Journal excerpt: Coding Clinic’s process

Coding Clinic’s value comes in part from code inquiries being freely available to everyone. Anyone can send a question or comment to Coding Clinic by simply registering on their website; you don’t have to be a member of the AHA. Of course, there is a process to submit questions, and a lot happens behind the scenes between Coding Clinic receiving a question and providing an answer.

“In my facility, a manager or CDI specialist contacts me with a coding or documentation dilemma,” says Kay Piper, RHIA, CDIP, CCS, inpatient coding educator at SSM Health System in St. Louis, Missouri. “Then I create a document with the medical record excerpts that shows the related information. You must provide clinical documentation. Coding Clinic answers are based on actual documentation, not theoretical scenarios.”

According to Sharme Brodie, RN, CCDS, CRC, CDI education specialist at ACDIS/HCPro in Middleton, Massachusetts, the process is much more labor intensive than it once was. In the past, all someone submitting to Coding Clinic had to do was write their question and explain the details of what they were asking.

“Let’s say I want to write in and ask: With influenza and pneumonia, which is sequenced first when the patient also has emphysema? I used to be able to write in that the patient has COPD [chronic obstructive pulmonary disease], influenza A, and pneumonia, then ask how I sequence,” she says. “Now, you have to send Coding Clinic all the clinical information from the medical record related to the scenario—whitewashed, of course.”

According to Piper, sometimes a question will be rejected because a specific city is mentioned in the documentation or a hospital acronym is used that may identify the facility, so it is important to carefully edit your document before submitting. Once Piper has the document set up with the medical record excerpts and the question, she goes to the Coding Clinic website to begin her submission.

“You only have so many characters available to write your questions, so generally I’ll write a straight-to-the-point shortened version there, and on my document that I’m submitting, I’ll write the longer questions or scenario,” she says. “In total, I submit the shortened question [and] attach the file that has our medical record excerpt and the expanded question.”

After submitting your question, Coding Clinic provides a reference number. Keep this handy for tracking purposes. If you submit questions to Coding Clinic regularly, Piper recommends keeping a log of your submissions. You can include a synopsis of the question asked, relevant clinical information, the date submitted, the reference number, and the date an answer was received (if applicable) as well as what the answer was.

Once your question is submitted, you could get an answer in anywhere from a couple of weeks to more than a year, depending on several factors. All questions that come to Coding Clinic are logged, so when a new question is received, someone first checks to see if the question has been asked before, and if so, what the answer was. If it has been asked before, a consultant will write the answer and then pass it along to all other Coding Clinic consultants to make sure they agree. Once an answer is agreed upon, you will receive an email back with the answer to your question.

If, however, the question has not been asked before, one consultant will research it and come up with an answer. From there, the answer will be passed around to fellow consultants, and if all are in agreement, an email will be sent to the requestor. However, some questions require that more steps are taken. This is where a lengthier response time is more expected.

Coding consultants refer more involved questions to the Editorial Advisor Board (EAB) for a decision. The board is made up of three hospital representatives, several physician representatives, and members from the four Cooperating Parties, who all weigh in, Piper explains. “Answers to these questions may take up to a year or more to receive,” she says. “When I was on the EAB in 2016-2017 the board met quarterly, except for the fall meeting which is just one day due to preparations for the upcoming annual code updates in October. This explains why it can take so long. The two-day board meetings provide limited time for discussion of especially complex questions. Board members are given the questions in advance so members have time to research, then come to the meetings prepared to discuss answer options. The EAB may also reach out to professional medical organizations and subject matter experts for opinions on these particularly complex questions.”

Coding Clinic staff, however, may escalate a question to the EAB based on how many people write in on the same topic. “For instance, many people inquire about the correct code for viral sepsis,” Piper says. “Some thought it should be coded to viral illness, others, to sepsis. This was definitely a hot topic needing a prompt decision because it impacted payment as well as sepsis quality initiatives and mortality statistics. These larger, escalated items are most likely to be published in Coding Clinic. In contrast, a one-off question, such as a specialized procedure that is not performed by most entities, will answer privately to the requestor when there is not broad application to health care entities in general.”

Editor’s note: Read this full CDI Journal article here.