Sarah Humbert, RHIA, Vice President of Coding Operations, KIWI-TEK,LLC and Catrena Smith, CCS, CCS-P, CPCO, CPC, CIC, CPC-I, CRC, CHTS-PW, Coding Manager, KIWI-TEK | December 20, 2018
In a recent edition of HCPro’s JustCoding.Com, we shared best practices for one of HIM’s most important challenges—onboarding new inpatient coders. Failure here triggers coding compliance issues, hindered coder productivity, payer denials, and a dissatisfied workforce. Our article identified three distinct scenarios for HIM and coding managers to consider:
- Inpatient coder transferred from outpatient coding
- Inpatient coder hired from another facility
- Inpatient coder straight out of school
From outpatient to inpatient: focus on what’s different
Best practice here is to focus on the differences between outpatient and inpatient diagnosis coding. Once coders know those differences, they can be educated on the procedure coding variations between inpatient and outpatient cases. These eight areas of variance between outpatient and inpatient coding were detailed in the article.
- Medical record documentation
- Principal diagnosis
- Secondary diagnosis
- Previous conditions
- Coding guidelines
- Inpatient-specific guidance (abnormal findings
- Uncertain diagnosis
- Comparative or contrasting diagnoses
Transferring from another facility
These coders are expected to be proficient in coding guidelines and best practices. With these new inpatient coders, focus your educational efforts on facility-specific policies and coding guidelines. Target what is unique about your setting, case mix, physicians, clinical documentation improvement (CDI), and coding workflow. Technology applications commonly vary between facilities, so some amount of technology training is certainly warranted. Here are three specific areas where we often see differences between facilities.
- Coding guidelines
- Case mix
- Physicians and CDI
Straight out of school
Recent coding graduates require the most hands-on support from their coding managers, directors, and peers. A stepwise approach is considered best practice. Gradually advance this coder’s workload while slowly reducing the percentage of cases requiring quality assurance (QA) or managerial review.
Specialty by specialty, introduce recent coding graduates to each type of case they will encounter at your facility. Let the coder focus on these cases for two weeks, then move to another case type such as uncomplicated obstetrics.
Set up work and review queues within your coding software so cases can be automatically assigned and monitored. Check off new inpatient coders for each type of case and then move them to a new diagnosis or procedure.
Check with local colleges and universities for additional support. For example, Renown Health System in Reno, Nevada, worked with a local university to establish a year-long supplemental program.
Is coder specialization in your future?
In our article we also introduce a new practice being employed by some larger hospitals and health systems. Specializing coders may be an effective strategy for organizations with a large coding team. Coders assigned to specific types of cases realize greater productivity, improved accuracy, and higher earnings within that specialty. For example, coders knowledgeable and experienced with cardiology increase their efficiency and are more valuable to their employers. Downsides to this approach were also covered in the article.