Creation of a Coding Knowledge Center for providers to access on the Madigan SharePoint site. This knowledge center will be an accumulation of guidelines and coding information derived from data analysis, new or changes in medical coding, and coding tips related MHS GENESIS. It will assist physicians and residents to identify desired material and create a user-friendly site that can be easily accessible by anyone in the facility. This will also empower providers to improve their coding skills, and provide guidelines for clarification purposes. The one-stop “shop” will help improve providers knowledge of coding, HIM and improve coding accuracy in the organization. Clinical documentation improvement tips will also be included.
Keywords: coding, education, clinical documentation improvement, GME, compliance
Coding Knowledge for Residents in GME Programs
Medical coding has become increasingly difficult with the implementation of ICD-10 and stricter documentation guidelines, not only coding personnel but more so for physicians. It’s even more difficult for physicians who are attempting to document in a difficult EHR the complete course of care, capture all relevant diagnoses and procedure codes to ensure proper reimbursement. It is imperative there are coding tools and resources available to physicians at their fingertips to access to gain knowledge when coding staff are not available. To foster transparency of coding guidelines, reduce the number of coding errors and empower physicians and residents in a GME residency program; the creation of a Coding Knowledge Center on the Madigan Army Medical Center’s SharePoint site with coding guidelines, coding tips and EHR functionality tips will provide a one-stop shop for access to all things coding.
Shortage of Coding Resources
When coding resources are limited for an organization, coding errors increase, reimbursement can be compromised, compliance is at risk and clinical documentation will not be completed according to regulation.
Limited coding personnel is a major problem for the Health Information Management team when coding training is needed for providers. There are more than 1200 physicians at Madigan, not including nurses, technicians and other clinical staff and there are only 43 medical coders (Ace, 2018). That is a 1:27 ratio of coders to providers. Coding personnel can’t provide the training support to the large volume of physicians in a large acute-care facility.
There is also a high volume of turnover among the residency population at Madigan as it is an accredited teaching hospital for the Army. Residents rotate regularly with graduations every year in June. This makes for a scenario where there is continuous educational needs for incoming personnel.
GME Residency Program Requirements
Currently, there is no obligation of GME residency programs to include medical coding as one of the mandated competencies for graduation. Referencing the Army GME Residency Program for Madigan Army Medical Center, there is no mention of medical coding of diagnoses or CPT procedure codes (Army, 2017-2018). There is no requirement to train residents on coding. It is imperative that medical coding is taught to residents to ensure that patient care and workload is captured completely, accurately and timely.
Coding Knowledge Center
The creation of a Coding Knowledge Center on the Madigan SharePoint site will assist coders in educating residents and staff physicians on correct coding and pertinent data capture procedures.
In order to provide informative coding information for providers that are busy providing quality patient care, the Coding Knowledge Center will ensure that providers can research an issue quickly while feeling confident that they are receiving accurate information. There must be transparency of issues and trends in order to effectively influence change and spark improvement. It is difficult to provide coding assistance outside regular work hours so this will also assist providers when this situation arises. Due to the various off-site clinic locations belonging to the Madigan family, there is no guarantee that a medical coder will be available to assist when education is necessary. Also, to promote transparency, the guidelines and previous training slides will be available for further review. Providers will be empowered to access the data quickly to seek answers when there are questions they need answered quickly. Additionally, providing coding information at their fingertips will assist in reducing coding errors, preventing other compliance issues and prevent inaccurate reimbursement as providers will be better prepared in coding correctly at the time of the encounter.
Through focused and non-focused audits many different trends can be identified and common miscoded scenarios can be identified. Providing both of these in manners that are user-friendly for providers to review will reduce the number of miscoded encounters. Coding tips1 will be listed and available to review by medical specialty or organization wide concerns. This will help providers to drill down to find coding scenario examples or coding information quickly, again saving time for patient care.
Recently, Madigan implemented a new electronic health record (EHR), MHS GENESIS, which has posed a learning curve for providers. An additional tool that will be accessible will be tip sheets1 for EHR functionality. The tip sheets will assist providers, especially new incoming residents, tips that will be useful in documentation completion and coding. Again, this will assist providers in learning the new system, while preventing unnecessary issues and mistakes with data capture, as the coding will be accurate at the point of documentation completion. Since the implementation of ICD-10, the need for more accurate documentation is necessary to assign the correct diagnosis code on encounters. Providers have to drill down farther to get the correct specificity level of the code. MHS GENESIS has created a higher level of difficulty for providers to assign the desired code so having these tips sheets available will surely be an effective tool to save time as it takes more and more time for providers to complete necessary tasks in the EHR. According to the article, “Why this is the Hardest of Times to be a Physician in America”, one of the biggest frustrations for physicians is entering and retrieving information in the EHR (Pearl). It takes more and more clicks to complete necessary tasks so if they are able to access, learn and accomplish their coding tasks quicker, the happier they will be and the more time they will be able to focus on patient care.
Another tool that will be available, is a listing of coding contacts so providers will be able to easily identify their coder, knowing where the coder’s office is and their phone number. Supervisors and coding managers will also be listed to ensure that there is complete transparency of coding personnel in the event that additional training or information is necessary.
AHIMA BAS-HIM Program Outcomes
To ensure that the Coding Knowledge Center is a tool that will promote effective coding improvement and truly be a beneficial tools for providers, it is important that it meets criteria consistent with the American Health Information Management Association (AHIMA Press, 2018) program outcomes and best practices.
One of the most important reasons for creating and implementing the Coding Knowledge Center is to improve coding compliance and accuracy. One of AHIMA’s core competencies is to “analyze and interpret policies regarding compliance” (AHIMA Press, 2018) which includes the improvement of compliance in medical coding and clinical documentation improvement. This coding knowledge site will provide a useful tool for providers to effectively improve their own documentation and increase their coding accuracy.
Another, core competency that is met by the implementation of the Coding Knowledge Center is to “Evaluate various leadership models and skills required for successful leadership” (AHIMA, 2018). This core competency addresses training and development. Madigan providers will receive additional training, resources and tools that will assist them with clinical documentation improvement and medical coding. They will know what codes to assign and when it is appropriate to do so when there is confusion because answers will be available at their fingertips.
Conclusion and Future State
In the future, the Coding Knowledge Center will be proven as one of the essential go-to tools for residents and other providers at Madigan Army Medical Center. Many providers already spoken too, are eager to access the tool and begin usage. Most have agreed that this tool would be useful for new incoming residents as coding is one of the most difficult and time consuming aspects of their job. Additionally, future state will bring more medical coding training for incoming residents so problems and issues can be addressed sooner rather than later. Hopes are high that standardized face-to-face training can be written into the GME guidelines at Madigan. That issue will be addressed soon. For now, the Coding Knowledge Center will empower providers to seek out answers to avoid coding pitfalls, ensure coding guidelines and regulations are transparent for all who seek answers and coding errors are minimized, decreasing the need for re-coding. Knowledge is power, so providing this information to the many physicians that treat patients at Madigan will reduce the coding stress, improve documentation and allow providers to focus on patient care.
Ace, Michael. Personal interview. 29 May 2018.
Ahima Press: Registered Health Information Administrator (RHIA) Exam Preparation, Seventh Edition. (2018). Retrieved from http://ahimapress.org/shaw5757/.
Army Graduate Medical Education – Madigan Army Medical Center. (2017-2018).
Pearl, M. R. (2015, August 06). Why This Is The Hardest Of Times To Be A Physician In America. Retrieved June 7, 2018, from https://www.forbes.com/sites/robertpearl/2015/08/06/why-this-is-the-hardest-of-times-to-be-a-physician-in-america/.
TotalMed Coding Solutions. 2016. 7 Foolproof Strategies to Reduce Lost Revenue in Your HIM Department. https://medicalcoding.totalmed.com/2016/06/28/reduce-lost-revenue-in-your-him-department/.