Health Information Management

Agreement is a beautiful thing

HIM-HIPAA Insider, September 8, 2014

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The ICD-10 transition has been nothing if not contentious. We’ve had delays mandated by both CMS and Congress, as well as ongoing attempts by the AMA to kill ICD-10 altogether.

 
Another discordant note is a lack of coder agreement. Not on the merits of ICD-10, but on which codes to assign.
 
Both 3M’s Donna Smith, RHIA, and AHIMA’s Angie Comfort, RHIA, CDIP, CCS, say determining the correct code isn’t a sure thing. Coders aren’t always ending up at the same code.
Why? Well, first of all, the system isn’t live so no one is really coding in it. We’re still doing some guess work.
 
Second, physician documentation is not where we need it to be, even for ICD-9. As a result, some coders may be guessing or choosing an incorrect default code.
 
Third, not everyone is finding the same information in the record. In many cases physicians already document laterality, Donna says; it’s just that coders might not know where to look for it.
 
Fourth, we still don’t have a ton of guidance for the gray areas. We have 30 years’ worth of Coding Clinic advicefor ICD-9. We have a few issues for ICD-10.
 
Many organizations are doing some type of dual or double coding. I’m not sure how many are actually checking to make sure coders are coming up with the correct answer. And that’s another problem. How do you decide who got the correct answer?
 
You need a plan, Donna says. Part of that plan should include identifying the top diagnoses and procedures at your organization. Pull actual cases that include those conditions or procedures and have all of your coders code the record.
 
Once you’ve done that, compare the results, Angie says. Did you all come up with the same answer? Probably not. Agreement rates are pretty low right now, according to Donna.
 
So you came up with one code and your coworker came up with a different one. Maybe a third coworker came up with something completely different. Now what?
 
Sit down and talk about it, both Angie and Donna say. No one knows everything about ICD-10 yet (no one knows everything about ICD-9 either and it’s been around way longer). Try to figure out why you came up with different codes. Did someone miss a piece of information in the documentation? Did someone make an assumption based on his or her knowledge of the physician’s habits? Is the physician’s documentation so vague that everyone was just guessing?
 
If you can’t come to an agreement among yourselves, ask Coding Clinic. Send the de-identified record to AHA and ask them how to code it. Coding Clinic loves real-life examples, Donna says. So send them in. The more actual documentation they can look at, the better they can answer questions for everyone.
 
This article originally appeared on HCPro’s ICD-10 Trainer blog.



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