Compliance emphasizes coding education

Program copied in other parts of health system

(Editor’s note: In last month’s Hospital Payment & Information Management, Ray Pinder, MS, RHIA, talked about establishing a baseline and monthly coding reviews for a coding compliance and education program. This month, Pinder addresses the education component of his program and how the program will affect the entire Holy Redeemer Health System.)

Establishing baseline and subsequent monthly reviews is an important first step of a coding compliance and education program, according to Ray Pinder, MS, RHIA, director of medical records services for Holy Redeemer Hospital and Medical Center in Meadowbrook, PA. Education is also an important component.

Once the initial reviews were completed, Pinder and his coding manager, Margaret Giancaterino, RHIT, began holding monthly educational sessions for their three full-time and three part-time coders. In these sessions, they often use audio and Web-based programs provided by the American Health Information and Management Association (AHIMA) in Chicago. "The programs are relatively inexpensive, and many people can attend," Pinder observes.

Pinder had considered sending his coders to seminars, but the cost would be more than $100 per person, whereas he can usually purchase an AHIMA program for under $150. In addition, he can ensure that he, Giancaterino, and their coders are reviewing the same content and information with the audio or Web-based programs.

"If you send half of your staff to one seminar and half to another seminar, many times they return with different stories because the speakers presented differently," Pinder says. "We found that we could have consistency in our coding education by having everyone attend the same program."

During these monthly sessions, Pinder and Giancaterino also focus on hospital-specific coding issues such as coding by diagnosis, diagnosis-related group (DRG), ambulatory payment classification, or documentation issues. "We first do a review of our data to make sure we identify the right issues to be reviewed and addressed," Pinder says.

He sometimes finds that increases in certain codes could be due to the time of year, such as an increase in flu-like symptoms and pneumonia. "With pneumonia being an OIG [Office of Inspector General]-targeted DRG, we wanted to make sure that our pneumonias were coded correctly." If the patient had a simple pneumonia, Giancaterino checks to ensure it was coded that way. Likewise, if the patient had a complex pneumonia, the codes should be supported by documentation in the medical record.

Coders also occasionally attend the hour-long, noontime lectures held for the medical staff. Their attendance depends on the relevance of the topic. "For instance, we might ask the coders to go to the noon conference to hear the medical information behind pneumonia or severe strokes," Pinder says. "So when they are coding those charts, they understand the process better."

Pinder has also developed a coding resource center for his staff. "We printed off the web the OIG-suggested coding resources that every coder should have available," he says. He and Giancaterino made sure they had an up-to-date Physicians’ Desk Reference, a current Merck Manual, and updated subscriptions for the AHA (American Hospital Association) Coding Clinic. On an annual basis, new ICD (International Classification of Disease)-9, CPT (Current Procedural Terminology), and HCPCS (HCFA Common Procedure Coding System) coding books are reordered for all coders. They also subscribed to several newsletters that address inpatient and outpatient coding best practices.

All of these resources were placed in a centralized area. "We have a well-labeled binder for each subscription, and we post other materials or announcements on the coders’ bulletin board," Pinder says. "Our coders also have e-mail and use many additional coding newsletters and references via the web."

Pinder has initially established his coding compliance and education program in Holy Redeemer’s acute care facility. Since the program has been in place, Pinder says the coders feel they have all the necessary tools to do their job better. The coders’ participation in monthly educational programs has resulted in positive returns on the health system’s time investments.

Senior management is now working with Pinder to review coding compliance programs at other Holy Redeemer entities, including its two long-term care facilities and home health care agencies. "We feel that the experience that we have on the acute care side can only benefit our long-term care facilities and our home health care agencies. Both of those other entities of our health system have medical record personnel in place," Pinder says.

A long-term care consultant visits the health system once a month and is contracted to complete coding reviews. In the future, that review will be given to Giancaterino, who will then provide feedback on the review and recommend educational programs for the long-term care staff. She will also review coding and provide coding feedback to the home health care agencies.

One focus in these programs is to have qualified staff coding the records. At Holy Redeemer, all coders were certified or qualified as a result of years of experience and high review scores. "Any coder that we had on staff when I came on board who was not an RHIA, RHIT, or a CCS was grandfathered because of their experience and their review scores," he says. Coders who were qualified but not certified were encouraged to take their certification exams. In the future, Pinder will fill coding vacancies with credentialed coders. "We want to make sure we are doing the proper coding."