August 3, 2015

ICD-10 Brings Attention to Contracted Coding Resources

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For years and years, there has been a national shortage of coding professionals – and by that I mean professionals who are well-educated, trained, credentialed, and experienced.

 

Often we can find individuals who are educated, trained, and credentialed, but not always experienced. Also, for years healthcare has utilized external contracted coding services/resources and staff to help with daily workloads due to vacancies, backlogs, and special projects. On occasion you’ll find a coding professional who is not credentialed, but the trend is clear in the industry that credentialing is being required by employers.

Now is the time to take a look at the knowledge requirements of the coding professional for the contracted coding resource vendor that you might be utilizing before and after implementation of ICD-10.

Coding Professional Competencies

Coding professionals need to have specific competencies in order to do their jobs successfully and accurately. Whether the coding is for the hospital, physician, home health, rehab, long-term, or other healthcare setting, it is critical that the individual performing the coding (assigning and selecting the codes) has a strong suite of knowledge competencies. Whether the setting is inpatient or outpatient, again, the same holds true. It is not a question of simply opening up a codebook and now “I’m a coder.” It is not taking 12 hours on a weekend either.

One area that is an industry standard, and a place to start as it pertains to minimum competency, is within the medical sciences. The medical science domains for coding include but are not limited to the following:

  • Anatomy/physiology
  • Disease process
  • Medical terminology
  • Pharmacology

Strong competencies are also needed in:

  • Coding conventions, general guidelines, and chapter specific guidelines
  • Coding classifications and systems: ICD and CPT
  • Reimbursement and payment methodologies
  • Compliance, ethics, and privacy
  • Coding computer systems

Where do we obtain these competencies? There are accredited coding programs that offer these areas as curriculum within a coding education program. In addition, many community colleges and universities offer pertinent courses. And there are “coding programs” that cover many of the above mentioned competencies over a span of six months up to a full year; some are private coding programs and some are associated with academia.

In addition, we see that job descriptions often have requirements that include work experience, which is another area that is often difficult for those new to the profession to achieve. Before one can gain the experience that one needs in order to perform coding at a successful level, one needs to have completed education and training that captures the scope of the work to be performed as a coding professional.

Then, obtaining often one year of coding experience can get you your first coding position. It’s important to note that the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) indicated in its 2005 Supplemental Compliance Program Guidance for Hospitals that “hospitals need to pay close attention to coder training and qualifications.” And the OIG stated in its 1998 guidance that it “recommends that hospital compliance programs address the need for periodic professional education courses that may be required by statute and regulation for certain hospital personnel.”

Contract Coding Resources/Services

Using contracted coding resources/services has long been a great way to obtain coding staff to help out when needed. Over the past five years we’ve seen new companies come into existence and others merge to become larger. With ICD-10, it’s important to have a written contract in place for these resources, but also to think about the vendors’ coding staff readiness, knowledge, and skill levels, specifically in regard to ICD-10.

Coding Vendor Preparations for ICD-10

In an effort to ensure that your external coding vendor (supplier) is ready and that the coding staff they are providing you with is well-prepared for ICD-10, you’ll need to validate that certain steps have been taken. Four key areas to focus on over the coming six weeks are a) what the coding vendor’s ICD-10 education and training program consists of; b) obtaining a written ICD-10 education and training program for the coding vendor staff; c) whether the external coding vendor tests for hiring and meets and supports the competencies needed for clinical coding; and d) quality and productivity expectations.

I recommend you request that the external coding vendor provide you with a written summary of the total number of education and training hours their coding staff has had. Pay attention to the number of hours provided in the classroom setting versus online-only; one should see around 30-40 hours in the classroom at a minimum, with more hours if the coding professional is coding hospital-provided inpatient surgical encounters. An added safety check might be to request a written attestation statement from the vendor confirming that their coding staff does in fact have the hours they stated in their plan.

The next area to check on is the use of a coding test exam for the purpose of hiring. This is a fairly standard process in the hiring and screening of applicants for most employers. The key here is for you to request a copy of the coding test they provide to applicants (keeping it very confidential) so you know for which competencies they are testing. Some tests I’ve seen are very simple, with 10-12 case scenarios, and that is it. I usually recommend the following to coding vendors for their coding test:

  • Include actual case scenarios to code (full information to include history and physical, progress notes, discharge summary, operative notes, etc.)
  • A minimum of six IP cases (medical/surgery)
  • A minimum of five cases each of OPS, ER (Dx and CPT) and physician office encounters
  • ICD-10 code set questions – conventions and guidelines (6-8 questions minimum)
  • Two to three questions in each area of the health sciences:
    • Medical terminology, A&P, disease process, and pharmacology
  • Include multiple choices (maybe a few true/false, but not many)
  • A minimum of 25 multiple-choice questions  

If the vendor is not thoroughly testing the applicants, then you could have someone coding your encounters who really does not have the knowledge and skill you expect.

The last piece to confirm with your coding vendors is quality and productivity expectations. The norm I see across the industry is 95 percent accuracy for coding. Sometimes it’s a little higher. Productivity standards certainly have changed with the electronic health record, and we don’t really have an industry standard to reflect this as we did with paper records. Ask the vendor(s) what their requirements are for productivity and share your expectations. You may want the vendor to meet or exceed the productivity requirements you have in place for your own coding staff. With ICD-10 being new to all coding professionals, we are going to see a learning curve initially; thus, monitoring quality and productivity closely is very important, both for the vendor and also for you. This learning curve may be longer for some than others.

In these final weeks prior to implementation, it’s time to discuss with your external coding vendors/suppliers how ready they are and to share your requirements and expectations.

Being successful in the coding arena will require that the external coding staff you are using have a high level of coding competencies – and that they too are ready for ICD-10 come Oct. 1 and post-implementation as well.

 

Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer

Gloryanne is a coding and HIM professional with 35 years of experience. She is the past president of the California Health Information Association. Gloryanne is a member of the ICD10monitor editor board and is a popular guest on Talk Ten Tuesdays.

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