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	Archive > September, 2002	Vol. III, No. 9

Insurance

Sharpening Your Coders Saw

Lolita M. Jones, RHIA, CCS

Your coder's ability to stay current with the latest coding guidelines is critical to the success of your facility. But most coding specialists are so busy nowadays that they can't seem to find the time to keep pace with fast-changing guidelines. Here are seven things you can do to help.

How Surgeons Can Help

Many coding specialists complain that the medical records rarely contain documentation for such issues as:

The dimensions of wound repairs
Types of wound repairs (simple, intermediate, complex)
Dimensions of skin/subcutaneous lesions that are excised
Types of splints and immobilizers that are applied to patients
The location of "buried" orthopedic implants: superficial vs. deep
The clinical signs/symptoms/chief complaints for ancillary referral visits
The type of nasal hemorrhage: anterior vs. posterior
Surgical versus non-surgical wound debridement
Post-operative pain management injections or catheter placements
The application of casts/strapping devices for either comfort or for closed treatment of fractures/dislocations

1. Allot time for reading. Consider granting each of your coding specialists two hours per week to read new coding guidelines. For example, each coding specialist could take an extra 30 minutes for lunch four days a week and use that time to read the latest guidelines. You can help maximize the efficiency of the extra time by making the materials readily available to your coders (see "Coding Guidelines" on p. 17).

2. Test staff on review of official guidelines. One way to be sure that your coders read and comprehend the coding guidelines - and that the extra time isn't going to waste - is to write and administer a brief quiz to them. There need not be "passing" and "failing" scores, but the test will let both you and your employees know their strengths and weaknesses.

3. Take advantage of online coding references. Install onto each coding specialist's computer such invaluable online resources as official ICD-9-CM and CPT coding guidelines, anatomical diagrams, pharmaceutical references and code edits. Save links such as E-MDs (www.e-mds.com) onto the list of favorites on the Web browser. These sites are handy coding and medical information reference tools and have links to other helpful sites.

Procedures Without Guidelines

Why should you take the time to write your own outpatient coding guidelines manual? So that your staff can code for conditions and procedures for which the national Coding Cooperating Parties have not published guidelines. Some examples:

4. Write an outpatient coding guidelines manual. Create a hard copy or electronic "Ambulatory Surgery Coding Guidelines Manual" to provide facility policies for reporting ICD-9-CM, CPT and HCPCS Level II codes for conditions or procedures for which the national Coding Cooperating Parties have not published guidelines (see "Procedures Without Guidelines" on p. 16). You will find that if you take the time to write a manual of procedures, it will create greater efficiency and consistency among your coders.

5. Schedule regular coding meetings. Conduct meetings on at least a monthly basis with the coding specialists. Consider discussing topics such as difficult coding scenarios encountered by the staff as well as new updates and guidelines. These meetings are a good opportunity to hear the concerns of your coders, foster teamwork and to raise and answer questions.

Coding Guidelines
PUBLICATION	PUBLISHED BY
Coding Clinic for ICD-9-CM	The American Hospital Association
Coding Clinic for HCPCS	The American Hospital Association
CPT Assistant	The American Hospital Association

6. Facilitate a healthy relationship between clinicians and coders. A successful practice should promote camaraderie between the coding specialists and the clinicians. Schedule meetings or luncheons where the two parties can discuss issues that may be hindering timely and accurate coding. For example, if your facility does a lot of orthopedic surgery, schedule an orthopedic surgery in-service so that your coding specialists and orthopods can get a better understanding of how certain conditions and procedures are performed and coded. This is the time for your coders to ask questions. "Is a knee immobilizer a splint or strapping?" "What do the various splints and casts look like?" This will let the surgeons know they have to guide the coders to the proper reimbursement codes.

7. Educate physicians on medical records documentation. Just as coders need guidance on medical issues that pertain to coding, your docs may need help creating coder-friendly records (see "How Surgeons Can Help" on p. 15). By training your physicians to create better records, you'll be saving your coders much time and sparing them more aggravation.

Contact Lolita M. Jones at lolitamj@aol.com.

Categories:

Code/Bill/Reimburse

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