Guest Post: Communication eases challenges of fiscal year 2018 code changes

by Crystal Stalter, CDIP, CCS-P, CPC

It’s that time of year again—time to wonder just how the 2018 IPPS final rule will affect CDI and coding efforts.

The 2018 IPPS final rule includes more than 800 ICD-10-PCS changes. Previously recognized operating room codes have become non-operating room codes, affecting DRG assignment, changing surgical DRGs to medical DRGs, and thus affecting reimbursement. Some diagnoses are gaining new definitions and explanations that will result in new ICD-10-CM code assignments and shift DRGs as well.

Coders usually have first access to information about the code changes, with a number of organizations releasing early copies of ICD-10-CM/PCS books. This information should also be passed to CDI specialists, who need to understand the importance of capturing diagnoses and procedures correctly and must comprehend why a procedure that has fallen under one DRG for so long is now assigned to another.

Who is responsible for keeping all parties in the know when it comes to coding changes and DRG impact?

As we approach October 1, the burden of staying abreast of new code changes falls to both the CDI and coding departments. The C-suite of any hospital or organization relies on its revenue cycle team to make sure the dollars arrive, and the revenue cycle team depends on the coders to include the appropriate codes on claim submissions; the coders in turn rely on the CDI specialists to capture all current diagnostic processes happening with the patient.

Luckily, in today’s world of EHRs, electronic billing and coding systems, and software designed to do the heavy lifting throughout the patient encounter, it is much easier to maintain this balance.

Every hospital has its way of handing interdepartmental communication. Some even go as far as to educate the physicians (a great practice) on the upcoming code changes by doing “commercial” spots on their on-campus TV systems. I have also seen HIM, coding, and CDI departments work together to host lunch-and-learns where information is presented in a game show-type event, or even holding educational sessions for 30 minutes before or after work to get the information out to all concerned parties. In turn, this education aids in fostering interdepartmental communication.

Armed with new information early, daily routines can be more efficient, resulting in more time to spend on tougher cases and harder-to-code encounters. Staying abreast of code changes and guidelines is every bit as important as correctly filing the claim. Cooperation by all departments is paramount, and a team effort is the most effective way to ensure success.

Editor’s note: Stalter is the CDI manager for M*Modal in Pittsburgh. She has more than 30 years of experience in the healthcare industry, with most of her focus on coding, compliance, and physician documentation. Contact her at crystal.stalter@mmodal.com. Advice given is general. Opinions expressed are that of the author and do not represent HCPro or ACDIS. This article is an excerpt from content previously published in JustCoding.