High-Cost, High-Frequency Cases Challenge New Coders

Facilities are urged to re-double coder training and education.

Coders and auditors are taught to be diligent for the high frequency, high cost, and problem-prone cases as these topics are the focus on third-party reviewers. What does that mean for the new coder? The new coder may not be aware of what cases align with these criteria. All of this depends on the training and preparation that new coders are provided.

The best situation is that new coders are provided a training course which includes the facility’s specific coding guidelines, the state data commission (if applicable) needs, introduction to other parts of the revenue cycle, and opportunities to code sample cases with feedback. The new coders have the opportunity to become familiar with the facility’s approach to coding. Also, what is the definition of “new”? Does this definition apply to coders who are new to the facility or inexperienced coders? The answer is based on your description. Perhaps you have the training separated based on the experience of the coders.

You may ask why we should care so much about the new coders.   New coders can create a compliance issue if they are not made aware of the facility’s guidelines and data needs. For example, a new experienced coder is not aware which devices are utilized by the facility or where to find that information in the electronic health record (EHR). In this situation, the New Technology device is not coded, and the facility could lose millions of dollars. Another example is for the inexperienced coder who follows the physician documentation of spinal fusion.  In this case, the spinal fusion dictated by the physician is not really a spinal fusion, but an insertion of internal fixation device which results in overcoding the MS-DRG which is a compliance concern. 

Inexperienced coders require additional training after graduation.  There is a need for coding using “real” documentation to ensure that their skills are accurate. The benefit of feedback is invaluable for these coders. The benefit to the facilities is also invaluable and economical compared to monies returned to payers or fines with penalty and interest for a compliance issue paid to the regulatory agency. I find that the give-and-take with coders is the best education that anyone can receive. We all learn from other coders. 

Please think about your coder orientation to your facility. And determine if you should include the following:

1. Facility specific coding guidelines
2. Review of clinical documentation in the electronic health record
3. Discuss the data needs for the facility, payers, and/or state regulatory agencies
4. Demonstration of other software tools available to the coder
5. Career ladder
6. Job descriptions and expectations
7. Introduction to contacts within the revenue cycle
8. Productivity requirements by chart type
9. Accuracy requirements
10. Opportunity to code sample charts with feedback
11. Review of correct query writing, if needed

There are many activities with which a coder must deal. The best approach is to provide a detailed orientation and a safe space to allow the coder to practice and become proficient before a compliance risk is created.