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Conquering CPT Codes

Utilize spreadsheets to correct billing and coding errors

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Your charge master runs your laboratory. For each test performed it adds a CPT (Common Procedural Terminology) code, a five-digit number determined by the American Medical Association, to the patient bill. Since patient insurers pay hospitals based on these codes, they need to be accurate. Periodically verifying thousands of CPT codes in a charge master is time consuming, tedious and error-prone. Fortunately, much of the heavy lifting can be done by a computer spreadsheet.

Spreadsheet software such as Microsoft Excel and others do more than add up rows and columns of numbers or graph scatter plots. Behind the scenes, a spreadsheet contains a powerful programming language that can combine information, cross reference other spreadsheets and filter tens of thousands of lines of data in seconds. Using spreadsheet power, you can keep your charge master up to date and make sure your CPT codes are accurate. 

Time Is Money -- So Are CPT Codes 
"Time is money" is often attributed to Benjamin Franklin, who used the phrase in Advice to a Young Tradesman, Written by an Old One, writing that a worker making ten shillings (half a pound, perhaps as much as $145 today1,2) a day effectively throws some of it away in addition to whatever he spends on fun during his time off.3 It made good sense in 1748, and it still does.

Whether you delegate or update billing codes yourself, the time it takes is costly. Physically comparing one or more CPT codes to reference laboratory codes, for example, may take less than a minute each. But the upfront time to gather, organize, sort and filter both lists can be considerable. During the process, you'll discover errors that need to be corrected, obsolete codes that need to be changed or deleted, and tests that don't exist on one or the other list. Such "bookend" times are open-ended variables. Add into that the cost of fatigue and eventual errors -- you won't be able to afford to double-check your work -- and time really is money.

The time needed can be so expensive that it becomes impossible to perform religiously. One HIM expert recommends a frequency of at least quarterly, involving finance people to review pricing and revenue codes. Ideally, however, this task should be ongoing.4

A less abstract incentive is the Tax Relief and Health Care Act of 2006 that made the Medicare Recovery Audit Contractor (RAC) program permanent in all 50 states. RAC auditors looking for Medicare fraud and abuse may review at least three years of claims that include laboratory services, using software to find billing errors. Paid on a contingency basis, RAC auditors are financially motivated to save money.5 Their time could be your money.

Get the Data
Downloading or importing data into spreadsheet software such as Microsoft Excel (the below applies to most spreadsheet software) lets you manipulate and link different sets of data quickly and easily, saving time, reducing errors and beating the auditors at their game. All you really need to know are a few steps.

Here's what you need to start:
  • Download billing data from your information system. Include fields to identify the patient, test, CPT code and quantity, but also any identifiers unique to the encounter. Most systems have an ad hoc reporting capability that can export data into a spreadsheet format (such as Excel) or a CSV (Comma Separated Value) text file that can be imported into a spreadsheet.
  • Ask your reference vendor for a similar data file that matches the most recent invoice. The same "key" identifiers should be in both files.

Your IT department (or resident geek!) can help. Converting a date into text, for instance, may require a special function combining YEAR(), MONTH(), and DAY(), special date conversion functions.

Find the Keys
A computerized spreadsheet is a grid made of columns denoted by letters and rows denoted by numbers. Thus, A1 is the grid element (called a cell) in the upper left corner of the spreadsheet. Cells may contain text, constants or functions. Constants are numbers you enter that don't change (e.g., 100); functions are equations that manipulate any data in the cells. A function is "behind" the value in the cell and visible in a special field on the top of the spreadsheet.

Once your data is loaded into a spreadsheet as illustrated in Table 1, you need to create a unique key for each billed item. In both spreadsheets, which can be tabs in the same notebook, insert a column called Key (column E in the Table) and add the function as shown to concatenate the cell text values. Then, copy and paste the cell down the entire column.

Table 1: Create the Keys

Fx =

=A2&C2&D2

 

A

B

C

D

E

F

G

1

Acct No.

Item No.

Date

CPT

Key

Qty

Ref  Qty

2

12345

220011

20120805

88305

 

2

 

3

12346

220120

20120805

88304

 

1

 


Link the Keys 
Once both spreadsheets contain the same key -- a simple but effective method -- they can be linked using the powerful VLOOKUP (Vertical Lookup) function as shown in Table 2, putting the value in "Qty" in the cell where both keys match. Here's the syntax:6

VLOOKUP(lookup_value, range_of_cells, col_index_num, range_lookup) 

  • lookup_value - the Key we have created. 
  • range_of_cells - this points to the reference laboratory spreadsheet; e.g., Path! denotes the tab label and $E$2:$G$588 the two columns that contain the Key and the Qty values. Remember the $ character to keep the range values the same. 
  • col_index_num - the number of columns from the first sampled to return the value (2). 
  • range_lookup - this may be optional; for our purposes, leave at zero.

Table 2: Link the Keys

Fx =

=VLOOKUP(E2,Path!$E$2:$G$588,2,0)

 

A

B

C

D

E

F

G

1

Acct No.

Item No.

Date

CPT

Key

Qty

Ref Qty

2

12345

220011

20120805

88305

123452012080588305

2

 

3

12346

220120

20120805

88304

123462012080588304

1

 

Once the keys are created and the sheets are linked, an additional column can be created to subtract Qty from Ref Qty, for example, and filter it for values other than zero. Nonzero values indicate an incorrect quantity was billed; an error (such as N/A) indicates the CPT code may be incorrect.

Spreadsheet power helps you compare and filter hundreds to thousands of items in a few minutes, leaving only a handful for review. This lets you correct your billing and coding errors with time to spare, letting you return to the important work of ensuring better patient care.

Scott Warner is lab manager at Penobscot Valley Hospital in Lincoln, Maine.

References on page 2...


Conquering CPT Codes

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