Coding:
The Best Clinical Coders On The Planet, At Your Beck And Call

No function in the ASC revenue cycle impacts your bottom line more than coding. Ironically, it’s also the most complex and demanding. Coding is art and science that requires both interpretive skill and analytical rigor. Assigning the appropriate codes to any encounter is a complex task with an untold number of variables involved. These variables can be a function of surgical technique, the size of incision, the type of anesthesia, and the list goes on. And that doesn’t even take into account other factors such as CMS mandates, AMA guidelines and local contractual issues.

GENASCIS can help your facility turn what has traditionally been an industry bottleneck into a decided competitive advantage. Our sizeable team of well-trained, high-caliber certified coders simply has no peer. Doctors, nurses and other medical professionals comprise a large portion of our clinically educated coding staff. Providing cost-effective and accurate coding for ASCs, surgical hospitals and specialty physician practices, as well as Medicare-compliant coding, these clinical coding specialists will maximize your reimbursement potential and, as a result, improve cash flow.

Coding Platform

In addition to thoroughly understanding and remaining current with a wealth of ASC- and specialty-specific clinical procedures and terminology, our coding experts are also cognizant of regulatory mandates from multiple governing bodies. Documentation and coding guidelines issued by CMS, including CCI (correct coding initiative) edits , are adhered to faithfully; however, should there be a guideline issued by the AMA (American Medical Association) in conflict with CCI edits, the AMA guideline supersedes to accommodate third party payors.

In an ASC setting, the CPT code determines reimbursement, while the ICD-9 diagnosis code establishes medical necessity. Inextricably linked, the reconciliation of each is a top priority for our coding experts.

Coding Process

The coding process starts with a certified coder reading the entire report and abstracting appropriate CPT codes. The procedures dictated under “Procedure Performed” in an operative report are used as guidelines. The final documentation to issue a CPT code must reside within the narrative of the operative report. If a procedure is listed yet not supported in the body of the report, the CPT code will not be issued.

The reverse is also true. If a procedure is not listed under “Procedure Performed” but is documented in the narrative of the operative report, it will be abstracted, coded and submitted for billing.

The coder also evaluates the operative report for all bundling edits and applicable modifiers.

To establish medical necessity, appropriate ICD-9 diagnosis codes linking to the CPT must be issued. The guideline for this documentation varies slightly from the CPT requirement. The primary source of diagnosis codes in an operative report is the “Postoperative Diagnosis.” If this is insufficient, anything documented in the narrative or “Preoperative Diagnosis” may be used to help establish the medical necessity of the procedure. In an ASC setting, any diagnosis dictated as, “rule out”, “probable” or “may be” cannot be used to support the procedure. Only a definitive diagnosis may be reported. If a definitive diagnosis is not available or established, the coder will attempt to establish the medical necessity via reporting of signs and symptoms.

In brief, the operative report is read in its entirety. Following all guidelines set forth by CMS and AMA, the coder must strategize to ensure: (1) all possible CPT codes are captured, (2) supporting ICD-9 diagnosis codes are abstracted, (3) appropriate modifiers are applied and (4) all of this documentation is submitted for billing.

  • Risk of erroneous or incomplete coding is minimized, while first-time acceptance of claims is greatly enhanced
  • Reimbursement is maximized and payment processing time reduced through quality control processes
  • Forget about regulatory and compliance issues and focus on patient care
  • Affordable access to a team of certified coders with diverse, clinical expertise that is devoted to remaining current with coding trends and mandates
  • No training or infrastructure costs for the facility
  • Expedite the transition from coding to billing when both services are handled by GENASCIS
  • Avoid the immense task of hiring, developing and retaining skilled coders
  • Near-encyclopedic knowledge of coding processes and procedures
  • Coding qualified and its viability examined prior to the claim being processed
  • Constant monitoring and examination of most recent regulatory requirements and compliance guidelines
  • Certified and highly trained coders with clinical backgrounds providing ASC, multi-specialty and Medicare coding
  • Commitment to on-going education initiatives among our coding experts, including the seminars, tradeshows, training courses and independent study of the most recent coding mandates
  • Available as part of a seamlessly integrated revenue cycle solution from the industry’s only single-source resource