Donna: Sue, do you know what the UHDDS definition is for a significant procedure?
Sue: Of course! I hate to admit it but I was actually involved with coding issues in 1986 when the UHDDS revision occurred. The UHDDS definition of a significant procedure is a procedure that is one, surgical in nature, two, carries a procedural risk, three, carries an anesthesia risk, or four, requires specialized training. Why do you ask?
Donna: Well because some hospitals are assigning ICD-9 procedure codes for every procedure performed during an inpatient stay. This will definitely impact coding productivity!
Sue: Can you give me an example?
Donna: I was talking to an HIM department that assigns ICD-9 procedure codes for the transfusion of blood products – you know, platelets, plasma, packed cells, etc. I explained to them that with ICD-10-PCS they are going to have to identify if the transfusion was administered through a peripheral or central vein, or a peripheral or central artery and whether the approach was open or percutaneous as well as indicating the specific blood product. That is definitely labor-intensive for the coding professional – looking through transfusion records trying to discern the type of vessel, the approach, etc.
Sue: I agree, Donna – what a nightmare! So, what is the solution?
Donna: Coding departments need to take a critical look at the procedures they are coding today under ICD-9 and determine if they really meet the definition of a significant procedure, if there is truly an institutional need for the information, etc. They also need to take a close look at the diagnoses they code and report. The HIM department should determine if reporting things like family history of disease is really necessary in the inpatient setting.
Sue: I see what you mean as productivity impact of ICD-10 on coding is a big deal.
Donna: When discussing this concept with one hospital, the coders stated that these types of codes were on their “gray” list.
Sue: What is a “gray” list?
Donna: To the amazement of the HIM Director, the coders explained that this was a list of codes that they could use if they wanted.
Sue: It would seem that the hospital should take a look at this list and make it official rather than leave it up to the decision of individual coders.
Donna: Exactly! Hospitals should review the process for coding outpatient claims as some hospitals report that they assign both CPT codes and ICD-9 procedure codes on outpatient claims. They need to determine why they are assigning both code sets and if that is really necessary.
Sue: Anything that hospitals can do now to streamline their coding policies and procedures as well as setting the standard for what codes need to be assigned might have a positive impact on coding productivity come October 1, 2014.
Donna: Oh Sue, one more thing! Hospitals should also review their current workflow stream to try and eek out more efficiency. When I talk with hospitals about their revenue cycle, they inevitably say that their denials process doesn’t work well. Now is the time to evaluate any process that is not working.
Sue: Well, gotta run – February is a short month and I need to get working on all of these to-do’s you just brought up!
Donna Smith is a Project Manager with the Consulting Services business of 3M Health Information Systems.
Sue Belley is a Project Manager with the Consulting Services business of 3M Health Information Systems.