Along with patient registration, the encounter form and chargemaster (or charge description master, or CDM) serve as the starting point for medical coding and patient billing of outpatient and physician office health care services and procedures. Each health care setting creates an encounter form or chargemaster unique to its organization. The ongoing maintenance of each is necessary to ensure the accurate reporting of medical codes for reimbursement purposes. Although medical codes are routinely updated, the organization’s encounter form or chargemaster team reviews them to ensure that appropriate codes are associated with services and procedures provided. This helps eliminate the possibility of reporting erroneous or outdated medical codes, reducing the incidence of claims denials.

Anywhere Medical Center has implemented the concept of single-path coding, which combines professional and institutional coding to improve productivity and ensure the submission of clean claims, leading to improved reimbursement, it means that each medical coder is responsible for performing professional coding to capture the complexity and intensity of procedures performed and services provided during an outpatient or physician office encounter, as well as institutional (or facility) coding to capture the intensity of services used to provide patient care (e.g., intensive care unit) and severity of illness to classify how sick patients are (e.g., respiratory failure).

Bhavika Kapoor, CCS, CPC, RHIT, holds the position of Coder III at Anywhere Medical Center, which means she performs single-path coding for the same patient accounts. She is assigned to assign ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Level II codes to patient accounts whose last names begin with letters A through E. After having served in the position of Coder I, II, and now III for the past ten years, Bhavika was appointed to serve on the Encounter Form/Chargemaster Team four years ago. It meets as needed when the coordinator identifies potential inaccuracies regarding CPT and HCPCS Level II codes and possible new codes that are needed. This means that throughout her scheduled shift, Bhavika can be contacted to gather with the Team to add, delete, or revise codes listed on the master encounter form or chargemaster documents. (The Team consists of representatives from each medical center ancillary department along with the clinical documentation improvement coordinator, who also serves as the Team’s coordinator.)

Because the encounter forms and chargemasters are used by Anywhere Medical Center to help populate CMS-1500 and UB-04 claims with medical codes for procedures and services provided, their comprehensive maintenance is instrumental in capturing all potential revenue owed. Bhavika is proud to serve on the Team, and she knows that her role as a medical coder helps contribute to accuracy of the encounter forms and chargemasters and the medical center’s “bottom line.”

Bhavika is an active member of her professional associations, especially at the local level, and she attended monthly in-person and virtual meetings that alerted her to upcoming availability of the codes. She routinely reads all journals and newsletters that she receives, sometimes as e-journals and e-newsletters. She also participates in several coding forums where professionals ask questions about code assignment, and others communicate possible answers.

During the COVID-19 pandemic, Bhavika’s representation on the Encounter Form/Chargemaster Team became especially significant because she became aware of the new ICD-10-CM disease code for COVID-19 and CPT codes for the COVID-19 vaccines before other areas of the medical center. Bhavika attended a local virtual meeting of her professional association where she learned that a new ICD-10-CM code for COVID-19 would soon be released on the cms.gov ICD-10-CM website. After the meeting, she checked the cms.gov ICD-10-CM website daily so she could be among the first to learn of that new code. When the code was released, she notified the Team Coordinator so that the Team could convene and update the master encounter form and chargemaster documents immediately. Then, the following year, when it was announced at a virtual meeting that new CPT codes would be released for the COVID-19 vaccines, Bhavika diligently checked the CPT update website daily and was again among the first to view the new codes. This placed her medical center in a great position to properly capture disease and procedure/service data so that revenue was optimized.

Because of her dedication to this aspect of her Coder III position, her supervisor has asked Bhavika to orient the newly hired Coder I, Manuel, about her role on the Encounter Form/Chargemaster Team.

What explanation can Bhavika provide to briefly explain how she came to be appointed to her role on the Encounter Form/Chargemaster Team?

Manuel asks Bhavika to explain the details of her role on the Encounter Form/Chargemaster Team. He is wondering what, exactly, does Bhavika do?

Manuel then asks Bhavika how she knows which codes need to be added, revised, or deleted from the master encounter form and chargemaster documents? He shares that this sounds intimidating because there are over 100,000 codes, and how could anyone be expected to remain updated about them?