April 17, 2015

Decoding the Encoder

By Cathie Wilde, RHIA, CCS, AHIMA-approved ICD-10-CM/PCS Trainer

It’s often said that one’s journey is just as important as one’s destination. In other words, the process of achieving a goal is as vital as the achievement itself. In coding, the goal is to assign the correct code. Although encoders help achieve this goal, they must always examine whether a suggested code is correct. This requires a “journey” through the coding book, using basic logic and reasoning to determine whether each code is truly appropriate based on the documentation provided.

Why coders can’t rely on encoders in ICD-10

Coding is a process, and although encoders play an important role in that process, the technology certainly isn’t 100 percent accurate. As with computer-assisted coding (CAC), human intelligence is required as an extra layer of quality assurance. This is true in ICD-9, and it will continue to be true in ICD-10. If a coder answers even one question incorrectly when using an encoder, the encoder could lead him or her down a completely wrong path toward code assignment. In ICD-10, there is far more room for error, given the specificity inherent in the code set. This is particularly true for ICD-10-PCS.

As encoders become more prevalent, hospitals have begun to forgo purchasing printed coding books. These books are often viewed as an unnecessary expense. However, there are many reasons to purchase the ICD-10-CM and ICD-10-PCS coding books, including the following:

  • To provide additional resources on which coders can rely to ensure compliance: Coders use these books to verify information suggested by the encoder. Many coders also personalize their coding books with notes and references that help save time and ensure accuracy.
  • To increase coder confidence in the codes that are assigned: The more resources coders have at their fingertips, the more confident they’ll feel when assigning codes in the new and more complex world of ICD-10.
  • To ward off potential denials: Proactive denial management is critical in ICD-10. Providing coders with the resources they need wards off potential denials that could cripple productivity.
  • To help understand the logic and process of assigning ICD-9 and ICD-10 codes: Coders need to understand how and why codes are assigned rather than rely solely on the encoder’s suggestions.
  • To ensure a contingency plan when IT systems go down: Coding books allow coders to continue to code in the event of downtime when they’re unable to rely on an encoder.

How to make the most of the coding book

Ideally, organizations will provide the professional editions of both the CM and PCS coding books. These editions include many helpful references, tools, and symbols that make coding more efficient and compliant. For example, some professional CM editions include shading in the index to assist coders in following the subterms listed under a particular condition. Other helpful elements include different font colors to highlight variations in code descriptions, footnotes to alert coders whether a condition is a CC or MCC, and notes to highlight relevant Coding Clinic references. Some professional PCS editions may include notes about non-operating room procedures or specific PCS coding guidelines.

Regardless of the specific edition of the coding book that a coder uses, it’s important to make the most of these books by inserting as many helpful hints as possible. Coders should consider the following advice:

  • Tab each body system for quick reference.
  • Highlight common diagnoses and/or ones that are difficult to locate in the index.
  • Tab each of the following PCS appendices:
    • Appendix A (Root operation definitions) — Highlight definitions with which you have the most difficulty (e.g., excision versus resection). Consider photocopying this appendix and keeping a copy at your desk for easy reference and portability.
    • Appendix B (Comparison of medical and surgical root operations) — Review each root operation to better understand differences.
    • Appendix C (Body part key) — Reference this appendix when you’re unsure of the particular PCS body part that corresponds with a particular muscle, vein, or nerve. Consider photocopying this appendix and keeping a copy at your desk for easy reference and portability.
    • Appendix D (Device key and aggregation table) — Use this appendix to identify the appropriate PCS descriptions for devices commonly used in your facility. Then note this information in the appropriate PCS tables for quick reference.

The sooner coders have access to these books, the better. Coders can make notes and insert reminders in their books during refresher training and dual coding efforts, making these resources even more valuable. If the organization can’t afford both the CM and PCS books, consider providing the PCS book only. Coders will get more use out of this book and its tables. Even though the coding books are an investment, it will certainly be money well spent in terms of mitigating denials. When used properly, an encoder is an extremely valuable tool. However, coders must remember that the encoder is just that: a tool.

The coding book is the only official resource.

About the Author

Cathie Wilde, RHIA, CCS, is the director of coding services for MRA. Ms. Wilde has been active in the healthcare industry for more than 30 years. Her previous positions have included assistant director of HIM, DRG coordinator at the Massachusetts Hospital Association, and DRG validator at Blue Cross Blue Shield. She has extensive experience in ICD-9-CM and CPT coding, auditing, data analysis, development and testing of coding products, specialized reporting, and in-service training. As director she is responsible for overseeing the coding division, providing the strategic direction of MRA as a local industry leader of quality coding, auditing, and denial management services. Ms. Wilde is an American Health Information Management Association (AHIMA)-approved ICD-10-CM/PCS trainer.

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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.

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