Benefits of Coding and Case Management Collaboration in Healthcare

 

In this article, we discuss the benefits of coding and case management (CM) collaboration – in particular, the value of CM documentation.

By no means is this going to be an article about how case management should be cross-trained to learn coding. However, we believe there is value in coding professionals being able to engage in discussions with case management regarding the role of case management documentation in the coding process. Specifically, we want to emphasize how clear documentation on patient dispositions and social determinants of health (SDoH) risk factors can greatly enhance record integrity. As we have discussed in previous articles and broadcasts, there is no better way for coding to gain insight into and accurately capture Z-codes than by leveraging the descriptive documentation provided by case management in their initial assessments and ongoing progress notes related to patient involvement, including SDoH risk factors during hospitalization and their impact on the disposition plan.

The subsequent vital piece of information provided by Case Management (CM) pertains to the Post-Acute Care Transfer (PACT) policy. This policy, established by the Centers for Medicare & Medicaid Services (CMS), applies specifically to certain Medicare Severity Diagnosis-Related Groups (MS-DRGs) listed in Table 5 of the annual releases within the Inpatient Prospective Payment System (IPPS) final rule. Its purpose is to potentially modify payments in cases where a patient is transferred to a post-acute care setting before the expected geometric mean length of stay (GMLOS) associated with their respective DRG.

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