Facility guidelines promote data consistency.
As we begin the spring season, it is a good time to update or develop new facility-specific coding guidelines. The hardest step in developing such guidelines is collecting the information necessary to write them.
There was an article in the Journal of the American Health Information Management Association (AHIMA) on Jan. 14, 2020, which discussed the process of developing facility-specific coding guidelines. In full transparency, I co-wrote that article with Angela Rickard, CCS, of Allegheny Health Network.
The writing of these guidelines has become my passion. Written coding guidelines promote data consistency, as well as ensure that the data collected has a purpose. My fear is that without written guidelines, each coder is trained differently, and valuable information may be lost or not collected.
The Talk-Ten-Tuesdays Listeners Survey on April 13, 2021 showed that the majority (51 percent) of respondents had written facility-specific coding guidelines. Making up the remaining responses were 5 percent who had verbal guidelines, 9 percent who had guidelines in process, 11 percent who did not have documented guidelines, and 24 percent for whom the topic was not applicable.
The American Hospital Association (AHA) Coding Clinic and the Official Coding and Reporting Guidelines support the development of facility-specific coding guidelines. Please note that your facility guidelines cannot conflict with the Official Coding and Reporting Guidelines.
In preparation for writing your coding guidelines, understand the data reporting needs. Here are some questions to consider:
- Does your facility have an approved cancer program? If so, you may want to capture personal and family history of cancer to assist in statistical reporting.
- Does your state have a state data commission? If so, there may be some specific data elements requirements such as external cause codes. Your state may mandate which external cause codes to use (how the injury occurred, place of occurrence, activity at the time of injury, and employment status). The state may require CPT® reporting on inpatients.
- Do you know which payors are reimbursing on MS-DRGs? APR-DRGs? HCCs? Alternative Payment Models? Other reimbursement models? The reported codes may impact the received reimbursement.
The article from the Journal of AHIMA references a spreadsheet that can assist in the development of facility coding guidelines. This tool can be opened when clicking on “Excel Tool” in the body of the article; it is a workbook that contains several tabs, beginning with Instructions. This tool also has a tab that provides one coding manager’s experience with developing facility-specific coding guidelines. Access the tab titled “Coding Rules” to begin a review of areas to be addressed when writing coding guidelines. The topics in the spreadsheet include:
- Documentation Used for Coding
- Family History
- Past Medical History
- Smoking Status
- Long-Term Drug Use
- External Cause Codes
- Conflicts with PSI, HACs, etc. Data Collection
- Procedure Status
- Discharge Status
- Abstracting Information
During Talk Ten Tuesdays, in the coming weeks, we will be reviewing these categories and weighing the importance of data collection. The hardest part of this journey is taking the first step. After the journey is completed, you will be confident that your coders are collecting data consistently. I hope that you will listen in as we work through the Developing Facility Coding Guidelines Tool.
Programming Note: Listen to Laurie Johnson’s Coding Report every Tuesday on Talk Ten Tuesdays, 10 a.m. Eastern.