Get the DRG and move on. For better or worse, and with rare exception, that was the primary directive governing inpatient coding behavior back when I was coding in the early 2000’s. This edict made sense in context of the limited reach of coded data at the turn of the millennium. The role of codes, at least as it relates to hospitals, centered mostly on payment determination. Sure, there were peripheral use cases for coded data like decision support, and yes, coded data was beginning to factor into both internal and external quality measures, but the stakes overall were relatively low. This created a natural bias towards productivity; therefore, coding quality was a secondary concern, if it was a concern at all. Codes for conditions like hypercholesterolemia, uncomplicated diabetes and countless others received little attention at the point of coding or upon coding quality review.
My how things have changed.
Fast forward to 2018 and practically every code carries with it some degree of importance. Whether it’s the traditional role in payment determination, the ever-expanding role in healthcare quality measurement and population health, or the emerging roles in risk adjustment, practically every code matters to some degree, and by the way, there are a lot of them. ICD-10 made it so. The reach of coded data has never been greater and there is little to suggest that this will change.
The idea that we can “get the DRG and move on” or even the idea that coding attention can be selectively allocated to a manageable number of codes is simply not viable in 2018. A practical approach to coding nowadays is simply assuming that every code matters or may matter soon; shifting our approach to coding and coding quality review accordingly; allocating the same amount of critical thought to all codes, even the seemingly unimportant ones. This, of course, is easier said than done, optimizing comprehensive coding accuracy and coding productivity, simultaneously, is a difficult balance to achieve.
So, where to begin?
A successful approach to comprehensive coding accuracy begins with instilling into coding personnel the idea that every code matters. Providing hard evidence of coding’s influence in non-traditional areas like risk adjustment, and reminding coders of coding’s influence in traditional payment determination is a great way to reduce or eliminate coding tunnel vision. Follow this step by expanding training and education efforts to address the areas of coding that have historically received little attention, diabetic complications, early stages of chronic kidney disease, lipid disorders, to name a few. Consider experiential training solutions that engage coders and provide quantitative feedback on performance. Finally, if you lack the time or resources to regularly evaluate comprehensive coding accuracy, partner with a capable vendor that understands the depth and breadth that you are looking for in a coding quality review.
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