Journal of AHIMA - July 2011

Coding Workflow

Include All IT Systems in Gap Analysis—
New Ones, Too

A SOUTHEAST HOSPITAL conducted an ICD-10-CM/PCS gap analysis only to learn that a new anaesthesia billing system it had recently installed was not ICD- 10 compatible. Worse yet, the system could not be upgraded.

The hospital was shocked; however, it never considered asking about ICD- 10 compliance during the vendor selection process because the code set upgrade was not on its radar at that time.

for coding had decreased. The templates were not clinically sound and lacked specificity.

HIM professionals should be involved in system selection whenever electronic, template-based physician documentation is considered, and they should be involved in template development. This will be especially true in ICD- 10 coding.

The heightened specificity of ICD- 10 will require clinicians to become more thorough in their documentation. Templates and their associated alerts and reminders must support this change. Well-written templates focused on documentation specificity will also enhance CAC accuracy and coder productivity.

Next, identify all technology applications that store or process codes. In addition to coding systems, these include financial, quality and performance, registration, laboratory, registries, and many other systems, including system interfaces. Questions to ask include:

x Will any systems be replaced? If so, when and how will the
new system change coding workflow?
x How many systems do coders have to toggle between to-
day? Will this change?
x Are all vendors ready for ICD- 10? Which version will be
ICD- 10 ready? Which version will be ICD- 10 compatible?
x Will interfaces between documentation systems and any
coding applications also be updated as EHR, CAC, and
ICD- 10 are implemented?
x Which paper-based or scanned documents will become
electronic? Can these documents be prioritized for be-
coming electronic?

2. Outline the Future State Determining the future state of coding at the facility requires creative thinking on the part of HIM professionals and IT teams. They must consider new and evolving capabilities of CAC and EHRs while considering the interrogatives of ICD-10: who, what, and where.

Consider Who

Who will code which records is an important consideration in creating future coding workflows. The increased specificity of ICD-10-CM/PCS is driving the need for coding professionals to sharpen their skills, including their clinical knowledge of dis-

ease processes and surgical procedures. Traditionally coding professionals have focused their expertise around the type of encounter (inpatient, outpatient, emergency, or physician office). ICD-10-CM/PCS creates an opportunity to review coding workflow designations beyond encounter type.

For example, orthopaedic conditions are dramatically expanded in ICD- 10. Coders with an in-depth knowledge of orthopaedics can be assigned these cases automatically using CAC routing technology. Additionally, they can be directly paired with orthopaedic physicians and clinical documentation improvement specialists to create a highly effective team. Cardiology, which also contains greater specificity in ICD- 10, is another area that may benefit from specialized workflows.

In the six to 12 months following ICD-10-CM/PCS implementation, master coders should be shadowed and cross-trained in order to share knowledge and round out the coding team. Switching coders to other specialties over time also ensures adequate back-up coverage within the department. As necessary, outsourced coders can backfill processes during implementation of both CAC and ICD- 10.

Finally, a frank conversation with the entire coding team is warranted with regard to the future state. With so many changes on the horizon, HIM directors must manage the coding staff’s perceptions and expectations of the changes and determine the best path for each individual. Some organizations may have a need for alternative positions, such as clinical documentation improvement teams, and limited ICD- 9 coding needs. (See the sidebar “Discussion Topics for Coding Teams,” opposite, for a list of discussion topics.)

Determining coding’s future state at a facility requires considering new and evolving capabilities of EHRs and CAC against the interrogatives of ICD-10: who, what, and where.

Define “What”

From a document perspective, the majority of HIM departments currently operate in a hybrid environment, part paper and part electronic. This will change over time as more and more of the paper-based documentation coders currently use becomes electronic. When plotting future coding workflow, HIM professionals should create timelines identifying when each document is expected to transition to electronic format.