Customer story: HIA consultant brings fresh perspective
Partnering with HIA for Interim Auditing services provides immediate solutions to fill the gap in your Health Information Leadership team so you can maintain productivity and performance. How? Read Diana’s story below.
“Oh, I was concerned,” said Diana, Director – HIM Coding at one of the largest pediatric medical centers.
“I can almost laugh about it now that we are on the other side of it.”
Two years ago, Diana was at a crossroads: her coders lacked coding confidence and her bosses were frustrated with lack of production. This, matched with the implementation of ICD-10, created the perfect storm.
To navigate the changes, and to hopefully increase support for the coding staff, Diana knew she had to implement a plan and soon.
“Our intention was to increase our coder’s professional development by performing ongoing audits throughout their training process,” she said. “We wanted to be able to provide constructive feedback when the coders made errors so they could learn and improve.”
Long story short, the education was not taking root quick enough for her staff.
“Not only did we find the same errors in their coding repeatedly,” said Diana. “the coders began to doubt themselves.”
Diana says coders started to turn to other coders for help rather than following the proper protocols. “That’s when we knew it was time to look at other options and bring a fresh perspective to my team” she laughed.
Diana already had a relationship with the team at HIA and reached out for help.
“Together, we developed the interim auditor position that is now in place today,” she said.
Until it Clicks
Heidi, HIA’s Coding Consultant, has been working with Diana and her team for only a short period of time and the success of the partnership is already evident in more than just increased production.
“When they ask a question, Heidi not only provides feedback, but she will walk them through the process – she works with them until they understand,” said Diana. “Our coders are learning how to use the coding guidelines to apply to other principles – and they have more confidence in doing so.”
For Heidi, communication is key when working with coders and mutual respect is crucial in an interim auditing scenario.
“It takes an immense amount of work to reach a conclusion when coding and, if it isn’t correct, that can be defeating,” said Heidi. “What I love about our team – HIA’s, that is – is that if something is incorrect, we don’t just tell them what the code is and be done with it. That helps no one.”
Instead, Heidi says she works directly with each coder to understand their thought process in reaching the first conclusion.
“If I understand their thought process, I can start to understand how their mind works and how I can provide the proper response and education so that they truly understand it – and, more importantly, the same mistakes do not continue to happen,” Heidi said.
“It’s nice to have someone to assimilate with,” says Diana, who credits the partnership with repairing the communication barriers present before.
“We have a very diverse group of coders – some even speak different languages. So, in the past, I always thought they understood the instruction. But I’ve learned that was not the case,” said Diana. “Heidi will sit with them and field as many questions as they ask. She waits until it clicks.”
Heidi and the HIA team want to debunk the myth that auditing is a ‘bad word.’
“I know when they first come in to these type of positions, coders can be apprehensive because of bad past experiences,” said Heidi. “But we approach it as we are joining a team.”
And that team mentality couldn’t ring more true to HIA’s education philosophy.
“If I don’t have the answer to something, or if I want another opinion, I have an entire education department with some of the best in our industry to talk to,” Heidi said. “When I came into this position, on paper it may have looked like it would just be me. But really, it’s the entire company – and I know that is not the industry norm.”
Diana says their accuracy rate is improving and, this time, she knows it’s accurate. “Our coders are progressing quickly with the added education and training, there has been a decrease in the number of charts being denied.”
“Based on the increase in quality results we have been seeing, we’ve even been able to release one coder to be working on her own. That’s a great benefit,” Diana said. “The others are coming along.”
Diana says that while she knew the partnership with HIA would be beneficial on all fronts, she still had to convince her CFO to approve the added cost.
“I knew that the longer we left our coders untrained, the longer we would have to be spending money to outsource a portion of our coding and our quality wouldn’t improve,” she said.
Since HIA had been doing audits for the hospital for more than four years, Diana could show the quality of work to the CFO.
“Our cases are so unique. I’ve worked with other companies before and the quality just isn’t there,” she said.
“I just don’t trust other companies the way I do HIA.”
We have finished with the step-by-step coding tidbits on coding of spinal fusions. If you were not able to catch Parts 1-13 of this series focused on spinal fusions, please visit hiacode.com/topics/series/spinal-fusion-coding/.
In Part 12, we focused on intra-operative peripheral neuro monitoring used during spinal fusion surgery. In Part 13, we are going to focus on harvesting of autograft and is it coded. Remember in Part 6, we learned that autograft is bone from the patient.
In Part 11, we focused on identifying the computer assisted navigation used during spinal fusion surgery. In Part 12, we are going to focus on intra-operative peripheral neuro monitoring.
In Part 10, we focused on identifying whether or not hardware from a previous spinal fusion is coded. In Part 11, we are going to discuss computer assisted navigation.
In Part 9, we focused on identifying if decompression was also performed and if so, on which body part. In Part 10, we are going to focus on identifying if hardware was removed from a previous fusion site.
In Part 8, we focused on identifying if a discectomy was performed, and if so, if it was a partial or a total discectomy. In Part 9, we are going to focus on identifying if a decompression was performed, and if so, was it of the spinal cord, spinal nerves or both?
In Part 7, we focused on identifying any instrumentation that may be used during a spinal fusion. In Part 8, we are going to focus on identifying if a discectomy is performed and if this is an excision or a resection of the disc.
In Part 6, we focused on identifying the type of bone graft product used for the spinal fusion. In Part 7, we are going to focus on identifying any instrumentation or device used.
In Part 5, we focused on identifying the approach being used for the spinal fusion. In Part 6, we are going to focus on identifying the type of bone graft used for the spinal fusion.
In Part 4, we focused on determining the spinal column being fused. In Part 5, we are going to focus on identifying what approach is being used to complete the spinal fusion (anterior, posterior or both).
This past year, HIA implemented “Buddy Up,” a program designed to help the new hire have a smooth transition into their new HIA roles with the assistance of a “buddy.” What is a Buddy? The Buddy is simply a peer who can guide the new hire in order to make them feel more comfortable. We are very proud of this program and have many success stories that we would like to share. Take a look at the wonderful feedback we have received below.
In Part 3, we focused on determining the level of the fusion(s) and how to determine the number of vertebrae fused. In Part 4, we are going to focus on identifying which column is being fused (anterior, posterior or both).
Part 3: Spinal Fusion Coding — Determine the Level(s) or Region of Fusion and Number of Vertebrae Fused
In Part 1, we learned the diagnoses associated with the need for spinal fusions, and in Part 2 the need to identify if the fusion is an initial or refusion of the vertebrae. In Part 3, we are going to focus on determining the level(s) of fusion, as well as the number of vertebrae fused.
In Part 2, we are going to look at the differences between initial fusion and a refusion. In ICD-9, there were specific codes to show if the fusion was an initial fusion, or if it was a refusion. In ICD-10-PCS, initial fusions and refusion procedures are coded to the same root operation “fusion.”
This is Part 1 of a 14 part series focusing on education for spinal fusions. Spinal fusion coding is a tough job for coders. There are so many diseases/disorders that result in the need for spinal fusion, and even more choices in reporting the ICD-10-PCS codes.
The official definition from the Centers for Medicare & Medicaid Services (CMS) states that a Medicare overpayment is a payment that exceeds amounts properly payable under Medicare statutes and regulations. When Medicare identifies an overpayment, the amount becomes a debt you owe the Federal government.
The question asked in a physician query may be the most important element of the document. Query questions need to be as simple and concise as possible. The physician should have no doubt what the coder is asking.
Coding complications of transplanted organs has always been a coding dilemma. With the implementation of ICD-10-CM that didn’t change. However, coders have multiple directives to help in determining what a complication of the transplant is vs. non-transplant conditions and diseases.
We interviewed our most productive coders, reviewers and members of our education team, asking them what steps they take to find a rhythm that works for them. This week, we talked with Beth Martilik, MA, RHIA, CDIP, CCS, Assistant Director of Education, about the steps she takes to find her routine.
With the implementation of ICD-10-CM came more codes for reporting many different conditions and diseases, and atrial fibrillation is one of those. For many years there was only one code available for reporting this condition, even when the physician further specified the type of atrial fibrillation that the patient had. In ICD-10-CM, there are four codes to report atrial fibrillation.
We have a case where the physician removes mucoid casts found during bronchoscopy. We have also seen mucus plugs removed during bronchoscopy. The MD performs bronchial washings then removes a large amount of tenacious and thick mucoid casts via bronchoscopy. Is this coded drainage, extirpation or excision? What body part is used?
The key to making the query process more efficient is to look for words or documentation while reviewing the record that may signal a potential query opportunity and to note the finding at that time. By the time a coder reaches the end of a record, documentation may have been found to eliminate the need for the query.
Question: This patient is noted to have “Lymphangitic carcinomatosis of lungs with mediastinal lymph nodes.” How would I code the diagnosis? Would I code metastatic cancer to the lung (C78.01) or metastatic cancer to the lymph nodes (C77.1)?
This would be considered a “mechanical” complication of the stent graft since the MD states it is a fracture of the endograft and it is folded over on itself. I would change T82.898A TO T82.598A for Other mechanical complication of other cardiac and vascular devices and implants, initial encounter. I did not use “displacement” because the surgeon did not state that the graft was displaced, only that it collapsed upon itself causing obstruction.
We interviewed our most productive coders and reviewers, asking them what steps they take to find a rhythm that works for them. This week, we talked with Valerie Abney, CDIP, RHIT, CCS, about the steps she takes to find her routine.
Osteoporosis alone is responsible for over a million fractures every year. Stress fractures are not as common but they do occur. There are more than 1 million total joint replacements in the U.S. each year, so there was a need to create codes for injuries that occur around or near the prosthesis. These are called “periprosthetic” fractures.
Back in April, the Office of the Inspector General (OIG) published a report detailing its findings from a review of two groups of high-risk diagnosis codes, acute stroke and major depressive disorder. The objective was to determine whether selected diagnosis codes submitted to the Centers for Medicare and Medicaid Services for use in CMS’s risk adjustment program complied with Federal requirements.
There seems to be differences of opinions on the issue of a 40w0day gestation Can you clarify if P08.21 should be assigned for 40w0day infant or if it would not be assigned unless the infant’s gestation age was 40w1day or greater?
Coders may find situations where a patient is documented as meeting SIRS or sepsis criteria, or has some clinical indicators reflective of possible sepsis, but the physician never documents sepsis as a diagnosis. Should the coder always query for sepsis in these instances?