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March 3, 2008

A Little Help From Your Friends
By Judy Sturgeon, CCS
For The Record
Vol. 20 No. 5 P. 6

Buzzwords abound in the business world—teamwork, synergy, win-win, leveraging, key players—and who knows what string of vendor speak will be added to our vocabulary in the coming year. But no matter how the terminology varies, the concepts stay constant: If you want to get the most done with the people you have, they need to work together when necessary and communicate regularly to do so effectively.

Some people with whom the effective coder will build a professional relationship are those closest to them, while others may come from unexpected areas. Let’s review some of those key players and how their roles overlap those of the hospital coding staff.

Quality management (QM): To be effective, QM staff cannot merely rely on others to tell them when something is amiss or if there is an issue regarding the quality of patient care. While word of mouth is certainly part of their information stream, they also rely on internal and external patient data reporting.

Key indicators in infection control, adverse events reporting, risk of mortality issues, and related concerns are often derived from the medical and procedure codes entered into the hospital system by the coding department. Coders can benefit from knowing what types of problems top the list for quality reporting and review and provide education to their own group about any technicalities in related coding rules. This, in turn, will keep coders on top of industry trends and needs and make certain that relevant data are captured.

The QM staff can also optimize the information trade for themselves by having access to coding professionals who can provide education about the quirks and vagaries of CPT and ICD-9-CM coding, diagnosis-related groups (DRGs), and Medicare-severity (MS) DRGs, as well as the differences between them. This will ensure accuracy for internal reporting and comprehension of externally reported statistics with which they must contend.

Care/case management: Whether your facility calls this group case managers or care managers will not affect the wonderful things they can do for you—and you for them. When coders are scratching their heads in dismay trying to decipher a patient’s correct discharge status code, having a contact among this valuable group of professionals is critical. A quick page or e-mail to the case manager and physician—and a prompt response—can clarify skilled vs. nursing home resident care in short order and finalize the documentation in a more timely manner.

In return, coding can assist the care managers who must justify services such as home oxygen or rehabilitation to a third-party payer to facilitate discharge. Frequently, this cannot be completed without accurate ICD-9 diagnosis codes to validate the requested services’ medical necessity. The results of this partnering are compliant discharge status codes, correct DRG payment, improved patient care and satisfaction, and facilitated discharge planning to reduce unnecessary hospital days.

Clinical documentation specialists: If your facility has staff who review patient documentation while in-house and can get your physicians to clarify diagnoses and procedures prior to discharge, count yourself among the most fortunate of coding departments. Their front-end work minimizes the number of coder queries, decreases the days to final billing, and helps ensure the most appropriate MS-DRGs and accurate reporting of illness severity and mortality risk. Give them your office number, your boss’ cell phone number, invite them over for doughnuts—whatever it takes to make them understand that they’re appreciated.

In return, they will be thankful for access to the experts on coding clinic rules, prompting information on changes in coding regulations and new documentation issues that they may be able to correct—thus preventing potentially significant negative impacts to compliance, reporting, and finance. Make your knowledge available to them any time they have questions and offer to help with difficult case scenarios or anything else they may need. Not only are they your “new best friends,” but you are quite possibly their greatest professional asset as well.

Compliance professionals: Work with your compliance people, not behind them. Ask them to put your staff on their mailing list for new compliance information, problem issues, and changes in audit targets by external forces. Exchanging information freely between your departments can facilitate better coding and result in more favorable outcomes on internal and external audits. Remember, compliance is not “the police,” and their goal is the same as yours. They want the best, most correct coding and billing to be performed at your facility. So do you, and working together can produce optimal outcomes for both departments.

The “other” coders: In facilities where there are separate physician coders and hospital coders—for example, if the doctors are not employed by the hospital or if they hire or outsource professional coders—the two groups can be a significant source of help to each other. Your documentation needs for illness severity and their documentation needs for service level can overlap. Invite them to your educational events and attend theirs when possible. Sharing knowledge can uncover issues common to both groups, and a joint effort to correct them is likely to be faster and more effective than separate endeavors.

While these are several critical relationships to create and maintain, this is by no means a complete list. Work closely with your medical record technicians, who may be able to find missing volumes or borrow in-house charts to facilitate timely coding. They can notify your group of patient chart issues such as duplicate patient numbers and possible patient status errors, while coding can help the chart technicians identify errors in transcribed reports or documentation found in the wrong patient’s chart.

Information system associates can identify new software or digital tools to make coding tasks and daily processes easier—but only if they know you well enough to understand your needs. Desktop support can teach coding staff self-help basics while providing benefits to their own department by decreasing coders’ downtime and the number of calls for technical support.

Office and administrative support staff are also priceless. They keep your department paperwork in order, which in turn helps ensure the timeliness of critical needs such as paychecks, reimbursement, codebook orders, and subscriptions to the AHA Coding Clinic for ICD-9-CM and CPT Assistant. Never underestimate their importance; be certain to tend to their needs as quickly as possible, and they’ll do the same for yours.

The longer you remain in any profession, the more varied the working relationships that you create and nurture. Value your associates not only for the services they can provide but also for the return on investment you will certainly receive for your services. What you know isn’t always sufficient to complete the task at hand. Sometimes, it’s who you know that will get you to the finish line.

— Judy Sturgeon, CCS, is the hospital coding senior manager at The University of Texas Medical Branch in Galveston and a contributing editor at For The Record. While her initial education was in medical technology, she has been in hospital coding and appeal management for nearly 20 years.