Tiny House Movement
If you watch home improvement television then you must have seen the shows on the “tiny house movement” featuring adventurous individuals downsizing their lives into a less than 300 square foot space. I am always amazed at how convinced they are that they can live without all the things they have accumulated to fill their current home of 2000 square feet. Suddenly, it appears that my neighbors have bought into the tiny house movement. They had a garage sale that included what looked like the entire contents of their home including one queen size bed, three children’s beds and one crib. The next thing I know, an RV arrives and they begin moving in small items. Now I’m not sure if they are brave or crazy because they will be living in the less than 250 square foot RV with 4 small children and 3 dogs but the entire process did make me think – is there stuff I’m holding onto that has become clutter?
As I look around my office I notice the bookshelf with multiple years of CPT Manuals, ICD-9-CM Manuals, ICD-10-CM Manuals, specialty resource guides, government publications, coding magazines and more. Before I can commit to decluttering my office, I need to determine what resources I really use or need to use on a regular basis and what is no longer useful.
As coders we depend on current and accurate resources to get the job done but are we hanging on to out of date resources? To take it a step further, are we cluttering up our workflow by accessing multiple systems and reviewing “source” documentation rather than just the physician’s documentation? What if we put our workflow through the “tiny house movement” and decluttered our resources as well as our coding process. Are you ready for the “tiny house movement?” Let’s find out.
First, review all your coding resources and make sure the ones you rely on daily are for this current year. If you are responsible for auditing, it can be necessary to keep resources for the prior year but you should not need the CPT Manual or ICD-9-CM Manual from 3 years ago on your desk. If you have older resources, box them up and move them out. You do not need them for your daily workflow.
Second, review the systems you are accessing to code reports. The radiologists dictation should be the source document for all codes assigned with one exception. When the exam is negative or normal, the diagnosis code assigned is based on the clinical indications documented on the order by the patient’s treating provider. For a negative/normal study, when the dictated clinical indications do not provide sufficient information to assign a specific diagnosis code, the treating provider’s order may be reviewed. Accessing additional systems, like a PACS system to view images, should not be part of the coding workflow. If the order and dictated report do not support CPT or diagnosis code assignment, then you should query the radiologist for clarification not search the patient’s medical record for information. Are you searching multiple systems for coding documentation that should be in the report or order? Why? Are all the coders doing this or just you? Does the management team know? Rather than accessing multiple systems/records during the coding process, consider quantifying the type of information that is missing. Then utilize the information to provide feedback to radiologists and treating providers on the documentation improvement needed.
By eliminating all the clutter, we can be less stressed and more productive. Let’s give it a try!