April 03, 2017

Create a New Auditing Experience to Improve the Quality of ICD-10 Coding

By Sandra Routhier, RHIA, CCS, CDIP is President of H.I.M.point with Darice Grzybowski, MA, RHIA, FAHIMA

Hospitals have been thorough in most places in setting up productivity standards for coders but it’s all about quantity, not necessarily quality of the documentation to support coding. This means they may be leaving more money on the table than they realize. It should not be a luxury to have a second review team or process in place to examine the quality of the coding but that is not the norm.

HIM and Coding deserve more respect for the role they play in the mid-cycle. Everything a coder does has a direct impact on how the hospital gets paid. Yes, it is important to get the bill out the door but consider for a moment what happens if is incorrect. With so many human and technology touches to complete the coding process, there lies a great potential for errors. With the transition to ICD-10 CM and ICD-10-PCS, the sheer volume of codes available puts coding accuracy at risk, it may be difficult to perform as accurate coding as it has been historically.  Coding takes human intervention with training and experience but perhaps more than that, such as automated tools which help to audit coding compliance. Additionally, there are prospective clients who haven’t had an external audit completed since ICD-10 was implemented. Coding updates continue to be released on a yearly basis along with new coding guidelines and quarterly AHA Coding Clinic advice.  This adds to the complexity and could result in missed opportunities because of not picking up these updates – all with the potential for financial impact.

Consultants tend to see the same types of errors during auditing activities. Leading edge hospitals are using automated tools that can scan 100% of the accounts and identify coding anomalies as well as documentation improvement opportunities.  The goal is to get those cases screened and corrected prebill or within the payer’s rebill period. The idea is to screen for the quality of coding since if you can provide feedback to coders, the staff in the hospitals can learn from the intelligence in the software and do not repeat the error. There is also a large opportunity for an educational blitz for physicians to improve documentation so the coders don’t have to deal with this retroactively if the software can identify trends!

Other facilities may use manual routine internal and external documentation reviews and audits.  Audit criteria and process will vary depending on whether needed for hospital inpatients, outpatients, or physician practices.   It is important to review all the vendors in this space and ask to see actual reports on the quality improvement made for clients before making any technology additions.   Coding is a proud and noble profession – coding professionals have strong clinical training, must understand both paper and electronic health documentation to determine what diagnoses and procedures can be coded, and the ability to assign the correct codes based on coding guidelines, index & tabular instructions and other recognized resources. Isn’t it time we gave them the tools, process, time, and feedback to continue to do an excellent and thorough job under ICD-10-CM/PCS?

Darice Grzybowski, MA, RHIA, FAHIMA has over 35 years of HIM experience and is President and Founder of H.I.Mentors, LLC since 2005.   Sandra Routhier, RHIA, CCS, CDIP is President of H.I.M.point and has 30 years of experience in HIM, revenue cycle, and information technology.