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March-April 2021

Editor’s Note: A Separate Piece
By Lee DeOrio
For The Record
Vol. 33 No. 2 P. 4

Jean is a quiet, intellectual coder at a leading health system. During the fall, she became close friends with her outgoing colleague Fiona, whose talent for coding the most complicated charts was undeniable. Jean gradually begins to envy Fiona’s astonishing coding abilities, manifested in her winning a vendor-sponsored coding contest on her first try.

Jean begins to question just how Fiona does it. Surely, there must be a secret to her success. Is she a phenom, or is there some trickery in play? Jean’s suspicions transform into resentment, but she nevertheless maintains a professional attitude as she tries futilely to keep pace with her more efficient counterpart.

With quarterly reviews fast approaching and despite their rivalry, Jean figures it’s time to have a heart-to-heart with Fiona. It’s better to get ahead of the curve, she rationalizes. Otherwise, with Fiona’s marks ballooning the chart efficiency numbers, she’ll have little chance of looking good in management’s eye.

In somewhat of a surprise, it turns out that Fiona has a sincere desire to see Jean succeed. That being the case, Fiona confesses that she’s been using computer-assisted coding (CAC), sending her charts sans patient identifiers to a friend at a different hospital to run them through their encoder. Needless to say, Jean is shocked, not to mention furious.

Several weeks pass and Fiona’s outstanding coding continues. Finally, Jean has had enough. Knowing that Fiona is relying solely on CAC to get her charts completed, she manages to “tweak” the documentation post billing. Without quality assurance, the juicy errors start arriving regularly at Fiona’s doorstep. With the coding manager perplexed and quite angry, Jean seriously considers fessing up to the deed. However, before she can confess, the manager interrupts and announces that this is one of the reasons she’s led the charge to adopt CAC, a development that scuttles Jean’s plan.

Months go by and Fiona’s coding acumen returns to normalcy—still quite good but not perfect. Jean’s attempts to come clean to her colleague are rebuked but her guilt dwindles as she comes to realize that she was actually doing Fiona a favor by demonstrating that technology is not a cure-all.

Sure, this “version” of John Knowles’ classic novel is full of holes (most notably, Fiona using another health care organization’s CAC and Jean messing with patient information. Can you say “prison time”?) The point is CAC is a powerful option, but it needs to be accompanied by a set of expert eyes that can spot potential errors and understand the nuances that can complicate even the most straightforward charts. With apologies to Knowles, it is indeed “a separate piece” to the coding puzzle.