Use ICD-10 to Bring Coding Back Into Focus

Published on October 22, 2014

As the ICD-10 deadline approaches, pressure is mounting to ensure that the right resources are focused on the right tasks at the right time.

Organizations should match their strategic needs, and performance/compliance requirements, to staffing resource capabilities and capacity. This involves considering direct and indirect dependencies on coding workflows, and determining the current and future demands of HIM and revenue cycle initiatives (i.e., CDI, ICD-10) and their ramifications on resource selection. Factors to take into account include: location (onsite/remote, domestic/global); response time (turnaround time demands, SLAs); scalability (process for addressing overflow and demand spikes); organizational expertise (hospital insights, physician connections); and clinical expertise (anatomy and pathology).

Resources may be in-house or outsourced, and the tasks may involve coders specializing and/or switching to more complex coding areas, for example, from outpatient to inpatient, or moving from general to specialty ICD-10 coding sooner. The goal of optimizing resource use and deployment is to improve efficiency and quality, while increasing productivity and streamlining the revenue cycle for the organization as a whole. Considering outsourcing ER and/or outpatient records might prove beneficial in freeing up resources to focus on inpatient needs.

Cross-training of outpatient coders to do inpatient coding can offer new career opportunities and help with coder satisfaction and retention.

Coders should focus primarily on medical coding, not on other roles, such as abstracting, which could be completed by other staff members prior to coding. Cross-training of outpatient coders to do inpatient coding can offer new career opportunities and help with coder satisfaction and retention. This investment also increases the coder’s value to the organization, helping buffer the workforce against sudden spikes in demand, increases in scope and additional workload from new CDI/HIM projects.

Implementing a comprehensive, concurrent coding program can also be helpful, especially once a facility starts dual coding, by allowing the query process to start while the patient is still in-house and the physician is available for questions. Along with a concurrent coding program, facilities with limited resources can leverage multidisciplinary document review meetings that includes key stakeholders from case management, finance, and business management to help fulfill CDI needs. The ongoing dialog between coders and case management can assist in dealing with physician queries.

The ‘second look’ involved when discharged accounts are retro-coded can be helpful in identifying educational needs among concurrent and retro coders ahead of ICD-10.

The transition to ICD-10 brings the role of coders into the spotlight, with potential to take a stronger role. Now is a great time to re-evaluate coder responsibilities – and ensure that they focus where the return on their expertise is greatest – the role of coding.