In the last two decades of the 20th century, the coding profession has been elevated from one of individuals responsible for collecting statistical data to one of individuals responsible for the financial soundness of an institution. This eventually evolved to include individuals responsible for reimbursement compliance. Many coders who have lived through these decades describe themselves as "chameleons". They feel as though they needed to focus on coding for optimal reimbursement, clinical soundness, or legal compliance depending on which way the wind was blowing at any given time. Luckily, the compliance movement of the past few years has put coders in the position of focusing on "correct coding" for "correct reimbursement". Ideally, all facets affecting coding should be aligned at this point in every provider setting. Realistically, we know that is not entirely the case. The Coding Profession is still plagued by the following types of issues:
- Physician Documentation
- Cash flow
- Technology
- Coding is not a science
Physician documentation is an issue that continues to significantly affect a coder’s ability to do the job well. The most common complaints include incomplete documentation, illegible handwriting, or conflicting documentation. Some solutions that providers have tried to improve these issues include educating physicians on documentation requirements, hiring physician liaisons to communicate documentation issues to physician abusers, and taking away admitting privileges for incomplete records. None of these solutions has proven to be an absolute success. As time marches on, the likelihood of physician documentation improving significantly enough to have a positive effect on coding is very low. Therefore, if we are to improve coded data quality, we have two choices: increase the numbers of physician queries (to clarify physician documentation) or rely upon technology to act as a bridge between poor physician documentation and coded data. The first choice, physician queries, is acceptable in the short term only. This process increases the work load of both the coder and the physician and besides making the process inefficient is likely to result in both an irritable coder and physician where the coding process is concerned.
A second on-gong dilemma of coders is that their productivity and quality is constantly being challenged by the cash flow needs of their organization. Basically, coders are expected to "turn around" a record with codes needed for billing purposes within 3 days of the patient’s discharge from the provider site. Once this limit is exceeded, the financial results to the organization may be significant. The biggest hindrance to coders in meeting deadlines is that the patient record may be incomplete or they may be waiting for the response to a physician query. As a result, many organizations have adopted policies that allow the coder to code a patient record without complete documentation. This is particularly true in the case of inpatient records and the discharge summary. The problem with this is that it is contrary to compliance regulations and will often times result in coding and billing errors. So, the task of providing quality coding in a timely manner is a constant balancing act for most coders.
Technology is generally thought of as a positive, not a negative influence on the profession. There are however, several issues surrounding technology and coding that currently serve as a problem to many coders. Some of these include: interfaces with billing and other functions that may result in automatically altered coded data and the charge master process. While both of these practices make use of increased technology in coding and billing, they can also result in increased error rates. This is partially because of the process used and partially because of the fact that individuals with coding expertise were not used to develop the original systems. Some of these problems can be solved by involving coding professionals in building the coded data part of the organization’s charge master. Others can be solved through system edits or increased accuracy in technology. Eventually, this will have to be the case. Because eventually, technology will play an increased role in the coder’s job as it will with all knowledge workers. The idea is to get more out of the coder in terms of the depth of work. This does not necessarily mean a decrease in the numbers of coders, but rather an increase in the intensity of their work.
The fact that coding is not a science is not likely to change. Part of the reason for this is that coding is driven by medicine. And, medicine is both an art and a science. Therefore, the coder of today and of the future will need to adjust to the fact that certain ambiguities will exist in the system. This fact, in many ways, increases the knowledge that a coder needs to have to be able to logically apply coding rules and regulations in the face of ambiguity.
