Page 238 - DCAP305_PRINCIPLES_OF_SOFTWARE_ENGINEERING

Principles of Software Engineering

Notes Pilot 1

Our first pilot involved a vendor whose product assigned codes for inpatients and outpatients.
The software used SI coding. In order for the software to ‘read’ the clinical terms to be codes,
the diagnostic or procedural phrase had to start on the same line and at the same column in
each different transcribed document. It was not possible for us to meet this requirement with
transcription coming from multiple clients with varying report formats. The only alternative
was to place delimiters around the text to be read for coding. This proved tedious and time-
consuming. It negated any productivity increases by the coders. In addition, the requirement
for the strict identification of phrases meant that any diagnostic or procedural information
embedded in the body of the report could not be ‘read’ by the software.

Other problems became apparent during the study:
The software was unable to assign Current Procedural Terminology (CPT) codes, so this
eliminated its use for outpatients.
The software was fairly accurate in ICD-9-CM code assignment (approximately 70% accuracy
rate), but the list of assigned codes included extensive notes to physicians regarding possible
documentation improvement and extensive notes to coders about possible additional
or different codes. While interesting the first time they appeared, the notes became
overwhelmingly repetitive. Since each note was interspersed with its associated code in the
list of codes assigned by the software, it was not possible for a coder to quickly review the
codes for accuracy or completeness. The code listing spanned several screens or, if printed
out, several pages. There was no way to turn off this feature other than totally eliminating
all edits. Because of these operational issues—the pilot was discontinued.

Pilot 2
Our second pilot involved a product that only assigned codes for inpatients. It truly ‘read’ the
text and assigned ICD-9-CM codes for both diagnoses and procedures. It did not sequence
codes, but left that task to the coder. Human intervention was required to determine the
principal diagnosis. Once a coder made that selection, the software determined the diagnosis
related group (DRG). With the selection of additional codes for secondary diagnoses and
procedures, the software updated the DRG assignment.
The computer assigned codes appeared in a window. If coders clicked on the code, they
were taken to the report and text that served as the basis for the code assignment. If there
were multiple text references, the coder would be led to each one for review.

An encoder and grouper were embedded in the CAC product, so coders could ‘recode’ any
diagnostic or procedural term. All activity occurred on one screen through various windows.
The CAC software analyzed documentation for 100 patients as called for in our study method.
Results of Pilot 2
1. Coding Accuracy

Codes assigned were accurate, but not always appropriate. The coders did not accept 75%
of the diagnosis (dx) codes and 90% of the procedure (px) codes. In 58% of the cases, coders
added diagnosis codes. In 45% of the cases, procedure codes were added. The codes required
to determine the correct DRG were present in 48% of the cases.
Specific Problem Areas
• The codes assigned by software were listed in numeric order, making review and
resequencing tedious.

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