September 28, 2015

Updating Job Descriptions and Hiring Assessments for the ICD-10 Countdown Checklist: Part 4 of a Four-Part Series

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Wow – we are now almost ready to implement ICD-10-CM/PCS this coming Thursday Oct. 1, 2015.

 

How are you doing with your ICD-10 countdown checklist? It has been a long process for many organizations, some of which started way back in 2010 and 2011 with initial planning, decision-making, and preparing. There are still a couple of items to check off before the big day arrives two days from now, however.

As you look over your readiness checklist, make sure you have included updating coding job descriptions. As part of the human resources (HR) requirements, we need to have up-to-date job descriptions; this is the time to review and revise them. If a job description has language regarding ICD-9 coding or codes, then it should be updated and/or revised. This would involve your coding compliance staff, coding auditors, coding educators, coding management, and of course, your primary workforce of coding staff.

Typical job descriptions for “coding” positions include qualifications: education, skills, and experience, as well as a summary of duties. You and your organization most likely have ICD-9-CM wording included in these job description areas, so again, they will need to be revised and updated. There are many different job titles for coding positions and/or levels, and also differences based upon the healthcare setting for the coding positions as well (i.e. inpatient, outpatient, physician coder, level I, level II, etc.).

A brief coding position summary might look like the following:

A coding professional translates a provider’s or physician’s diagnosis and the treatment (procedure) documentation and information from the patient medical record and/or encounter into alpha, numeric, and/or alphanumeric codes using a classification system. The medical or clinical codes are an integral part of health information management and are used by national and local governments, international agencies, and private healthcare organizations, among others. The standard codes (from ICD – International Classification of Diseases and CPT – Current Procedural Terminology) allow insurance providers to justify reimbursement of fees and expenses. These codes may cover specific topics such as procedures, pharmaceuticals, and diagnoses, just to name a few. The coding function is performed and follows national standards, guidelines, and compliance rules.

The specific coding “educational requirements” are a very important component to include in job descriptions; however, they will vary depending on the specific coding position or role and the healthcare setting.

An example of an education requirement: Graduation from an accredited coding program with certification or credential (RHIA, RHIT, CCS, CCS-P, CPC). Completion of courses in anatomy, physiology, disease process, medical terminology and pharmacology. ICD-10-CM education and training in the past 2-3 years totaling 40 hours at a minimum; ICD-10-PCS (Procedure Coding System) 30-plus hours at a minimum.

An example of an experience requirement: Three years’ experience coding in (setting) using both ICD and CPT (HCPCS) codes. Five years conducting medical record chart reviews/analysis of documentation and translating into coding classification systems.

The years of experience required to start in a coding position varies depending on the healthcare setting and the organization or company. Most often we see one or two years of experience as a requirement.     

Another item on your checklist should be to update and/or revise your coding hiring assessments. Most often, when applying for a coding position or a coding auditor position, there will be a skills assessment or test that will need to be taken to confirm knowledge and competencies. Most coding assessments will have a variety of multiple-choice questions followed by some actual case scenarios the applicant would code.

An example of some multiple-choice questions:

Question No. 1

Which of the following is the correct definition for the coding convention “with”?

  1. The word “with” should be interpreted to mean either “with” or “and” when it appears in a title
  2. The word “with” should be interpreted to mean “associated with” or “due to” when it appears in a code title
  3. The word “with” is not part of the conventions
  4. The word “with” means that there is a causal relationship between the diseases and manifestation.

Question No. 2

An acute STEMI is coded within what time frame to be classified as acute?

A. 8 weeks
B. 6 weeks
C. 4 weeks
D. none of the above     

Question No. 3

Documentation of gout for ICD-10-CM should include which   

A. Identification if drug-induced
B. Identification if lead-induced
C. Specification of the acuity
D. All of the above    

You’ll want to have a minimum of 25 multiple-choice questions, which usually take about one minute per question to complete, so be sure to  allocate enough time for your applicants to complete this portion of the hiring screening. Keep in mind that these case scenarios should be answered from recall, or without resources or books. Try to avoid using “true/false” questions, as those are typically too easy and don’t offer a good indicator of true competencies for a job knowledge and skill assessment.

The next portion of the hiring coding assessment should contain case scenarios, which can be collected using a code book or an online coding resource (i.e. grouper or code search tool). You’ll want to have 8-10 case scenarios to code, depending on the healthcare setting.  You’ll also again want to have a set amount of time allocated for this portion of the assessment. Here is an example of an emergency room encounter that might be a part of your assessment:

        CHIEF COMPLAINT: Spells of dizziness and light-headedness.

HISTORY OF PRESENT ILLNESS: The patient is a 78-year-old who has a history of spells of dizziness and weakness, and on evaluation, she was found to have intermittent complete heart block for a period of two to three

seconds.

PAST MEDICAL/SURGICAL HISTORY: The patient had a Cesarean section in 1950, cataract surgery on the left eye in 1965, and a history of hypertension.

MEDICATIONS: Takes Norpace 5 mg once a day, takes B12 injection once a month, uses Timoptic drops, and also takes aspirin once a day.

ALLERGIES: Has no known allergies to any medicine.

FAMILY HISTORY: No history of diabetes or cancer in the   family.

SOCIAL HISTORY: The patient is a retired social worker. Does not smoke, does not consume liquor; is still married.

REVIEW OF BODY SYSTEMS: Revealed no skin problems, occasional blurring vision, and no history of sinusitis or chest pain or palpitations. No breathing problems, no history of gastroesophageal reflux disease, no urinary symptoms; has a history of arthritis, no headaches, occasional dizziness.

PHYSICAL EXAMINATION:

GENERAL: This is an elderly 78-year-old female, weight 115     

158/70, respiratory rate of 15.

SKIN: Normal. There is no apparent jaundice. No mass in the     neck.

LUNGS: Clear.

HEART: Regular. Good air entry on both sides.

TRUNK: Unremarkable.

 


ABDOMEN: Shows a scar from a cesarean section.

Holter monitor strip shows complete heart block lasting for a period of two to three seconds. This is intermittent in nature. This most likely explains her dizzy spells. Her laboratory work shows that her electrolytes are normal, BUN and creatinine were also normal, glucose was normal, white blood count is 7,800, hemoglobin is 12.5, and hematocrit of 35.1 volume percent; platelets are adequate. The chest X-ray shows no cardiomegaly. No acute respiratory problems.

PLAN: Referral to the cardiologist for probable pacemaker insertion.


Assign the ICD-10-CM code(s) and CPT (E&M) for this encounter. ______________________

Example of an inpatient operative case scenario:

A 34-year-old female was admitted in labor and due to pelvic disproportion was scheduled for a Caesarian section. This is the patient’s second pregnancy. The past history includes a previous Cesarean section in 2011 for CPD (cephalopelvic disproportion). The patient was offered to deliver vaginally for this pregnancy, but declined and preferred to deliver by C-section. A low transverse C-section was performed under epidural anesthetic and the patient delivered a 6 lb., 10 oz. male. There appeared to be no fetal abnormalities at the time of delivery. The patient did well and was sent to the recovery room in good condition.

Assign the correct ICD-10-CM and ICD-10-PCS codes. __________________________

When scoring the assessment, you most likely will give one point for each correct multiple-choice answer. For the case scenarios you could give multiple points, as you may want to give two for each principal (first listed) diagnosis code that is correct, one point for each secondary diagnosis, and one for each procedure code that is correct. You could also decide to deduct a point for each wrong code that is assigned. So this is an area you’ll need to contemplate, and develop an answer key for scoring purposes. Ultimately, look at moving the hiring assessment from paper to electronic and/or online if you’ve not moved in that direction already.

With the final steps being complete and all items listed on your ICD-10 coding readiness checklist checked off, next will be the post-implementation and transition phases of implementation, which also will take some coordination and oversight. Your project management team should assist with monitoring completion of your checklist elements and preparing for the transition phase with coding audits and re-education.

For the past four weeks we’ve looked closely at the readiness checklist for those in the coding arena. This has included the coding command center, physician queries, policies and procedures, job descriptions, and coding hiring assessments. So now is the final chance to take a look at your readiness checklist and then let’s get started!

Best of luck to all, and congratulations!

 

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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