Find Your Routine: Increase Reading Speed to Maximize Productivity
When it comes to coding and documentation, finding your own rhythm can lead to positive results. For our new series, Find Your Routine, we interviewed our most productive coders and asked them what steps they take to find a rhythm that works for them.
This week, we talked with Brooke Sechrest, RHIT, CCS, Coding Specialist with Health Information Associates, about the steps she takes to find her routine.
Q: Describe in detail your daily routine.
A: I check HIA email, if it’s something that can wait until the end of the day, I do that. Since we do so much reading throughout the day, I try to limit the amount of information in the morning before I begin coding – I feel that’s best. Next, I check my client email and pending chart list. If I have any high dollar accounts or accounts that have been pending for a long length of time that I know the client would want dropped immediately I will take care of those, otherwise I will complete charts at the end of my shift or throughout the day. Here is why – when I know I have 8 full hours to work, I spend more time re-reviewing those pending charts. When I leave those charts for the end of the day, there’s only so much time that I can spend on them. Also, if I feel I need a break from a “new” chart throughout the day, I may switch over and do a pending chart just to give my mind somewhat of a break. I almost always take a break a couple hour into work, but if I’m feeling extremely productive that day and have a good rhythm going, I will wait until lunch time. After lunch I code for the rest of the afternoon. I will check email again and complete any pending charts usually about the last hour of the day.
When I start coding a chart, I enter all account information in log and do any abstracting—disposition, admitting, and attending—take care of all of that first. ED, H&P, consult, progress reports, and discharge summary. I check CDI for any queries and just read their notes to make sure there is nothing missing on my end. If query is needed, I will complete that at that point.
Q: How do you maintain your routine day after day, week after week?
A: I think once you understand all of your client’s policies/procedures, their EMR and coding system, and their physicians and how they document you can start to develop a good routine. I started to notice doing the same thing over and over each day that I was only getting better. It did take time to get there, but once I started to consistently reach my goal, I knew that is WAS possible and could be done and the negative thoughts of “I can’t do it” were finally out of my head. At the end of the day I feel like I’ve done my job and that makes me feel happy and want to continue that each day.
Q: What techniques have you found to minimize distractions?
A: My two biggest distractions were the cell phone and email. I’ve learned in order for me to be productive, my phone has to be out of sight. It’s too easy to grab it when it’s near. Even just spending a couple minutes on it during a chart can throw me completely off. I also have to exit completely out of emails. Otherwise, I think I can multitask by answering an email while I’m in the middle of a chart and the email ends up taking way more time than I thought. The sound of an email notification or seeing one come through while I’m in a chart will have me wondering what it says, so I find it best to exit out. If something is urgent, the client has your phone number.
Q: What are the productivity goals that you set for yourself? And how do you track them?
A: My goal is to code two charts an hour. This is what most of the clients that I have worked for expect. I find that thinking of and setting my goal of two charts an hour, rather than thinking of it as 16 charts in a full day makes it easier for me to work through. I like to keep an eye on the timer each time I’m in a chart, and make sure that I stay around the 30-minute mark per chart. If I feel that I’m behind, I’ll take a look at lunch time and see where I was at 4 hours and how many more charts, I need to hit goal and see how much time that leaves me per chart and just try and set goals that way throughout the day. Thankfully, HIA tracks our number of charts coded per day and the time it took to code each and this is visible to us during coding so that we don’t have to track time ourselves.
Q: What motivates you the most? Positive feedback from managers, self-motivation by reaching personal goals, financing incentives? Or other?
A: For me, all of the above could be motivating. Thinking back to when I really started to consistently hit productivity, I was self-motivated as well at motivated by my co-workers and how they were performing. I would hear that other coders that I worked with were hitting their productivity goals and that made me question myself. There’s no reason why I shouldn’t be at 100% too. If I am not doing my job at 100% then I feel like I have failed. I also remind myself that the company I work for only wants the best of the best, and I’m extremely lucky to be here, so I need to represent them the best I can!
TIP: What else can I do to meet productivity? Speed reading. Don’t spend too much time reading each and every sentence in the notes. I would take a good look at the most important notes such as H&P, Consults, DS, and then scan/speed read the rest. Most of the time there’s a lot of repeat in the notes, and if there’s not, it will stand out to you. I think if your quality is under control, give speed reading a try to increase productivity.
In the past, there had been an Excludes1 note at I46.- Cardiac arrest that excluded R57.0, Cardiac shock. HIA had also received a letter from AHA on a case in the past that had stated that only I46.- Cardiac arrest would be coded if both were documented. In addition, the Third Quarter Coding Clinic page 26 had a similar case that asked if both could be coded, and AHA had instructed that only I46.9, cardiac arrest, cause unspecified would be coded if both were documented and that the CDC would be looking at possible revision to the Excludes1 note.
A higher CMI corresponds to increased consumption of resources and increased cost of patient care, resulting in increased reimbursement to the facility from government and private payers, like CMS. We know that documentation directly impacts coding.
Lately we have seen several cases where the endarterectomy was assigned along with the coronary artery bypass (CABG) procedure when being performed on the same vessel to facilitate the CABG. A coronary artery endarterectomy is not always performed during a CABG procedure, so when it is performed it becomes confusing as to whether to code it separately or not.
Assign code Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases” for all patients who are tested for COVID-19 and the results are negative, regardless of symptoms, no symptoms, exposure or not as we are in a pandemic.
The Centers for Medicare & Medicaid Services (CMS) announced new procedure codes for treatments of COVID-19 – effective as of August 1, 2020. Among the new codes are Section X New Technology codes for the introduction or infusion of therapeutics including Remdesivir, Sarilumab, Tocilizumab, transfusion of convalescent plasma, as well as introduction of any other or new therapeutic substances for the treatment of COVID-19.
One common element in many value-based programs is risk adjustment using Hierarchical Condition Categories (HCCs) to create a Risk Adjustment Factor (RAF) score. This method ranks diagnoses into categories that represent conditions with similar cost patterns.
Why are so many AKI records being denied? It’s hard to give one answer for why so many AKI records are being denied lately, but most appear to be due to the multiple sets of criteria available for use in determining if a patient has AKI, as well as physician documentation. As stated in Part 3 of this series, there are three main criteria/classifications used to diagnose AKI.
In previous parts of this series we looked at the definitions of AKI/ARF, causes, coding and sequencing, and the common clinical indicators that patients present with that are diagnosed with this condition. In Part 4, we will look at the documentation that should be present to report the diagnosis without fear of denial, as well as when a query is needed to clarify the diagnosis.
If the facility does a COVID-19 test, and test is negative, do I need a diagnosis code. The answer is yes, you will report a Z-code. The Z-code depends on the record documentation and circumstances of testing. For any patient receiving a COVID-19 test, if negative, there MUST e a Z-code to describe why the test was taken. (Test negative for COVID-19 and MD does not override negative results).
In the first parts of this series we looked at definitions of AKI/ARF, causes, coding and sequencing. In Part 3, we will look at what clinical indicators would possibly be present to support the diagnosis of AKI/ARF.
The FY2021 IPPS Proposed Rule is out and here are some highlights from it regarding ICD-10 Code proposals. We will know if these changes are permanent after the public comment period is over on July 10, 2020 and CMS prepares the Final Rule, usually out by August 1.
As discussed in Part 1 of this series, AKI/ARF is a common diagnosis that coders see daily. In Part 2, we are going to focus on the different types/specificity of AKI/ARF. We’ll learn what they mean, as well as how to code the diagnosis.
This is part 1 in a series focused on coding of acute kidney injury (AKI) and/or acute renal failure (ARF). AKI/ARF is reported often, but is also one of the most common diagnosis found in denials.
With the proliferation of COVID-19 cases, we thought we would put together a quick reference listing of some of the common scenarios that coders have asked about. As with all coding, coders should follow Official Guidelines for Coding and Reporting and the COVD-19 Frequently Asked Questions document by the AHA.
Effective March 1, Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19. This great for providers whose patients are reluctant to visit the office.
The biggest reasons why some hospital systems are moving to single path coding is to eliminate duplicative processes and to optimize productivity. In addition, costs are reduced when only one coder “touches” the record and completes both types of coding.
Effective with 4/1/2020 discharges, ICD-10-CM code U07.0 is used to report vaping -related disorders. ICD-10-CM code U07.0 (vaping related disorder) should be used when documentation supports that the patient has a lung-related disorder from vaping. This code is found in the new ICD-10-CM Chapter 22. U07.0 will be in listed in the ICD-10-CM manual under a new section: Provisional assignment of new disease of uncertain etiology or emergency use.
The US government and public-health officials are urging consumers to utilize telemedicine for remote treatment, fill prescriptions and get medical attention during the new coronavirus pandemic. The goal is to keep people with symptoms at home and to practice social distancing if their condition doesn’t warrant more intensive hospital care.
Coronavirus: Tips for working from home. Companies around the world have told their employees to stay home and work remotely. Whether you’re a new to this concept or a work from home veteran, here’s some tips to staying productive from our #HIAfamily.
This is the final part of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we provide an actual example of an effective communication response to CDI.
This is part two of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we discuss mismatches and how to best go about resolving them. In part three we will provide a case example of best practice interaction.
This is part one of a three part series in which we address how coders can better interact with Clinical Documentation Integrity (CDI) professionals. Many times these departments are separate and the remote environment makes it difficult to interact efficiently between the two departments. In part one, we will discuss the history and objectives of CDI so the coder has a better understanding of CDI’s role.
One reason that coders should report chronic conditions (including history and status codes) on outpatient records is the HCC’s—Hierarchical Condition Categories. The quick and easy explanation of what HCC’s are is each HCC is mapped to certain ICD-10-CM codes or code ranges. HCC coding is designed to estimate future health care costs for patients.
For Part 4 of this 5-part series, we will look at Chapter 10 within ICD-10-CM—J00-J99—Diseases of the Respiratory System. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
For Part 3 of this 5 part series, we will look at Chapter 9 within ICD-10-CM—I00-I99—Diseases of the Circulatory System. This chapter contains so many of the everyday diagnoses that we code such as hypertension, heart disease and stroke.
For Part 2 of this 5-part series, we will look at Chapter 1 within ICD-10-CM—A00-B99—Certain Infectious and Parasitic Diseases. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
For Part 1 of this 5-part series, we will look at Chapter 21 within ICD-10-CM—Z00-Z99—Factors influencing health status and contact with health services. There is no possible way to include every guideline or coding reference for this chapter, but I’ll do my best to touch on some off the most common issues.
The HIM world has been buzzing recently with discussion of “Social Determinants of Health” and coded data. What does this mean for coders and the HIM field?
In response to the recent occurrences of vaping related disorders and in consultation with the World Health Organization (WHO) Framework Convention on Tobacco Control, the WHO Family of International Classifications (WHOFIC) Network Classification and Statistics Advisory Committee (CSAC) was convened to discuss a diagnosis code for vaping related illness for immediate use.