SYNERGISM— WHERE TO TAL outcome is greater than the sum
of individual parts—is fast entering the daily HIM vernacular.
That’s because three forces are coming together to revolutionize the clinical coding function: electronic health records,
computer-assisted coding (CAC), and ICD-10-CM/PCS. Taken
together these changes will profoundly alter how coding is performed, managed, and integrated into the healthcare delivery
The convergence offers health organizations a unique opportunity to re-engineer their coding workflows with an eye toward
the future, when health information is completely electronic
and codes are assigned by a computer first and validated by
coding professionals second. Tackling this redesign as a single
process that addresses all three forces together can create a
workflow that is more effective and efficient than the sum of its
Five steps can help HIM professionals through a process to
evaluate and change their coding workflows, beginning now to
maximize the benefits.
Five Steps to Re-engineer the Coding
1. Assess current workflow: map the process
2. Outline the future state: who, what, and where
3. Define the gaps and identify solutions
4. Set realistic expectations and timelines
5. Re-engineer the process (and celebrate success)
helps budgeting for future years. Fewer surprises make for happier CFOs—and stronger executive sponsorship of the project.
Time Spent Now Equals Dollars Saved Tomorrow
With the ICD-10-CM/PCS deadline more than two years away,
healthcare executives may question the need to undertake a
coding workflow re-engineering project now. But there are good
reasons to begin. Documenting the current process and establishing benchmarks are necessary steps in demonstrating value
later. Tackling workflow can lead to faster process improvement,
lower overall costs, and more informed ICD- 10 budgeting.
Organizations that evaluate and re-engineer coding workflow
have the opportunity to identify bottlenecks in clinical documentation, coding, and billing. They shore up broken processes
and remedy intradepartmental disconnects that consume time
and slow down clinical coders, ultimately slowing the revenue
cycle. In some cases technology can facilitate the necessary
workflow improvements; for example, CAC technology can
automatically assign records to coders by speciality, diagnosis,
procedure, or other factor.
Additionally, the human resources to conduct assessments
and implement changes are more likely to be available now
than they will be in future years as organizations approach the
ICD- 10 deadline. Internal staff may be increasingly committed
to near-launch tasks, and external consultants may become
scarce (and more expensive) as demand rises.
Finally, identifying the dollars required to upgrade or purchase technology necessary to streamline the coding process
1. Assess Current Workflow
With executive support secured, the first step in the process is to
evaluate and define the current workflow.
HIM professionals should map the coding workflow in a flowchart format. Mapping the flow by record type and coding location is a best practice, as coding may occur in many locations
and in a variety of ways. Primary areas to include are ancillary,
emergency, clinic, and same-day surgery coding.
The flowchart should begin at the first point of information
capture and identify every feeder system involved in the coding process. Because information collection begins prior to the
patient being admitted and may contain diagnoses, feeder systems such as scheduling, registration, and medical necessity
validation are important steps in the process.
The next step, physician documentation, is the foundation for
clinical coding and billing. It continues to take many formats.
A brief survey of HIMSS Analytics Stage 6 EMR hospitals revealed a variety of physician documentation methods, including speech recognition, voice recognition, and structured EHR
templates. 1 Many facilities still use handwritten documentation,
particularly for physician progress notes.
HIM professionals will need to gain a clear understanding of
planned changes for physician documentation and the timeline
under which changes will be implemented. Doing so will be important in identifying the impact on the coding process.
The current-state assessment also should identify opportunities to improve documentation and optimize the quality of narrative reports. Changes in physician documentation to support
ICD-10-CM/PCS will require physician education in advance of
Furthermore, physician use of electronic, template-based
documentation has a significant impact on the coding process
and must be considered in the overall,
multiyear plan. For example, one hospital converted to electronic, template-based physician documentation in the
emergency department (ED). When the
facility needed a hard copy of the ED record, it had grown from six pages to 50
pages. Despite the burgeoning charts,
the quality of documentation available
Tackling the redesign as a single process that
addresses EHRs, CAC, and ICD- 10 together can
create a workflow more effective and efficient
than the sum of its parts.