Can Medical Coding Be Leveraged to Improve Patient Experience?

Medical coding is often looked at as an administrative mechanism for ensuring prompt and timely payment in a fee-for-service medical environment. But with an emerging emphasis on transitioning from fee-for-service to outcome-based medicine, does medical coding take on a new role? Can it be leveraged to improve patient experience?

 

A recent Managed Healthcare Executive post from Codametrix CEO Hamid Tabatabaie seems to suggest that. Tabatabaie's perspective is definitely worth considering. If what he proposes is any indication of what the future holds for medical coding, a coder's work moving forward will be less about payment and more about improving outcomes.

 

Medical coding in the fee-for-service model does exactly what it is intended to do: facilitate accurate bills that lead to timely reimbursement. Indeed, this is why the grandfather of all medical code sets – the Common Procedural Terminology (CPT) set – was developed decades ago. Medical coding has always been a billing mechanism.

 

Given that fee-for-service medicine is viewed as a business transaction in the back office, the current system works fairly well. But more than a decade after the Affordable Care Act (ACA) was signed into law, its goal of transitioning America's healthcare to an outcome-based model has begun in earnest. This presents medical coding with new challenges.

 

The outcome-based model is not so straightforward. Capturing medical events isn't always as easy given the room for so much interpretation and overlap. Yet medical coding is still necessary in an outcome-based environment. But as less emphasis is placed on collecting fees for services, medical coding could be leveraged to improve patient experience, thereby making the transition to outcome-based care more effective.

 

Tabatabaie wrote in his post that "diagnosis (ICD-10) and procedure (CPT) code sets offer substantive data insights to support the patient journey and experience." He went on to explain that tracking patients over time plays a role in clinical decision making. Any such decisions can be further enhanced through analyzing the medical codes used to capture patient activity.

 

If you are already a medical coder or biller, you know that medical codes are essentially shorthand. They capture medical events, procedures, diagnoses, etc. using standards easily understood by medical facilities and payers alike. The codes capture interactions between patients and healthcare providers. They could just as easily capture patient activities.

 

By analyzing activities and comparing them to outcomes, medical facilities could get a better understanding of the entire patient journey. Tabatabaie sees that as imperative to improving the patient experience in an outcome-based healthcare scenario.

 

We are still a long way off from a truly outcome-based healthcare delivery model. But we are trending in that direction. As for what that could mean to medical coders, the chances are pretty good that an outcome-based system would lead to a couple of systemic changes.

 

First and foremost, AI tools are pretty likely to take over for the most routine medical coding tasks. Any tasks that can be automated almost certainly will be. Second, it is quite possible that medical coders will eventually be focusing less on capturing individual incidents and procedures and more on capturing different aspects of the patient journey.

 

That could mean significant changes to CPT and ICD-10. It could also mean the introduction of an entirely new code set specifically designed around patients instead of providers. No one knows for sure, but time will tell.

 

Medical coding will have to evolve along with outcome-based medicine. Right now, things seem to be pointing to medical coding as a tool for improving the patient experience.