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.”
In Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments. Prepare yourself as this is rather lengthy due to continuation of NTAP that would normally expire.
Coders are instructed, at this time, to follow the AHA Frequently Asked Questions Regarding ICD-10-CM/PCS Coding for COVID-19. Lately, we have seen missing PCS codes for the new technology drugs that were introduced on August 1, 2020 and thereafter.
With the creation and implementation of ICD-10-CM, multiple codes are available to describe the type of pulmonary emboli that occur.
Hypercoagulable states are blood disorders that increase the risk of deep vein thrombosis or embolic disease. The state is either inherited or acquired. About 80% of patients with blood clots have been found to have either an inherited or acquired clotting disorder. These blood clots can be lethal and some require life-long therapy. Hypercoagulable state is also known as thrombophilia.
Encephalopathy is a general term and means brain disease, brain damage or malfunction. Physicians often use encephalopathy and altered mental status interchangeably. When coders see this documentation in the healthcare records, they typically need to query the physician for clarification of the diagnosis.
Spinal procedure coding can be daunting for coders. The spine itself can be quite complicated anatomically and the procedures done to address spinal conditions can be even more complicated!
In June CMS released the final ICD-10-PCS codes for FY2022, which begins October 1, 2021. We are giving you a sneak peek at the changes. HIA will have a full educational module on these changes available later this summer.
CMS released the IPPS proposed rule on 4/27/21 outlining the proposed changes to the Inpatient Prospective Payment System for FY2022, which begins October 1, 2021. Later this year, sometime in August, CMS will release the Final Rule. Currently CMS is reviewing responses to their proposed rule and will address them in the final rule.
A medical coding audit is a process that includes internal or external reviews of medical coding and billing accuracy, procedures or policies in place, and any other component that affects the medical record documentation. Medical coding audits…
Anticoagulants and antiplatelets are used for the prevention and treatment of blood clots that occur in blood vessels. Oftentimes, anticoagulants and antiplatelets are referred to as “blood thinners,” but they don’t actually thin the blood at all. These drugs slow down the body’s process of making clots. Their main function is to keep the patient’s blood from clotting or turning into solid clumps of cells. These drugs do this by interfering with either fibrin or platelets in the blood.
Carotid artery disease is a vague category that can incorporate many different carotid artery issues. Some physicians may feel that they are being clear the patient has plaque, stenosis, or occlusion of the artery, but in ICD-10-CM the specificity must be included in the documentation.
10 ICD-10 Codes for Superheroes. Superman: T78.2XXA Anaphylactic reaction; substance: kryptonite. Batman: F44.81 Dissociative identity disorder. Robin: F60.7 dependent personality. The Hulk: L30.4 Erythema intertrigo. Wonder Woman: T24.032A Burn of unspecified degree of left lower leg. Black Panther S93.401A Sprain…
Practices have not seen many revisions to the Evaluation and Management (E/M) office / outpatient visit guidelines in three decades – until now. As of January 1, there are new E/M coding guidelines. We’ll get to those in a bit, but first let’s look at why they changed.
Pseudoseizures are a form of non-epileptic seizure. These are difficult to diagnose and oftentimes extremely difficult for the patient to comprehend. The term “pseudoseizures” is an older term that is still used today to describe psychogenic nonepileptic seizures (PNES).
With the implementation of ICD-10-CM came different codes and coding rules for many diagnoses. One of these is the coding of bowel obstruction when the patient presents for this condition that is caused by another condition.
This is Part 5 of a five part series on the new 2021 CPT codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.
This is Part 4 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes in the urinary, nervous, ocular and auditory systems. There are 2 new urinary/male reproductive system codes with no revisions or deletions; 3 new female reproductive codes with 2 deletions, 0 new with 4 deleted nervous system codes with 5 revisions; 5 new eye category III codes; and finally a 2 new auditory codes with one deletion.
This is Part 3 of a five part series on the new 2021 CPT codes. In this series we will explore the cardiovascular system CPT changes. There are 5 new cardiovascular CPT codes added with 0 deletions and 4 revisions.
This is Part 2 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include some examples to help the coder understand the new codes. There are 0 new musculoskeletal CPT codes added with 0 deletions and 2 major revisions along with an extensive update to arthroscopic loose body removal requirements. For the respiratory system, there were 2 new codes, one code deletion and no revisions.
This is Part 1 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include examples to help the coder understand the new codes. For 2021 in general, there were 199 new CPT codes added, 54 deleted and 69 revised.
We have seen many updates and changes to COVID-19 (SARS-CoV-2) since the pandemic started. On January 1, 2021 we will see even more changes as outlined in this post. Also the CMS MS-DRG grouper will be updated to version 38.1 to accommodate the changes.
In the previous three parts of this four-part series, we discussed the new ICD-10-CM diagnosis code changes, ICD-10-PCS procedure code changes and FY2021 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2021.
In the previous two parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes and ICD-10-PC procedure code changes. In this session we will review the major IPPS changes for FY2021.
This is Part 2 of a 4 part series on the FY2021 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented. For FY2021 ICD-10-PCS there are 78,115 total codes (FY2020 total was 77,571); 556 new codes (734 new last year in FY2020)…
This is Part 1 of a 4 part series on the FY2021 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis changes. Here is the breakdown: 72,616 total ICD-10-CM codes for FY2021; 490 new codes (2020 had 273 new codes); 58 deleted codes (2020 had 21 deleted codes); 47 revised codes (2020 had 30 revised codes)
Acute pulmonary edema is the rapid accumulation of fluid within the tissue and space around the air sacs of the lung (lung interstitium). When this fluid collects in the air sacs in the lungs it is difficult to breathe. Acute pulmonary edema occurs suddenly and is life threatening.