As the healthcare industry continues to progress toward ICD-10, organizations are delivering education to coding professionals to provide them with the knowledge required to work with the new coding set.
There is no question that the documentation specificity required for ICD-10 is significantly greater than the clinical documentation requirements for ICD-9. To that end, no one can debate the importance of clinical documentation integrity in the coding process, nor the importance of quality. Coding quality is still the determining factor in accurately representing what is documented within the medical record.
One also must recognize that coding is a complex process that has many integrated contributing factors impacting final outcomes. To manage the coding process effectively, organizations must manage these factors in a coordinated manner in order to achieve accuracy in data capture, reporting and compliance.
Understanding the entire coding process – including the complexities of clinical documentation, coding personnel, the coding guideline, regulatory requirements, and operational challenges that impact the final outcomes – many times is something key decision-makers fail to do. To place too little emphasis on, or fail to acknowledge the importance of, each of these integrated components is a critical misjudgment that will impact processes, including reimbursement, compliance, patient health management, and others.
Many organizations are considering using computer-assisted coding (CAC) to address expected coding productivity losses associated with the transition to ICD-10. CAC technology is an excellent tool to assist in the coding process, as long as the clinical information being fed into the technology is reliable. One must remember that technology is only as good as the information it receives and the person operating the controls. As such, coding reliability is highly dependent on the critical-thinking skills of each individual coder. Coding technologies such as CAC should not be seen as a replacement for coders. These technologies shift the paradigm from simply coding a medical record to auditing or validating the information within a medical record.
There are two very different approaches to coding a medical record, and very different skill sets are required for each. Instead of trying to replace coders with technology, providers must devote time and resources to educating their coders about how to leverage this technology in order to tackle ICD-10 productivity hurdles. This is the case in very much the same way smart phones have changed the way we are communicating with each other. Such technology has provided us a vehicle through which we can communicate faster; however, users’ content knowledge is still the driver of effective communication.
We have evolved from calling to emailing and texting in our quest to communicate faster and more effectively. Such technology can be very useful (especially if you have teenage children to help you decipher some of the texting lingo). Otherwise, receiving a “WTF” text from a 13-year-old can be shocking if misinterpreted when they are really inquiring “where’s the food” on pizza delivery night. While not all such situations are so dramatic, we are all aware of email and texting communication issues attributed to user error.
The encoder was the first coding technology introduced to assist coders in the coding process. Today’s coders must be well versed in how best to leverage encoder and CAC technology, but they must not be entirely dependent on these technologies. Some coders who learned to code with an encoder wound up developing something of a dependency on the technology for providing the correct code assignments.
Many believe that the traditional, book-trained coders gained a deeper understanding of coding through enhanced critical-thinking skills attained by deriving the correct code assignments. That’s not to say there are not excellent encoder-trained coders in the industry; I have had the professional privilege of knowing numerous such coders who are excellent at their craft. However, I also have met numerous “encoder-dependent” coders who rely on technology to determine code assignments. With all this in mind, it’s critical that coders learn to leverage technology to improve their productivity while also maintaining and expanding their personal knowledge base.
With the conversion to ICD-10, understanding the instructional terms in the ICD-10 code book will be a critical success factor in determining correct code assignment. This is not to say that coders shouldn’t leverage technology to navigate this transition, however. Coders simply must recognize that these technologies are there to enhance and supplement their knowledge, not to fill a knowledge gap. Understanding this complex balance between knowledge and education will ensure that coders are fully prepared for the coming ICD-10 coding changes. We all have heard the phrase that “you cannot code what is not documented.” But remember, you also cannot code if you cannot code.
About the Author
John Pitsikoulis, RHIA, is the ICD-10 practice leader and an AHIMA ICD-10-Approved Trainer for Nuance Communications. John has more than 28 years of revenue cycle, health information management, coding, and compliance consulting experience. John has developed and led several corporate and client strategic engagements for managing the conversion to ICD-10, including ICD-10 assessments, implementation planning, integrated testing, education plan management and revenue preservation strategies.
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