Coding
Welcome to the GoRev Coding Tutorial. In this tutorial, we will focus on the process of navigating through the Coding module in GoRev.
1 : Begin Navigating to the Coding Module
As a GoRev user, the Coding module will allow you to Code a patients account in preparation for Batching the coded accounts. To begin, click on the “Coding” button present on the GoRev Homepage toolbar.
2 : Navigating & Understanding the Coding Buckets
At this point, the Coding Buckets should, now, be visible. In GoRev, Patient Accounts are sorted into a variety of Coding Buckets. A Coding Bucket categorizes Patient Accounts by their Coding Statuses. You will have the ability to select the appropriate coding status in the patient overview window present under the "Visit" Section. Once you have selected a coding status, that patient account will be added to that coding bucket. For instance, if the Coding Status for a Patient Account is set to Needs Review, then the account would be present in the Needs Review Coding Bucket.
In the GoRev Coding Buckets, the list of Coding Buckets available to you are unique to your GoRev Facility. However, below is a list of common GoRev Coding Buckets and their definitions:
Coding Buckets Definitions
Ready for Coding | Coding Bucket containing all Patient Accounts that are ready to be Coded by the user. Patient Accounts can either be automatically identified as Ready for Coding by the GoRev system or manually set to the Ready for Coding status by the user. | |
Coding Approved | Coding Bucket containing all Patient Accounts that have completed the Coding Process and are ready to be Batched. Once a Claim Batch is dropped, the Patient Accounts in this Coding Bucket will automatically be sent to the Coding Complete Bucket. | |
Coding Complete | Coding Bucket containing all Patient Accounts that have completed both the Coding and the Claim Generation processes | |
Completed | Coding bucket previously utilized for all accounts that have completed the coding and claim generation processes. The default coding status for completed accounts has since been changed to "Coding Complete" for all future accounts. | |
Needs Review | Coding Bucket containing all Patient Accounts that need to be reviewed prior to the Claim Generation process. | |
Pending Medical Records | Coding Bucket containing all Patient Accounts that are not Ready for Coding due to Pending Medical Records | |
Deficient Medical Records | Coding Bucket containing all Patient Accounts that the user has manually identified as either missing a medical record or having a medical record with a partial deficiency, such as a missing registration document or a missing IV Start Time. | |
Error | Coding Bucket containing all Patient Accounts that the GoRev System has identified as having an Error in the Coding process that will prevent the Claim from entering the Coding Approved Bucket and being subsequently Batched. | |
Batching Error | Coding bucket containing all patient accounts that have been rejected in the batching process due to a batching error. |
3 : Entering a Coding Bucket
Once you have determined which coding bucket you require, please open the Coding Bucket by clicking on the corresponding tile present in the Coding Buckets window.
While many Coding Bucket tiles will take you directly to the Coding window, some Coding Bucket tiles will prompt you to select additional Patient Account filters. In this instance, please select the filter(s) that you require by clicking on the corresponding filter tiles provided.
Note: Coding bucket filters can be created, by request, for all coding buckets by any service type in order to further filter the coding bucket. Please contact the GoRev Support team by email at ask@gorev.com or by creating a ticket in order to request the creation of a new coding bucket filter.
4 : Selecting a Patient Account to Code
After selecting the filter(s) that you require, the selected Coding Bucket will be visible. In order to begin Coding a Patient Account, please click on the corresponding Patient Account and double click to directly open the coding screen for the selected account.
Note: You may also open the coding window by selecting the patient line. Then, click on the patient overview button located in the coding toolbar and navigate to the coding button located in the patient overview toolbar.
If you have difficulty locating the Patient Account that you require, please utilize the Search box present in the bottom right corner of this window to aid in your search.
5: Patient Overview Coding Module Access
In addition to the GoRev Homepage toolbar, you may, also, access the Coding module for a known Patient Account in the account's Patient Overview window by clicking on the “Coding” button in the window's toolbar.
6 : Navigating & Understanding the Coding Module Sections
At this point, the Coding module for the selected Patient Account will be present on your screen. The Coding Module is made up of 8 major sections titled “Patient”, “Visit”, “Place of Origin”, “Diagnoses”, “CPTs”, “Procedures”, “Files”, and “Account Notes”.
Patient
The “Patient” section of this window contains the Patient's Name, Date of Birth, and Gender, which will be auto-filled using the information provided on the Patient's Overview window.
Visit
In the Coding Module, the Visit section is comprised of two sections titled “Account” and “Insurance”. First, the “Account” section contains a myriad of Patient Visit Information that is relevant to the Coding process. This section will allow you to edit or enter patient visit information.
The Visit section features a multitude of helpful fields to be utilized while coding a patients account. Some of the most commonly useful fields and their purposes are:
Coding Status: The coding status will allow a coder to move the patients chart to a new coding bucket manually. This can be utilized when changing the chart to "coding approved" once coded and many more options.
Disposition: The Disposition field is utilized to track where the patient is and/or where the patient was sent for insurance based purposes. For instance, if the patient was discharged to another facility, and/or discharged home, you would note this information here.
DRG: The Diagnosis Related Grouper is calculated by GoRev. It will calculate as you are entering in the diagnosis codes, once you are done, you can click the check box to add the DRG to the DRG field.
Claim Billing Note: The Claim Billing Note can be utilized in order to populate box 80 on the UB04. This function can be used for workers comp in order to specify what schedule you would like to utilize, for sending in corrected claims, and more.
CLIA: The CLIA number will default based on the information entered into the facilities location.
In addition to the patient visit information, the "Visit Account and Insurance" sections will also allow you to code the patients visit as an inpatient visit. To do so, please select the "Inpatient Visit" checkbox present in the top right corner of the "Visit" section.
Once the inpatient visit checkbox has been selected, this function will add a POA field to the patients coding window in order to indicate if that diagnosis was present when the patient was admitted.
In addition to POA fields, the Inpatient checkbox will also allow the user to enter PCS or Procedural Classification System codes for the patients inpatient visit.
Second, the “Insurance” section of the “Visit” area contains the Patient's Insurance information that is on file in GoRev for this Patient Visit.
Note: If the Patient Visit was Inpatient, please utilize the “Inpatient Visit” checkbox in this section to make this distinction.
The last tab under the visit section is the "Claim Timeline" that shows the history of actions done on the account
Place of Origin
In the Coding Module, the “Place of Origin” section contains the Patient's “Point of Origin for Visit or Admission” and “Priority (Type) of Visit or Admission”.
Diagnoses
However, the “Diagnoses” section of the Coding Module is the section where you will enter the Patient's Diagnoses Codes for this Visit/Admission.
While entering diagnosis codes for the patient, the GoRev system will provide autofill options in a drop-down menu based on the diagnosis code you typed in. Once visible, please select the correct code to autofill the fields provided.
Note: When entering the diagnosis you may select the correct option by utilizing your arrow keys and hitting enter to select the diagnosis code. Then select the tab button to go to the next diagnosis field for any further entries.
CPTs
Additionally, in the Coding Module, the “CPTs” section is the area where you will enter the Patient's CPT Codes for this Visit/Admission.
When attempting to enter a new cpt code for a patients account, GoRev will provide autofill options based on the charges currently entered into the GoRev chargemaster. Please select the correct option and hit enter to autofill the provided fields.
In the event that you are having difficulty locating a CPT code from the entered list, please utilize the Search field in this area to aid in your search.
Lastly, when entering a modifier into the GoRev cpt fields, you will be unable to enter an invalid modifier. Simply type into the field with your modifier and system will split them into appropriate modifiers.
Lastly, the CPT section will also categorize the entered charges by 7 series, 8 series, and 9 series charge codes in order to minimize the amount of missed charge codes and allow for better organization by code type.
Procedures
In the Coding Module, the “Procedures” section is the area where you will enter the Patient's Procedure Codes for this Admission. Its important to note that the procedures section does not currently autofill. Please ensure that you type out the full procedure code when entering a patients procedures.
Note: The Procedures section of the Coding Module will only be present if the Inpatient checkbox in the Visit section is checked, as Procedure Codes are only applicable to Inpatient Claims.
Utilizing the Coding Assistant
In GoRev, you will also have the ability to utilize the GoRev Coding assistant while coding a patients account. The GoRev Coding Assistant is able to notify the user of any coding errors such as charge duplication, inactive charges. and many other common coding errors. In order to utilize the coding assistant, please start by clicking on the required cpt or dx code.
Then, select the coding assistant tab located on the bottom portion of this screen in order to open the coding assistant tab.
Note: The coding assistant will also trigger an error pop up window when attempting to save the coded patient accounts with any errors present.
Utilizing Medical Necessity
In GoRev, you will also have the ability to utilize the GoRev Medical Necessity to check for LCD/NCD for certain CPT codes that you have entered that are subject to LCD/NCD. This information pulls directly from CMS.
You can view the article by right clicking on the row and selecting "View Article". This will take you directly to the CMS website.
Double click on the row to view all the supporting diagnosis for the LCD/NCD.
You also have the ability to add a supporting diagnosis from the list by right clicking on the supporting diagnosis and selecting "Add Diagnosis".
Once you have added the supporting diagnosis, you can select the "Refresh" to run the Medical Necessity check again to ensure it has Passed all Diagnosis Requirements.
Once refreshed, the system will show it has Passed all Diagnosis Requirements as show below.
2. Coding the Institutional and Professional Accounts Simultaneously
In addition to coding the institutional patient account, GoRev will also give you the ability to code both the professional and institutional accounts at the same time. In order to do so, begin by opening and coding the institutional account before setting the coding status to "Coding Approved".
Then, select the "Save and Go to Linked Account" button located in the upper right corner of the coding toolbar to open the linked pro account.
In order to import the same codes you entered onto the institutional patient account, please click on the "Import Linked Codes" button located in the top right corner of the coding toolbar.
3. Navigating through the Coding Toolbar
In addition to the main sections of the coding window, you will also have the ability to utilize a multitude of features including Coding Sets, quick statuses, other codes, the coding history, the coding ledger, the go to quick access feature, and more features located within the coding toolbar.
Coding Sets
The coding set button will give you the ability to enable or disable any coding set you require in the process of coding the patients account. In order to do so, please select the coding set button and click on any coding set you would like to enable or disable.
Quick Statuses
The Quick Status Feature will allow you to utilize coding shortcuts to quickly change the coding status for the selected patient account. In order to do so, you can utilize the provided shortcuts or select the option you require from the quick statuses drop-down menu.
Quick Status options:
Coding Approved: ALT + A
Deficient Medical Records: ALT + D
Needs Review: ALT + R
Pending Charge Entry: ALT + E
Other Codes
The Other Codes feature will allow you to add Condition Codes, occurance codes, and/or value codes to the patients account. These codes are used to provide the insurance companies with further information when batching these claims.
Condition Codes
In order to begin entering a condition code, please select the other codes drop-down menu and click on the condition codes option from the list.
One the condition code window is open, please enter the required condition code into the code field and select add to add the code to the patients account. Its also important to note that you may select an added code and click remove to remove the condition code from the patients account.
Occurrence Codes
In order to begin entering an occurrence code, please follow the steps above to open the occurrence codes window. Once open, please utilize the code field to enter the required occurrence code for this patients account.
Value Codes
Now, In order to begin entering a value code, please repeat the steps from above to open the value codes window. Once open, please utilize the code field to enter the required value code and then enter the value required for that value code.
Once entered, please select the "Add" button to add the value code to the patients account. You may also remove the added value code by utilizing the remove button.
Go To
The Go To feature provides the ability to navigate through the patient coding screen by utilizing quick access keys. To access this area, please select the Go To button present in the coding toolbar. Once the Go To drop down menu becomes visible, it will provide the available hotkeys you will be able to utilize in order to quickly navigate around the coding screen and between patient accounts.
Go To Hotkeys:
Diagnoses: F5
CPTS: F6
Procedures: F7
Comment: F8
Save and Go to Previous Account: ALT + P
The Save and Go to Previous Account hotkey will allow you to move from the currently open account to the previous account present in the currently selected coding bucket.
Save and Go to Next Account: ALT + N
The Save and Go to Next Account hotkey will allow you to move from the currently open account to the previous account present in the currently selected coding bucket.
Patient Encounter History: ALT + M
Coding History
The Coding History feature will provide you with the ability to view the coding history of the selected patient account. This includes the user that coded the account, any changes in coding status, diagnosis codes, when the changes were made, and more. In order to access the coding history log, please select the coding history button located in the upper left corner of the coding window.
Once open, you will have the ability to view the coding actions taken when coding this patients account.
Coding Ledger
Lastly, the Coding Ledger will allow you to view a history of all charges entered onto this patients account for all patient visits. In order to access the coding ledger, please click on the Coding ledger button present in the upper left corner of the coding toolbar.
Once open, the Coding Ledger will allow you to view the cpt codes and additional charge information that has been entered onto this patients account.
Overview, Financials, Workflow, & Charging
Additionally, the Coding Toolbar contains “Overview”, “Financials”, “Workflow”, and “Charging” buttons, which will allow you to navigate to the account's Patient Overview window, Financials window, Workflow window, and Charging window, respectively.
Anesthesia
In the Coding toolbar, the “Anesthesia” tool, if applicable, will allow you to access the Anesthesia Module for the Patient Account.
Waystar History & EOB
Lastly, if applicable, the Coding Toolbar will allow you to view the Claim's Waystar History and Waystar EOB by clicking on the corresponding buttons in the toolbar.
Files
The “File” section of the Coding Module contains any Patient File that has been uploaded to the Patient's Account since its creation in GoRev.
Account Notes
Lastly, in the Coding Module, the “Account Notes” section contains all of the Notes for this Patient Account.
7: Saving the Coded Account
Finally, once you are finished coding the patient account please select the “Save” icon in the toolbar to Save the Coding information for the selected Patient Account.
8. Switching to the Bulk Coding View
In addition to the original GoRev coding view, you may also utilize the GoRev Grid coding view typically utilized for coding bulk accounts with a mass amount of charges. In order to switch to this mode, please select your username in the top right corner and click on the preferences option in the drop-down menu.
Once the preferences window becomes visible, select the coding tab and click on the coding module drop down menu. Once the coding module drop-down menu becomes visible, please select the Grid Coding Module from the list.
Finally, select the save button in the bottom right corner of this window to successfully switch to the grid coding view.
At this point, navigate to the coding bucket or specific patient account that you require and open the patients coding window. Once open, you will have the ability to add diagnosis codes by utilizing the diagnosis tab and typing into the ICD-10 field. The ICD-10 field will begin to auto-populate results as you type. Once the correct result appears, you may utilize the arrow keys on your device to select the correct diagnosis code before hitting enter. In order to create a new row once you have successfully entered a diagnosis code, please click on the tab button on your keyboard.
In the instance that you would like to remove a diagnosis code, simply select the x button located to the left of the entered diagnosis code.
Next, select the charges tab and enter the patients charges by typing into the CPT /HCPCS field and utilize the same steps detailed above to select the auto-populated result and create new rows for additional charges.
The Charges tab, like the classic coding view, will also categorize the entered charge codes by series. In order to utilize these categories, please select one of the available categories located on the left side of the charges section.
In the event that you need to make the patient account an inpatient visit, please select the inpatient checkbox located in the top right corner of the patient area in this window.
Once selected, the inpatient checkbox will allow you to access and add procedure codes as well as the additional fields discussed earlier in this tutorial.
At this point, please add any procedure codes you require. Its important to note that the procedure code fields do not auto-populate.
9. Navigating the Coding Window Hotkeys
Finally, the GoRev Coding window also includes a multitude of hotkeys that will allow you to access a variety of functions and/or navigate around the GoRev coding window.
Save | Ctrl + S | This hotkey will save this account's coding information and close the window. |
Save and Go To Linked Account | Alt + S | This hotkey will save this account's coding information and open the corresponding linked account in the pro or institutional facility. |
Import Linked Codes | F12 | This hotkey will import all diagnosis codes that have been entered on the linked account. Its important to note that this will also clear any diagnosis codes previously entered on the open account. |
Coding Approved | Alt + A | The Coding Approved hotkey will set this patients coding status to "Coding Approved", which will then place this account into the batching window. |
Deficient Medical Records | Alt + D | This hotkey will change the patients coding status to "deficient Medical Records when utilized. |
Needs Review | Alt + R | The Needs Review hotkey will change the coding status to "Needs Review" for the open patient coding window. This coding status is utilized to move this chart to the "needs review" bucket to be reviewed before batching the patients account. |
Pending Charge Entry | Alt + E | This hotkey will change the coding status to "Pending Charge Entry" for the open patient coding window. |
Patient Overview | F1 | The Patient Overview hotkey will open the patient overview window for the open coding screen. |
Patient Financials | F2 | This hotkey will open the patients financials window when utilized. |
Workflow | F3 | The workflow hotkey will open a patients workflow window for the open patient coding window. |
Charging | F4 | This hotkey will open the charging window for the selected patient. |
Diagnoses | F5 | The Diagnoses hotkey will navigate to the Diagnoses section of the coding window when utilized. |
CPT | F6 | The CPT Hotkey will redirect you to the CPT section of the patients coding window. |
Procedures | F7 | The Procedures hotkey will navigate to the Procedures section of the selected patients coding window. |
Comments | F8 | The Comments hotkey will open the comments window for the current open patient account. |
Patient Encounter History | Alt + H | This Hotkey will open the Patient Encounter History window and provide a report of any visits this patient has had for all facilities. |
Coding History | Ctrl + H | The Coding History hotkey will open a detailed log of coding changes conducted on this patients account. |
GoRev Support Team
If you have any additional questions or concerns regarding this tutorial, please contact the GoRev Support Team by phone at (317) 794-3900 or by email at ask@gorev.com
Note: Always submit an IT Support Ticket detailing the problem that you are experiencing with this portion of GoRev, if possible, as this will give GoRev Support Agents access to information that will help expedite the resolution of your issue. If you are unsure how to submit an IT Support Ticket in GoRev, please see the IT Support Ticket Creation tutorial for assistance.