By Mike Evans, RHIA, CCS, vice president of coding and compliance at In Record Time, Inc.
Coders are among the busiest employees in any hospital nationwide. However, they must make time to practice using ICD-10 even despite strict productivity requirements. In particular, practicing ICD-10-PCS will be critical as the industry heads into 2015. ICD-10-PCS is far more complex than the ICD-9-CM procedure coding system to which today’s inpatient coders are accustomed. In PCS, coders must be able to complete a seven digit alphanumeric formula. If they’re unable to assign even one character in the formula, they’ll be unable to assign the entire code.
Experts agree that without critical details in the documentation, coders may default to non-specific codes. This is certainly not the intent of the more specific PCS coding system. It’s in coders’ best interests to practice using PCS as much as possible between now and October 1, 2015.
Where should coders focus their ICD-10-PCS training efforts? One of the most difficult aspects of ICD-10-PCS may be assignment of the root operation. For this reason, coders may want to devote significant time in this area. Identifying an improper root operation can lead coders down a completely incorrect path to code assignment. Incorrect code assignment ultimately jeopardizes both reimbursement and data integrity.
Coders should also spend the majority of their time practicing more complex cases, such as CABG procedures, OB/GYN procedures, orthopedic surgeries, and neurosurgical cases. These procedures are the ones that will likely cause bottlenecks in terms of productivity. Some of these procedures may even require more than one PCS code to fully capture the entire operation the physician performs.
Another approach is to focus on high-volume procedures; however, keep in mind that these procedures may not be the most complex and therefore time-consuming.
Once coders have mastered root operation definitions, focus on whether coders can translate clinical terminology to a specific PCS operation. Physicians are not expected to make this translation. The 2015 ICD-10-PCS Official Guidelines for Coding and Reporting state the following:
It is the coder’s responsibility to determine what the documentation in the medical record equates to in the PCS definitions. The physician is not expected to use the terms used in PCS code descriptions, nor is the coder required to query the physician when the correlation between the documentation and the defined PCS terms is clear.
How can coders work with medical staff to practice ICD-10-PCS? Ask medical staff members to identify the top 10 most complex procedures that they perform. Also inquire whether physicians would be willing to walk coders through the steps they take during each of these procedures. This can help coders visualize the procedure when coding.
Physicians should have already begun to document the additional details necessary for ICD-10-PCS, such as anatomical specificity and laterality. When physicians document these details, not only are they practicing good habits, but they’re also making records more helpful for coders who will use de-identified versions for practice purposes. If these details are missing from the record, coders have no choice but to assign an unspecified code.
Why is it important to audit for quality? Even when coders practice ICD-10-PCS on a daily basis, they’re still bound to make mistakes. Quality monitoring is critical, both now and once the new coding system takes effect. As coders practice using PCS, ensure that a manager verifies their work. When questions or discrepancies arise, address these topics during coding staff meetings. Develop internal coding guidelines to identify how coders will tackle certain procedures in lieu of updated Coding Clinic references.
How can organizations make coder training in general a priority? Unfortunately, training and education budgets are often among the first to be reduced or cut entirely when organizations seek to reduce operating costs. Coding managers and HIM directors must work with hospital executives to explain the importance of ICD-10 and the role it plays in the overall financial viability for the organization. As was the case with the transition to DRGs in the early 1980s—as well as MS-DRGs in 2007—organizations likely won’t realize the true impact of ICD-10 until after implementation. We shouldn’t let history repeat itself. Investing in up-front coder training will mitigate the impact of the new coding system as much as possible.