Navigating ICD-10: Tips for hospitals and coders
More than one year after the ICD-10 go-live on Oct. 1, 2015, CMS has ended the ICD-10 claims auditing and quality reporting leniency period. Guidelines now require providers to code to reflect clinical documentation in as much specificity as possible. Therefore, hospital and health system leaders must ensure both new and experienced coders are prepared to keep up with the coding requirements.
Julia Hammerman, director of compliance and education at St. Louis-based himagine solutions, and Terri Eichelmann, director of health information management at St. Louis-based BJC HealthCare, recently provided Becker's Hospital Review with tips for healthcare organizations and coders navigating the ICD-10 transition.
3 general tips for coders
Coders must use resources such as the code book, coding guidelines and the American Hospital Association's Coding Clinic newsletter to build their coding knowledge foundation, according to Ms. Hammerman. "We must support coding processes with available technology, unfortunately coders become reliant on technology and forget how to use their resources," she said. "The encoder can take the coder down an incorrect path, knowledge of coding resources, guidelines, and how to use the book helps the coder recognize when the encoder is leading them to an incorrect code."
Coders should also build their own resource libraries, Ms. Hammerman added. In himagine's preceptorship programs, for instance, the company aims to ensure coders are aware of reputable resources as well as how to create their own "resource manual" so they are able to quickly find information to assist when questions arise, she said.
Finally, Ms. Hammerman said, a coder "should not just memorize coding guidelines." Instead, she advised them to focus on understanding and interpreting the guidelines to apply them to the application of codes. "The coder should understand which guidelines apply to different body systems as well as chapters of the code book," she added.
Building career ladders for coders
Ms. Hammerman said coders should start at entry-level positions when they first enter the profession. When a coder enters an organization at an entry-level position, she said it allows them to build a strong foundation of coding guidelines and to develop an understanding coding processes. "Coders work in a number of electronic systems and must also learn how to navigate an EMR. Most millennials entering the profession are comfortable with technology but used to more intuitive programs. The EMR is not necessarily easy to navigate and not all hospitals have fully transitioned to one system and may have a hybrid record," she said. "Coders need to learn how the system works, if any documentation comes from another system, who documents in the medical record and where they enter their documentation, and what documents they can use to code. Additionally, the coder needs to understand when documentation from other caregivers supports the need to query." So, she added, if coders begin in the entry-level position, "that gives them the opportunity to build on those experiences."
Ms. Eichelmann from BJC HealthCare advised hospitals and health systems to determine required skill sets of coders for different work types, and then determine if the skill set is different enough to support varying coding levels.
Additionally, she said hospitals and health systems should discuss career opportunities with their coders. If bringing in an experienced coder, she advised organizations to understand where and what resources they can invest in to train the coder for the role they are hired into. "It is just as important to support career growth in current coders and understand their career objectives and guide them in professional development if they wish to climb the career ladder," she added.
Guidance for monitoring, managing coders
No matter where coders are on the career ladder, it is crucial that hospitals and health systems have guidelines in place for monitoring and managing these workers. Ms. Hammerman said organizations can't audit enough, especially with the transition to ICD-10. She noted that experienced coders have been following a set of guidelines for a long time, and now they are learning a new set of guidelines. "If I were managing coders, auditing to make sure the new coding guidelines were being interpreted and applied appropriately as well as providing follow up education would be critical," she said. "When working with new coders, you must be realistic about the time it takes for a coder to truly develop the skills needed to work independently. It takes at least a year of audit and mentoring to make sure they have mastered coding basics and they're able to apply that knowledge as the complexity of coding increases."
More specifically, Ms. Hammerman has seen that more education is needed to help all coders master ICD10-PCS coding. Inpatient procedural coding in ICD-10 is entirely different than coding a procedure in ICD-9. Therefore, she said, to build the correct code, coders must know anatomy and physiology and understand how procedures are performed. Additionally, she said, the coder must have time to read an operative report and understand how to identify the key components of the report. She added, "those skills and time to review the report allow the coder to select the correct root operation as well as identify the approach, intent of the procedure, and body parts involved."
Ms. Eichelmann noted that BJC HealthCare invested a lot of time in auditing and educating in PCS coding the first year after the ICD-10 transition to assure all coders exhibited proficiency in this area.
Use of preceptorship, mentorship programs
Since many coders work remotely, it is crucial for hospitals and health systems to establish mentorship programs that provide coders with someone they can reach out to with questions. BJC HealthCare, for instance, has a career ladder program that helps the organization build clinical coders. BJC also has a preceptor program for training and assigns new coders a coding buddy as an additional resource.
Ms. Eichelmann advises hospitals and health systems to develop an assessment tool for coders so they do not miss anything in the training process. At BJC HealthCare, an online tool is used to supplement and assess the coders' development.
Ms. Eichelmann also recommends that organizations train by service line or clinical department. Once coders master an area, they should celebrate and move on to other areas, she said. "Start with easier, straightforward, common types of charts and then increase the level of difficulty as coder progresses."
Hospitals and health systems should also receive feedback from the coders being preceptored/mentored as it can improve their program, according to Ms. Eichelmann. She said while the coders in training are learning about coding and the organization's processes they can help improve the organization's training program.
Ms. Hammerman added that a hospital should be focused on auditing and providing education that coders need to continue to develop as well as being able to "mentor" the new coder who needs more guidance. However, if a hospital does not have the resources to provide this level of support, she suggests they consider outsourcing education just as they outsource other health information management functions.
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