Sunday, April 1, 2012

The 21st Century Inpatient Coder - By Debra O’Halloran, RHIT



Hi all -
I’ve been asked to contribute some thoughts on Inpatient coding.  While the number of policy changes and guideline re-writes over the last thirty years rivals that of “burgers served”, there has always been one constant……QUALITY.  With a nod to that constant I’d like to focus on the single area I feel has had the most significant impact on the Inpatient coding professional….knowledge.
Let’s take a ‘memory lane’ look at the Inpatient coder.  In the early days coders functioned more in the role of a translator.  We were skilled in medical terminology and had a basic understanding of that ‘thigh bone connected to the knee bone’ thing.  Using those skills, the information in the patient record, diagnoses and procedures, were quite literally ‘translated’ into corresponding ICD-8-CM and later ICD-9-CM codes.  The physician’s word was final and the thought of asking for clarification; well let’s just say those encounters were few and far between. 
Things went alone in this manner for a number of years.  Everyone got paid and life was good.  Then someone invited our Uncle Sam to the party.  Hang on to your hats folks, we’re about to find out what’s behind the green door!
Fast forward, it’s nineteen eighty-two, can you say DRG?  Knew you could.  I believe this single government issued health care payment policy change caused the transformation of what was a coder then, into the HIM coding professional we know today.  This one single change moved the focus and thus the skill set and knowledge base of the Inpatient coder from objective to subjective. 
Subjective!  Lucy……you got some splaining to do.  Let’s think about that word…..subjective.  “A topic or issue described or depicted in an artistic work…..to cause to undergo some experience or action…..to make liable; expose.”  A pretty powerful word indeed!
The focus, skill set and knowledge base of today’s trained, quality oriented Inpatient coding professional often equals that of a nurse practitioner.  We interpret lab data, read EKG’s, screen and evaluate physician documentation and clinical indicators.  We understand drugs and dosage therapies.  We are fluent in medical terminology and can interrupt and process signs and symptoms.  We have a solid command of the anatomy and physiology of the human body.  We converse with various medical staff members, provide education and clarification to quality control committees.  We review and write appeals for various audits and payment rejections, and provide support to facility contract services and informatics. 
Inpatient coding professions are in high demand today, and the wider and deeper your fund of knowledge the higher the quality of your coding.  AHIMA will set a bar for you.  Medicare will set a bar for you and your employer will set a bar for you as well.  These should all pale in comparison to the bar YOU set for yourself my friends!!  Never stop learning and never lose sight of the prize.
Knowledge equals quality and quality assures a successful and rewarding career you’ll look back on with a smile on your face and joy in your heart.  For me the last 27 years have been a fabulous, exciting, hair pulling - crazy making experience and I wouldn’t have missed it for the world!
Debra -

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