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.
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.
In January, new CPT codes were released. There were 248 new CPT codes added, 71 deleted and 75 revised. Most of the surgery section changes were in the musculoskeletal and cardiovascular subsections. These included procedures such as skin grafting, breast biopsies, deep drug delivery systems, tricuspid valve repairs, aortic grafts and repair of iliac artery.
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.
“Client S” is a small, not-for-profit, 40 bed micro-hospital in the Southeast. HIA performed a 65-record review this year for Client S and found an opportunity with 15 of them. 9 had an increased reimbursement with a total of $43,228 found.
The coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebrovascular disease codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the intensive care unit regardless of medical condition.
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.
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.