Work The Process

By CodingStrategies on May 12th, 2017

University of Alabama football coach Nick Saban is well-known to coaches and players for his “process.”  It is the edge, according to Coach Saban, that has led to multiple BCS championships.  The process is simply breaking down a difficult situation into manageable pieces, and then repeat that process.  Work the process.  Repeating the steps in a consistent manner leads to consistent results.

During this college football season, coders can take a lesson from Saban’s playbook and think about how we “work the process” of abstracting sufficient clinical information to assign a diagnosis code within the ICD10 code set.  Just because the code set has been in play for a year doesn’t mean anyone has really mastered the process.

Diagnosis coding is difficult. But diagnosis coding follows an established process that if followed will result in success every time.  Success defined as applying a code to the documentation available - improving the documentation is clearly another “process.”

Whether coding an office visit, surgical procedure, or imaging study, step one is always the same. Identify why the patient is presenting for care? Step two – determine what the provider’s assessment was at the end of the encounter? Comparing these two pieces of information is crucial to distinguishing between reportable conditions, incidental findings, and signs/symptoms that are inherent in the final diagnosis code assigned.

The pressure coders feel to clear their coding queues is similar to the pressure athletes feel when preparing to face an opponent with a daunting reputation. Ignore the volumes, ignore the number of minutes left in a game – just work the process. Open the index and identify the key words.   Follow the directions (see, see also) and identify any non-essential modifiers or default codes that may be relevant.  Take the ‘suggestion’ of the index and dive into the tabular section to confirm any exclusions or “code first” / “code also” instructions.

Players who take short cuts in their conditioning workouts or during a specific play because “that” situation was different, or they just “knew” what to do generally end up in Saban’s line of fire because unfortunately shortcuts do not offer consistent results.

Assigning an unspecified code to avoid looking up the specific laterality documented is a coder’s shortcut.   Assigning the signs and symptoms because that code is finally memorized instead of taking the extra time to find the specific fracture of the specific bone is a coder’s shortcut.  Even if edema, or pain, or trauma are documented and defensibly and would support the assigned code, is that a ‘win’? 

It takes a player years to instinctively read the field or just know what play to run.  Coders need to remember that this is our rookie year with the new code set.  We will make mistakes, we will miss a pass or two, but if we work the process we can build a solid foundation for the years ahead in our careers.  The diagnosis codes we assign are used for so much more than paying a single claim.  Work the process.