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March 2016

Converging Career Paths
By Judy Sturgeon, CCS, CCDS
For The Record
Vol. 28 No. 3 P. 26

In the current health care environment, data are king. Diagnosis and procedure documentation generates the various diagnosis-related group (DRG) codes that drive payment, identifies hospital-acquired conditions that affect quality indicators, devises the relative weights of the DRGs used to calculate case mix index, and provides information for the public reporting of severity of illness and risk of mortality.

With all that's at stake, who is responsible for ensuring the most accurate diagnosis and procedure documentation is captured? Who makes certain that data are reported accurately and timely? Mostly, this essential task falls at the feet of coders and clinical documentation improvement (CDI) professionals. That's one of the reasons both inpatient hospital coders and CDI specialists are currently highly sought after throughout the industry.

The arrival of ICD-10-CM and PCS has created a high demand for these professionals, resulting in a well-paying position becoming even more lucrative. While this is wonderful for both income and job security, there are concerns about the futures of these highly skilled documentation technicians.

A hospital or health system employing a dozen production staff and one manager leaves little or no opportunity for advancement—unless an employee is willing to leave and earn more money somewhere else. This is not an ideal situation for health care organizations that should be doing almost anything to retain these coveted talents. If this is indeed the goal, then it is necessary to provide reasonable, timely, and attainable advancement opportunities.

Movin' on Up
What are the options for coders and CDI specialists who want to climb the health care ladder?

There is the traditional route: excel as a beginner, and then hope for annual raises. For those who aspire to reach a leadership position, they may very well have to wait until someone retires or moves on to another organization. This scenario does have potential—it's simple, straightforward, and familiar.

However, this two-step path is slow and relies on someone passing away or leaving before someone can move up the career rung. Often, it's an unappealing option, raising the risk that the department will lose valuable staff members.

Another option is to facilitate cooperation and communication between coders and CDI specialists, which is widely recognized as being key to the best-practice reporting of coded data. In the same manner, coders and CDI specialists could work together to define and develop skill levels within each specific department and create an expanded career path for both groups without having staff change employers.

Skill levels with associated expectations and pay increases can be defined to value many different attributes. Productivity, of course, is a priority to most employers. There are minimum levels expected and reasonably high levels that can be achieved without sacrificing quality and accuracy. Job experience can be another factor to consider.

But these are all standard fare, making it reasonable to include the cooperation factor. Coders boasting impressive clinical CDI skills are more valuable than "basic" coders. CDI-versed coders are more likely to know when a query is necessary, and so the likelihood of queries being completed increases.

CDI professionals who understand the complexities of coding rules and how DRGs work are likely to know how and when to query for an alternate principal diagnosis or for detail based on less common coding rules. More queries for a wider range of reimbursable issues translate to more value. When senior coders and senior CDI staff are offered an opportunity to help expand each other's skills, it benefits both employee and employer.

Basic job descriptions and levels of expertise can be easily identified, with advanced skills meriting advanced pay grades. Consider adding levels for cross-trained coder/CDI talent and for those dual-skilled people who also have a gift for teaching other coders and CDI staff as well as physicians.

Possible options to extend the career ladder in this manner could include the following:

Level 1: This is the trainee or apprentice coder or CDI specialist, with close oversight to ensure the minimum requirements are being met for productivity and code/DRG accuracy, and quality criteria in the CDI department. This may be the percentage of physician responses, percentage of offered diagnoses/DRGs that match the final coded diagnoses/DRG, or similar goals.

Level 2: Add credentials for the specific job—CCS for coders, CCDS or CDIP for clinical documentation specialists—and add two years of experience with minimum accuracy and productivity requirements. For coders, many facilities require a CCS credential at the time of hire. However, CDI specialists may have to gain the experience to sit for a credentialing exam. For this level, both would be required.

Level 3: In addition to the level 1 and 2 qualifications, there must be at least one year of experience in the corresponding skill. This would require coders and CDI specialists to work together on charts featuring complex documentation issues and coding rules. One way to identify such charts for dual review would be to target by department, length of stay, or complex surgeries—whatever is the facility's most persistent problem. Rather than slow production coders, complex cases could be pended for "dual review" with a 24- or 48-hour turnaround time as part of this level's productivity expectation.

Level 4: This is the spot for those talented professionals who have achieved level 3, have proven they can work with their partner department, and possess what it takes to help train less experienced peers and/or physicians. Another possibility for level 4 qualifications would be to require candidates to audit the work performed by level 1 staff.

This type of professional development can also promote access to management and administrative career levels. A seasoned DRG coder or CDI analyst with level 4 skills, related formal education, and business comprehension should have a significant edge for leadership positions in CDI, coding, HIM, corporate compliance, decision support, and even revenue cycle.

Staying Power
Top performers shouldn't have to leave and gain employment elsewhere to have their experience and knowledge valued. Organizations should value them now—and prove it. Create defined career paths internally, pay market value for critical talent, support continuing education, and develop fledglings so that they in turn can become future experts.

Consider the urban legend of the CFO who asks, "What if we spend all of this time and money educating our employees and developing talent and careers, and then they leave us?" The savvy CEO asks in return, "What if we don't do any of this, and they stay?"

— Judy Sturgeon, CCS, CCDS, is the clinical coding/reimbursement compliance manager at Harris County Hospital District in Houston and a contributing editor at For The Record. While her initial education was in medical technology, she has been in hospital coding and compliance for 26 years.