Notice ID: 36C25821Q0033
“The purpose of this contract is to secure services to assign the current appropriate International Classification of Diseases; Common Procedural Terminology; and Healthcare Common Procedural Coding System Level II codes based on health record documentation of outpatient, surgical, and inpatient care and services provided at or under the auspices of a Veterans Health Administration facility, to include all Community Based Outpatient Clinics, when applicable, and to conduct coding audits of inpatient and outpatient episodes as requested by a Veterans Health Administration facility. ”
- The contractor shall:
- Assign the current appropriate industry standard codes after careful review of the Health Record documentation for all inpatient, outpatient, surgeries, procedures, and ancillary encounters/services. Outpatient encounters include but are not limited to scheduled clinic appointments with physicians as well as other healthcare providers, ambulatory surgery/ procedures, radiology, laboratory and other ancillary services.
- Furnish validation of the integrity, quality, and assignment of codes to the data contained in the outpatient Patient Care Encounter, inpatient Patient Treatment File, and non-Veterans Affairs database and the Integrated Billing package, or that the record contains the correct Centers for Medicare and Medicaid Services (CCM) coder comment regarding the “reason not coded.” Note: Contractor shall validate any order for test procedures in health information documentation to validate medical necessity.
- Not use “incident to rules.”
- Use the latest United States editions of the International Classification of Diseases, Current Medical Information and Terminology, of the American Medical Association and the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association shall be used to provide uniform disease and operation terminology, which is complete and scientifically accurate.
- Assign codes in accordance with National Center for Health Statistics, Centers for Medicare and Medicaid Services, American Hospital Association, American Medical Association and American Psychiatric Association guidelines, as appropriate. On those occasions when there is a question, Veterans Health Administration Coding Guidelines take precedence. Local policies will direct how coding is accomplished and what quantitative and/or qualitative reviews are performed by the facility. The American Hospital Association Coding Clinic and other publications may be used for training and reference purposes.
- Ensure that the contractor’s coders providing services through contract use the national Veterans Affairs encoder product. All coding must be completed through the encoder product. The national Veterans Affairs encoder is a single transparent interface with the Veteran Affairs’ electronic health record system Veterans Health Information Systems and Technology Architecture and the Graphical User Interface version of Veterans Health Information Systems and Technology Architecture. All coding is required to be done via the national Veterans Affairs encoder; no other system shall be used or interfaced with the Veterans Affairs systems.
- Ensure complete electronic data entry into the VISTA system at each individual facility. Entry is to include CPT codes; modifiers; service-connected determination, when applicable; and diagnostic/procedure codes for the encounter or occasion of service into the appropriate VHA encoder software suite. It is to include associating the provider with the CPT code, when applicable. When documentation does not support a diagnosis code, procedure code, or CPT code, a secure compliance e-mail shall be sent to the provider requesting such documentation as appropriate. A suspense date of three days shall be set for reply & follow-up. When paper- based documents are provided by the VA, Contractor shall document codes and related information completely.
