer Assisted Coding incorporates the use of computer
software applications to generate a set of medical codes base on clinical information provided by
the physicians or providers according to Independent (Independent). The software is design to
used structured manuscript or natural language process to code clinical information. The
structured applications produce clinical documents with embedded codes. The natural language
processing use a flow chart that can be translate into code according to AHIMA “the natural
language processing employ a complex algorithms to recognize dictation, speech, and language
patterns to generate codes. Also, querying wording for matching code” (AHIMA).
The pro for computer assisted coding, is that, it was designed to provide solution for
coding in documented information. It has a comprehensive adherence to review information in
logical sequence, that is, inform of flow chart then assign code according to medical terminology
and procedures. Also, it is designed to provide a feedback for correct code thereby making
coding easier for the physicians or providers according to this statement by Ingenix “a provider
dictate clinical information, the computer assisted coding make sense of the meaning and
situation of words within medical records, and correctly identifies diagnoses and procedures. The
software then recommends appropriate code in compliance with ICD-9 and CPT codes to
confirm and if the suggested codes are, correct. . . Also, the computer assisted coding can
indicate if additional research is needed or adjustment is necessary” (Ingenix). After input of the
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correct information, the computer assisted coding will generate the electronic documentation and
highlight all pertinent medical terminology to capture diagnosis and procedure allowing the
physician to validate for billing.
In addition, the computer assisted coding is designed for interchangeable electronic data
thereby helping the physician or providers to conform to HIPAA requirement for electronic
health care transactions. As well, capable to identify providers with health plan coverage, or third
party thereby increases the chances for reimbursement. Besides, computer assisted coding is
better than the HIPAA 1500 claim form that have to be submitted through CMS and it require
the provider to read CMS articles.
Moreover, computer assisted coding is designed to increase accuracy, enhance efficiency,
and advance compliance. Computer assisted coding is able to match procedure code (CPT) with
the diagnosis (ICD-9) from the clinical information. Furthermore, it is designed to identify
inadequate clinical information and query information for clarification. Additionally, computer
assisted coding is able to categorize a procedure as non-coding with feedback and the alternative
that match clinical information thereby reducing denial of payment.
Moreover, computer assisted coding is faster, better, support encoder software, and it
supports remote coding thereby improving mix clinical case. In addition, computer assisted
coding is designed with constant monitoring and reports results at any time along with feedback.
Though “encoders software are color-coded systems” „typing in diagnosis or term, which
triggers a selection of codes, requires a verification to assign appropriate codes‟” (Independent).
For encoder software, you need to have a clear understanding for which medical procedures and
treatments in reference to the clinical information are appropriate for which code and the
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alternative if deem necessary require contacting billing office and insurance provider. For
example, which code applies when a family practitioner sees a patient after having coronary
bypass, what are the procedures for reading coronary bypass surgeries for billing? In reference to
what the third party considered deem necessary, such as, HMO or Medicare, what would
Medicare considered deem necessary for family practitioner to code for reviewing patience
report or correspondence.
Computer assisted coding improves electronic medical record documentation and is
affordable. In addition, it empowers physicians with correct coding that support clinical
information and it prevents third party from changing reimbursement due to third party
interpretation. What's more, it enables the review of document and allows changes to be made
quickly. Furthermore, it ensures appropriate coding and documentation that support the code for
the service provided thereby guaranteeing payment.
The con to computer assisted coding is the technology is new and still open to
interpretation according to AHIMA. Also, the technology lacks the standard for work processing;
although, it makes coding process easier and faster, the design varies by provider and the
organizational factor. For example, the amount of non-coding activities performed by coding
professionals were not defined and it requires each organization to define what type of computer
assisted coding will fits into the individual practice (AHIMA).
Another con to computer assisted coding is that the technology is designed as a tool for
coding is not based on knowledge, which requires the experience of a coder. Also, there are no
predefined categories for natural language or the act of dictating a text for coding clinical
information. Moreover, there are no standards in place to guarantee the accuracy of dictation text
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for complete data. AHIMA and its foundation are sponsoring workshops to develop
recommendation for computer assisted coding standard according to Independent (Independent).
Also, because computer assisted coding is in developing stage, it requires a continual education
to adjust to changes.
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AHIMA. "Automated Coding Workflow and CAC Practice Guidance." Journal of AHIMA 81,
no.7 (July 2010): 51-56
Ingenix Web.Strat, http://go.ingenix.com/webinars/microsite/11-25832/pages/info.html
Independent Medical Coding: The Comprehensive Guidebook for Career Success ...
By Donna Avila-Weil, Rhonda Reganhttp://books.google.com/books?id=Zx-