Researching as a Core Skill for Optimal Coding

Effective research leads to correct coding.

With the 2021 ICD-10 code updates already in use and the CPT® and HCPCS updates right around the corner, this is a prime time to talk about researching as a core skill for optimal coding.

Why are research skills important?

Years ago, I worked with learners who were just becoming acquainted with the coding process. One of the realities of coding that I emphasized with them is that there is so much information in the world of medicine that every coding professional, even seasoned coders, will come across, creating situations in which they may not know how to correctly or completely code a diagnosis or procedure. In those situations, what sets a good coder apart from others is that they know how to research and find the appropriate information upon which to base a decision about what code or codes to assign.

Effective research leading to correct coding has two key downstream benefits:

• Correct and complete coding leads to better-quality data: data that has an impact on future healthcare decisions. At an individual patient level, this data will influence how much they pay for an episode of care, and how they stack up when being considered for future healthcare benefits. This data also has broader implications for clinical medicine via influencing medical best practices and protocols.

• When codes are assigned accurately, the provider is reimbursed correctly, which serves as a protection against takebacks or penalties resulting from outside audits; optimally, this means the provider receiving reimbursement commensurate with the level of work provided. Thus, being able to perform appropriate searches to find solutions to coding questions puts a coder in a position to have a positive impact on the revenue cycle, and to be a financial asset to any provider.

Where can I find information?

Honing research skills begins right in a coder’s own backyard, as a large part of the direction needed to assign correct codes is found in the ICD-10 and CPT coding guidelines and conventions. It’s not necessary to memorize all the guidelines, but at a minimum, a coding professional should know what clinical or coding situations have corresponding guidelines, and where to find the information within the classification, when needed.

In addition to the coding guidelines and conventions, research leading to optimal coding takes place within the official sources of coding advice: the American Hospital Association (AHA) Coding Clinic and CPT Assistant.

The primary objectives of these sources include:

• Providing answers to frequently asked questions;
• Review of annual coding updates; and
• Providing coding advice and clarification on topics such as:
  • How guidelines are to be applied to specific diagnosis or procedure code assignments
  • Appropriate ICD-10-CM/PCS and CPT code assignment for specific clinical scenarios

Most importantly, applying the direction found in Coding Clinic and CPT Assistant helps ensure that code reporting for the same clinical circumstances is consistent across providers.

Coding professionals should keep pace with the changes and updates recommended in these publications and should refer to them often when direction pertinent to the coding situation at hand is not readily available in the coding guidelines.

In addition to the primary sources already mentioned, coders can find useful instruction by searching websites and publications of reliable professional, payor, clinical, and provider outlets, such as the American Health Information Management Association (AHIMA), AAPC, AHA, Centers for Medicare & Medicaid Services (CMS), Centers for Disease Control and Prevention (CDC), Journal of the American Medical Association (JAMA), and professional medical societies.

I’m too busy to spend time on research.

Unfortunately, I believe that the reality today is that too often, the pressure of keeping up with productivity quotas keeps coders from being able to really take the time to get in and fully explore and absorb the details needed to understand the pathophysiology underlying a diagnosis, or the intricacies of a procedure for which they are coding. Often, they end up just assigning what they estimate is the right code, and then cross their fingers and hope they don’t get audited.

However, if and when this is the case, I would put forward the idea that it would be worth it for coding professionals to consider spending some of their own time to perform the research required to come to an appropriate coding solution – because, after all, it is their names that appear alongside the final code assignments.

Programming Note: Listen to Cari Greenwood today as she co-hosts with Chuck Buck on Talk Ten Tuesdays, 10 a.m. EST.