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ICD-10 QUICK TIPS: Encoders: Friend or Foe?

Posted by National Compliance and Quality Audit Team on Dec 7, 2015 9:38:00 AM

ICD-10_1.pngAs the largest outsource coding provider in the country we have identified trends and gained unique insights from our coders throughout the transition to ICD-10.  We are sharing these insights with the broader HIM Community through our bi-weekly blog series "ICD-10 Quick Tips." 

The subject matter for this series is currated based on the trending topics in our online question and answer system which services over 1,200 of our HIM professionals.  Our Subject Matter Experts have an average of 20 years of experience and are considered leaders in their field. 

This week's post comes from featured author, National Compliance Manager, Melissa McLeod-Seyfert, CDIP, CCDS, CCS, CPC, CPC-I and AHIMA Approved ICD-10 Trainer.

The right encoding tool can provide tremendous benefits when facing coding challenges.  However, it is important to remember that encoders are meant to be a guide in code-selection and sequencing; not the final decision-maker.  Although encoders may provide a sense of security in the new environment of ICD-10, coders must be willing to roll up their sleeves and establish a new relationship with the ICD-10 guidelines in addition to relying on coding technology.  So, this week we ask, should encoders be considered friend or foe?

A common scenario I often see during the auditing process is the incorrect coding of ‘smoker.  In ICD-9 we selected unspecified when selecting diagnosis without further specificity required.  However, if you follow the 3M Encoder path down the ‘smoker’ pathway, we are confronted with the following selections:

  • In remission
  • Uncomplicated
  • Withdrawal
  • Other nicotine induced disorder
  • Unspecified disorder
  • Other/Unspecified

Often the ‘Unspecified disorder’ option is selected in error, when the correct selection for a smoker with no associated nicotine induced disorders would be ‘Uncomplicated’ or ‘Other/Unspecified’.  The increased selection of coding options can lead a coder to make an incorrect selection because, by habit, we are used to selecting ‘Unspecified' and not ‘Other/Unspecified'.  This directs the encoder to assign a code for an ‘unspecified nicotine induced disorder’ which will not be accurate if no such disorder exists.

Another example of the pitfalls of encoders are two guidelines I often see reported incorrectly which pertain to the guidelines referring to place of occurrence and activity codes.  With the extensive expansion of ‘injury’ codes in ICD-10, coders are prompted to report all codes, and the place of Occurrence and activity while being injured are part of the 3M Encoder process.

Place of Occurrence Guideline

Do not use place of occurrence code Y92.9 if the place is not stated or is not applicable.

Activity Code

Do not assign Y93.9, Unspecified activity, if the activity is not stated.

If the place of occurrence and activity are not stated in the medical record, coding guidelines direct us to not assign the unspecified codes.  However, when following down the 3M encoder pathway, the selections for unspecified place of occurrence (Y92.9) and unspecified activity (Y93.9) are part of the coding pathway and these codes are assigned by the Encoder.  Coding Guidelines direct us not to report these codes but the Encoder does not apply guidelines, coders do…therefore, coding errors are being made with the dependence on Encoders.

A coder’s dependence on an Encoder is a double edged sword.  When used correctly, Encoders can enhance coding and productivity.  When over-used, a dependence on Encoders can also lead to repetitive errors and a decrease in coder skillset over a period of time.  Coders benefit more when they have a clear understanding of the coding guidelines versus depending on technology.  Not only does this boost confidence, it also helps to offset productivity challenges. 

At himagine, we understand the pitfalls of encoder-dependence.  This is why before coders can join our team they must first pass two levels of assessments.  The first is a written exam during which they are allowed to use their books, encoders and other resources.  The second is a verbal assessment during which ICD-10 guidelines are reviewed without reliance on encoders.  This process has been very successful in evaluating the coder’s skill and understanding of ICD-10.

By adopting a new focus of relearning the Coding Guidelines and their application, coders can help ensure their accuracy and hopefully reduce the impact ICD-10 can have on productivity. 

Topics: Education