With the approaching conversion from the ICD-9-CM classification system to the much more granular (most specific)  ICD-10-CM/PCS systems, there has been much talk about additional coder education to accommodate the level of necessary detail.

AACCA:  WHY NOT USE CERTIFIED RN-CODERS & RN-AUDITORS?

Many educational programs covering anatomy and physiology are being offered to beef up the skill set of the existing coding workforce. There has been much discussion and plenty of chatter on websites such as LinkedIn debating the need for such major training efforts. It made me think about the difference between what is being coded now by the staff now doing the coding, and what things might look like two years from now.

What does it take to be a healthcare coder now?

AACCA:  WHY NOT USE CERTIFIED RN-CODERS & RN-AUDITORS?

Any coding professional requires clinical knowledge. Hands-on clinical experience is an immense help!  The coder must be able to read the medical record and decipher what has been documented.  WHO BETTER THAN A NURSE? Through this analysis, a coder determines what diagnoses and procedures meet the requirements for coding. So along with possessing clinical knowledge, the coder must be a detective and have a curious mind.

A coding professional must apply the clinical facts they discern from review of documentation to the coding rules that apply to the medical setting. Since ICD-9-CM has been in place since 1979, an experienced coder knows all the rules and their many nuances. Although coding guidelines are updated on an annual basis, changes usually center on specific problematic areas (for instance sepsis or avian and novel H1N1 influenza virus), so even an experienced coder still must be able to stay current with the rules. A coder therefore also must be a list-maker, keeping track of updated rules and the dates the updates became effective.

Above all, coding professionals must know the medical record. They must know who documents what and where it all is documented. This is no less true in the electronic environment than in the world of paper. I personally mourned the loss of the many different colors that once were used to differentiate between different documents in the medical records back when all things were being printed directly at the nursing station – a development that made every form white.

AACCA:  WHY NOT USE CERTIFIED RN-CODERS AND RN-AUDITORS?

proficient:

* clinical knowledge,

* coding rules (as applied to their specific setting) and

* the medical record itself.

If a nurse is working in a hospital setting, she or he already has had formal classes in medical terminology, disease process and anatomy and physiology, and coders apply this knowledge every day. No matter what type of facility, from a large teaching hospital to a small rural hospital, coders are familiar with the type of medicine that is practiced in their facilities. Nurses build on their foundation of formal anatomy and physiology on a day-to-day basis simply by reading and coding. Unless there is a change in

the services being provided, or if a new specialist joins the staff or new equipment is purchased, this nurses most likely already has the clinical knowledge they need to move to ICD-10-CM-PCS.

Nurses are already adept at reading a medical chart.  They understand the disease process related to the various medical and surgical procedures. And they are accustomed to clarifying the physician orders and/or reports.

It would be simple if the same set of rules applied to all care settings, but the rules are different for facility coding of professional, inpatient and outpatient services. A coder who works in all three always must be aware of setting, because at times the rules are not just different but conflicting. Coding rules also are changing for all coders across all settings.

As previously mentioned, a coder must be completely familiar with the medical record. If you are implementing any changes to your system it would be wise to have that process completed well before the October 2013 implementation of ICD-10-CM/PCS. The last thing a coder needs is to

be unsure about where they can find the information they need to identify what needs to be coded (in addition to mastering the new classification). If at all possible, the new record should be implemented long enough before October 2013 to allow users to work out all the bugs, and most importantly to become familiar with all new features and functions. This is also true if you

are implementing a computer-assisted coding (CAC) system to ease the coding burden.