Coding Quality: Obstacles and Solutions

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Original story posted on: February 25, 2019

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Developing a team approach can positively impact coding quality and reduce coding errors.

Coding professionals are faced with a myriad of challenges that can significantly impede coding quality. Such challenges include ongoing, increasing pressure to meet management productivity standards and CFO expectations to drop bills in a timely manner to keep accounts receivable (AR)days at a manageable level.

In order to drop bills this way, coders may do so without waiting for query provider responses clarifying diagnoses, when needed. In addition, less-experienced coders may lack clinical understanding, which can contribute to inaccurate code assignment further magnified by misinterpretation of applicable coding guidelines.

All of these influences can detract from coding quality and accuracy, resulting in an adverse impact on provider profiling, poor quality, data integrity concerns, and potentially, inappropriate reimbursement. In addition, coding guidelines and regulations that coders are bound by are constantly evolving, and must be interpreted and practically applied to individual medical records that often feature insufficient and/or inconsistent physician documentation.

The coder must review each record in its entirety, assign all relevant ICD-10 diagnoses, and research Coding Clinic when guidance may be needed for code assignment, all while maintaining strict productivity standards and achieving an overall coding accuracy rate of at least 95 percent. This, quite frankly, is not an easy feat to accomplish, particularly being as coding has evolved into a task, as opposed to the more legitimate role of acting in support of accurate data, optimal reimbursement, compliance, and a high-performing revenue cycle with net patient revenue integrity.

How are coding professionals supposed to combat these daily pressures to ensure quality coding?

The American Health Information Management Association’s (AHIMA’s) Guidelines for Achieving a Compliant Query Practice (2019 Update) is a tool that coding staff can use to effectively query providers compliantly, when necessary and clinically appropriate, to ensure accuracy of code reporting. For those who are not sure about the query process, the practice brief explains what a query is, who to query, why to query, and what to query for, along with what type of information should and should not be included in a provider query.

Developing a collegial team approach between each organization’s coding staff and the clinical documentation integrity (CDI) staff can positively impact coding quality, reduce coding errors, and help with timely bill submission to reduce AR days. CDI staff can assist coding professionals with understanding clinical conditions, which in turn can ensure appropriate code selection and assignment. Also, CDI can assist coders with orchestrating succinct, compliant queries.

Since CDI staff generally work closely with providers, they are able to assist the coding staff to ensure regular claim submission, with compliant queries that are answered and reflected in the ICD-10 codes assigned, with optimal DRG calculation. Furthermore, CDI staff can help the coding team with developing solid provider relationships. It is important for coders and providers to develop strong working relationships to prevent and drive down ambiguity in code assignment.

Once coder and provider relationships are established, coding staff can quickly and effectively clarify documentation that is unclear in order to report the most accurate diagnoses or procedure codes. In turn, the provider will also gain a better understanding of what documentation is required to ensure that the care they provide is accurately captured.

Critical to consistent achievement of quality coding is the recognition that coding is a key part of the revenue cycle and quality care; coding constitutes much more than simple throughput, converting diagnoses to ICD-10 codes to be used for seeking reimbursement. Coding serves a vital role as it pertains to the lifeblood of the hospital, with the financial health of the hospital directly dependent upon accurate and complete clinical documentation generated by the physician and other clinicians. It stands to reason that quality coding can be consistently attained if coders work in tandem with physicians, CDI specialists, and other healthcare stakeholders in the name of patient care and accurate optimal ICD-10 code assignment.

Quality coding can be achieved, provided that coding is not tantamount to that which is related to a production shop. Leave the production shop to the manufacturing sector.

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Heidi Hillstrom, MS, MBA, RN, PHN, CCDS, CCS

Heidi Hillstrom is a revenue cycle professional with a wide variety of experiences and accomplishments in clinical documentation improvement, case management, utilization review, and coding. She is currently a clinical documentation improvement as well as denials and appeals specialist at St. Luke’s Medical Center in Duluth, Minnesota.

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