I was recently asked by a medical coder if I thought our professional services would soon become obsolete as more and more computer-assisted coding (CAC) applications are developed.

I did not have to think about this for very long because CAC increasingly has been  brought on line in many specialties over the past 10-15 years . What I have seen that the need for coders has not diminished, but the demand for more experienced coders has increased. Organizations need coders who can teach the computers when they are unable to code from a note. Organizations need coders who can teach providers how to improve their documentation, so that the note will lead the CAC system to the most appropriate codes. Organizations need auditors to audit the CAC coding, to feed into compliance programs, the accuracy of the documentation and coding as determined by the CAC systems. Computerized systems cannot just work unchecked. CAC system performance needs to be audited to make sure that the programming is determining the proper codes.

CACs Not Always Right

I recently received an EOB for an adjacent tissue transfer of a defect that was created on the tip of my nose from Mohs surgery. The reconstruction was coded 14061, Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10. 1 sq cm to 30. 0 sq cm. There was no way that the secondary defect and the primary defect on the tip of my nose could add up to more than 10 square cm. When calling the surgeon’s office, the response I received from the nurse was that the “computer coded the procedure”. So, here we had a CAC scenario.

My question to the nurse was, “How does the computer get the dimensions of the secondary and primary defect?” Her answer was that the computer got the information from the physician’s documentation. My response was that the physician’s documentation was inaccurate, and I could send her pictures of the defect and the final reconstructed defect. I explained to her that there was no way that the primary and secondary defects could exceed 10 square centimeters. The computer is only as accurate as the input into the algorithms, and in our case, that is the documentation. That is why the coding and documentation must be audited.

What Does CAC Mean?

What does this mean for coders?  As we move into a more artificial intelligence environment, higher level coding skills will be needed, such as Clinical Documentation Improvement, Auditing and Education. And those who are developing and maintaining CAC systems will always need coders to continually improve and challenge the system. So, I do not think that CAC will be taking our jobs, but it will be causing us to step up our skill set as we evolve into more computer assisted coding.