High-Cost, High-Frequency Cases Challenge New Coders

By
Original story posted on: December 3, 2018

Facilities are urged to re-double coder training and education.

Coders and auditors are taught to be diligent for the high frequency, high cost, and problem-prone cases as these topics are the focus on third-party reviewers. What does that mean for the new coder? The new coder may not be aware of what cases align with these criteria. All of this depends on the training and preparation that new coders are provided.

The best situation is that new coders are provided a training course which includes the facility’s specific coding guidelines, the state data commission (if applicable) needs, introduction to other parts of the revenue cycle, and opportunities to code sample cases with feedback. The new coders have the opportunity to become familiar with the facility’s approach to coding. Also, what is the definition of “new”? Does this definition apply to coders who are new to the facility or inexperienced coders? The answer is based on your description. Perhaps you have the training separated based on the experience of the coders.

You may ask why we should care so much about the new coders.   New coders can create a compliance issue if they are not made aware of the facility’s guidelines and data needs. For example, a new experienced coder is not aware which devices are utilized by the facility or where to find that information in the electronic health record (EHR). In this situation, the New Technology device is not coded, and the facility could lose millions of dollars. Another example is for the inexperienced coder who follows the physician documentation of spinal fusion.  In this case, the spinal fusion dictated by the physician is not really a spinal fusion, but an insertion of internal fixation device which results in overcoding the MS-DRG which is a compliance concern. 

Inexperienced coders require additional training after graduation.  There is a need for coding using “real” documentation to ensure that their skills are accurate. The benefit of feedback is invaluable for these coders. The benefit to the facilities is also invaluable and economical compared to monies returned to payers or fines with penalty and interest for a compliance issue paid to the regulatory agency. I find that the give-and-take with coders is the best education that anyone can receive. We all learn from other coders. 

Please think about your coder orientation to your facility. And determine if you should include the following:

  1. Facility specific coding guidelines
  2. Review of clinical documentation in the electronic health record
  3. Discuss the data needs for the facility, payers, and/or state regulatory agencies
  4. Demonstration of other software tools available to the coder
  5. Career ladder
  6. Job descriptions and expectations
  7. Introduction to contacts within the revenue cycle
  8. Productivity requirements by chart type
  9. Accuracy requirements
  10. Opportunity to code sample charts with feedback
  11. Review of correct query writing, if needed

There are many activities with which a coder must deal. The best approach is to provide a detailed orientation and a safe space to allow the coder to practice and become proficient before a compliance risk is created. 

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.
Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer

Laurie M. Johnson, MS, RHIA, FAHIMA, AHIMA Approved ICD-10-CM/PCS Trainer is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an American Health Information Management Association (AHIMA) approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.

Related Stories

  • National Coding Contest Indicates Outpatient Coding is Getting Worse, not Better
    More than 4,000 cases were coded in the 2019 contest focused on outpatient coding. ICD-10 is well-established, and we are already discussing and planning for ICD-11. However, where are the long-anticipated and promised increased accuracy and most definitive diagnoses? At…
  • Be a Success in Your Coding Career
    Success can cost you more than you thought it would. You might have heard the phrase, “everyone wants to be successful until they see what it actually takes.”  While I’m not sure where the quote originates, I’ve seen it attached…
  • Looking at Possible ICD-10-CM Clinical Coding Challenges in 2020
    Seven coding challenges reveal a new compliance landscape in 2020. It’s here: 2020! This past year in healthcare, as in many years before, was full of changes, challenges, and some surprises as well. When trying to foresee the key future…