Find Your Routine: Set Your Own Schedule 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 Amy Pang, RHIA, 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 like to work later hours. My most productive hours are between 11 a.m. and 11 p.m. The key for me is to get as much quality sleep as I can – getting good rest allows me to think more clearly. I like to get my errands done in the morning so that I can focus all of my attention on work later in the day.
A few years ago, I read this article from the Harvard Business Review about the ideal work schedule. The article explains that “humans have a well-defined internal clock that shapes our energy levels throughout the day: our circadian process, which is often referred to as a circadian rhythm.” It really spoke to how I work best, which is with a flexible work schedule. Part of the reason HIA is such a great fit for me is because they allow me to set my own schedule and work at hours that optimize my daily energy levels. If you allow your employees to work at your most productive time, then you will get the most out of them. I worked in the restaurant business from the time I was 14 until my early 20’s, and that means I’m used to working and being productive at later hours in the day. So, HIA and our client allows me to set my work schedule for later hours to be my most productive self.
Q: How do you maintain your routine day after day, week after week?
A: Quite a bit has to do with how fast I read and skim the records. To be honest, I am surprised I am one of our most productive coders but am very honored to be on this list. HIA hires the best of the best! Which is another reason I have stuck around for almost 15 years. I work with amazing, smart and caring people; they always have my back.
Additionally, I really feel that I have found the perfect fit with the perfect client. I continue to find my work fascinating and interesting. Almost every day, I learn new diagnoses and procedures at my client site. I love that I am constantly learning and at a health system that keeps my interest. My client site is a research facility that uses the newest technology, so I am forced to do a lot of research to support them, which keeps me on my toes. At my site, I am able to use everything that Pat and Beth and Kim send out as far as new updates.
I truly love to learn, and I get that at HIA. When I first started, I made that very clear, and they have lived up to my expectations. One of the best things HIA offered me as an employee was assigning me to work at challenging client sites, where I could continue to learn and grow my knowledge and skills.
Finding the right fit for the coder is key. For me, the hardest clients are the best fit.
Q: What techniques have you found to minimize distractions?
A: Minimizing distractions is hard. I found that, because I am able to start later in the day, I can get a lot of my chores and errands done in the morning before I start work. This helps me minimize the distractions I would have otherwise been thinking about all day long. IF I had to go in at 8 a.m., I would be thinking about the things on my to-do list—groceries, UPS, pick up this or that. Setting my own schedule, works best for me and helps minimize those distractions that I would otherwise stress about all day long.
Q: What are the productivity goals that you set for yourself? And how do you track them?
A: My goal is to do as much as I can. Angie [Christen, VP of Operations at HIA] once said, “ask yourself if you can do one more chart each day.” Angie is very inspirational to me. She is such a go-getter. This challenge to push yourself to do that one more chart a day is something I remind myself of a lot. Using a chart timer or clock helps as well and allows me to constantly monitor myself to keep pace. Sometimes when I do get bogged down in a difficult chart, I stop coding it and come back to it at the end of the day. Sometimes when you come back to it, you are refreshed and not stuck on that same thinking mode.
Q: What motivates you the most? Positive feedback from managers, self-motivation by reaching personal goals, financing incentives? Or other?
A: I am very self-motivated. Over the years, I’ve completed nine marathons without any professional training. I really enjoy that challenge to try to be the best at everything that I do. It makes me feel good to exceed my own expectations. I always think that if I was managing someone, what would I expect out of them? I enjoy meeting, and even exceeding, those expectations that I would have for someone else. Like with running marathons, it releases endorphins to always do your best and validates the effort I am putting in.
TIP: One more tip, I write a lot of coding notes on index cards. I developed the habit of using index cards to study in college and it was very helpful. To this day, I’m obsessed with this learning/memory jogging method.
The picture below is an example of how I use the index cards to help me code faster. I believe these were once new technology codes and I rarely see them. So, the index cards help me to remember to code them when I encounter these procedures.
Also, SharePoint is a BIG help in assisting me to code faster. A lot of the difficult cases I have issues with are answered in SharePoint.
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.