Building a robust medical coding education program for providers and staff alike

Ensuring that your team stays up to date on medical coding changes — with ICD-10 updates effective on Oct. 1 each year and CPT® and HCPCS code updates generally on Jan. 1 — is a given for medical group practice leaders, but how far that education extends isn’t as predictable as those annual updates.

An Oct. 31, 2023, MGMA Stat poll asked medical group leaders how their organizations handle team training on medical coding updates each year. A solid majority (69%) reported that staff and providers receive this training, while 21% noted that only staff are trained on these updates, and another 9% noted some other arrangement. The poll had 443 applicable responses. [Editor’s note: The figures do not total 100% due to rounding.]

A few of the practice leaders who responded “other” noted that they only do coding update training with their providers; however, the vast majority of the remaining poll respondents typically told MGMA that billing and coding staff were more likely to receive more frequent education (ongoing or monthly, usually) on coding, whereas providers were sometimes more likely to only receive annual or biannual education to cover major updates.

At the same time, some respondents echoed what MGMA learned in previous polls: That the task of educating on this area of revenue cycle management is no longer an in-house operation with the outsourcing of coding to a third party.

There's also some variability among respondents in their view of how to handle the need for coding staff to stay up to date on shifting guidelines.

• In many practices, the training may be focused on team leads, a revenue cycle director or billing managers, or only certified coders, and not the entire team staff. Depending on the size of the organization, some practice leaders take a multi-phased approach to ensure these managers/team leads are “trained to be trainers” and then provide education for the rest of the staff.
• In other groups, some practice leaders say they dedicate a specific amount of professional development dollars for coding staff to seek out the education themselves.
• Some practice leaders opting to put their coding staff in charge of educating themselves on updates noted there is not an established cadence for those updates.

But among practice leaders that ensure staff and providers receive training on updates, there often is an expansive view of which roles should be aware of changes. For example, one practice leader told MGMA that — in addition to RCM staff, licensed providers and support staff receiving training on coding updates — the leaders of the compliance program and population health management are sometimes included in coding education.

New resources for 2024

• “2024 CPT® and ICD-10 Coding Update” — Join us Nov. 14 for this MGMA member-exclusive webinar on the latest coding updates from Veronica Bradley, CPC, CPMA, senior industry advisor at MGMA.
• “Office/outpatient Evaluation and Management (E/M) coding changes for 2024” — Office/outpatient visit E/M time-based coding will change in 2024 to align with other E/M codes. Time ranges will be omitted and replaced with base time to meet or exceed.  This article details this change in guidance that takes effect in 2024.
• “ICD-10-CM Coding and Reporting Updates for FY 2024” — MGMA members can access this resource that details FY 2024 guideline updates that took effect Oct. 1, 2023, and remain active through Sept. 30, 2024.
• Watch MGMA Insights and Washington Connection newsletters in the coming weeks for more resources related to the 2024 Medicare Physician Fee Schedule final rule and tools to calculate RVU variances year over year.

Engaging physicians in the claims cycle

As Taylor Johnson, MBA, CMPE, and Michael Tutty, PhD, MHA, FACMPE, noted in the October 2023 issue of MGMA Connection magazine, it’s important for physicians to not just have a basic understanding of medical coding but also “baseline billing and coding knowledge to engage in meaningful conversations with the administrative team.”

In designing an education plan for physicians around this area, Johnson and Tutty suggest these items:

• Evaluation and management (E/M) codes are CPT® codes used when a provider is evaluating or managing a patient’s condition or illness. Physicians should be aware of the E/M guidelines pertinent to selecting the appropriate level of service.
• Commonly used procedures and drug codes. Note: Consider explaining any procedures or medications that are bundled and standard global periods for common procedures performed in your practice. Also, consider dosage and how to document for proper revenue capture.
• Common modifiers used for E/M, procedure and drug codes.
• Specific procedures or plans that require prior authorization.
• Evaluating payer policies on modifier usage and customary codes.

Join MGMA Stat

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