The following article is drawn from our recent roundtable discussion on the Impact of COVID-19 on the Coding Function. To view the complete roundtable discussion, see The Impact of COVID-19 on the Coding Function: A Roundtable Discussion.
MODERATOR: Coding guidance continues to evolve as the medical community and CMS have worked to get a handle on COVID-19 and how it is treated. How have you ensured that your CDI and coding staff remain up-to-date with these changes?
“We are always expanding our knowledge. Along with continual learning comes the need for ongoing monitoring and assessments to ensure appropriate application of coding guidelines.”
AUGUSTE: At our organization, COVID-19 cases are discussed daily. It’s important that we have the most up-to-date coding guidance and follow that guidance at the time of claim submission.
TAKEI: I agree. We are always expanding our knowledge. Along with continual learning comes the need for ongoing monitoring and assessments to ensure appropriate application of coding guidelines. This includes Official Coding Guidelines for new COVID-19 diagnoses that took effect April 1, 2020 as well as interim coding guidelines for COVID-19 cases prior to April 1, and regularly updated Coding Clinics.
HARMON: We monitor our coders, and my CDI team works closely with providers and coders to ensure clear documentation and accurate coding.
RUSHBROOKE: I think the biggest challenge has been the lack of clear guidance for COVID coding. This is understandable given how quickly this hit us. However, in light of dealing with cost-sharing regulations related to the CARES Act, getting it right was paramount.
MODERATOR: How important is coder training during COVID-19, and how have you advocated for this training?
“If anything, it has been easier to advocate for training during the pandemic. Normally, the cost of training is primarily the cost of downtime. The cost of downtime for 100 coders to train for two hours is significant. During the pandemic, this wasn’t an issue because volumes were so low anyway.”
TAKEI: Training has been paramount. We spend about an hour every other week on educational opportunities. We also meet with our CDI staff once a month for an hour. During COVID-19, we’ve had a lot of impromptu training on how to code COVID-19 cases. We’ve also provided education on how to code spinal fusions, electrophysiology reviews, pacemakers, and automated implantable cardioverter defibrillators. In addition, we took part in Libman Education’s training on ICD-10-PCS root operations followed by an internal roundtable discussion. Finally, we provide two-day training sessions on a quarterly basis. This year, we held the quarterly education remotely.
HARMON: My organization has continued to support an hour of education every week. During slow times, I expanded that to two hours. During downtime, I want to make sure my team is able to improve or expand their knowledge.
PELLETIER: Training has been very important, and luckily for us, our organization has supported it. If anything, it has been easier to advocate for training during the pandemic. Normally, the cost of training is primarily the cost of downtime. The cost of downtime for 100 coders to train for two hours is significant. During the pandemic, this wasn’t an issue because volumes were so low anyway.
At our organization, we provided a lot of training during COVID-19. For example, all of our telephone and video visits go to a specific work queue, and we trained hospital-based coders and provider-based coders on what to look for documentation wise and make sure the appropriate CPT code went out on the claim. In addition, we knew we had to apply the CS modifier for cost sharing during COVID. We developed some guidelines with our EHR so that claims with certain diagnoses (e.g., cough or fever) that resulted in a COVID test to be ordered went into a work queue. We trained coders to look at those claims to determine whether the CS modifier was applicable. Finally, we provided immersion training for our apprentice coders so they could learn different types of surgical coding and inpatient coding more quickly.
Barbara Auguste, CPC, CPMA, Director of Professional Fee and Outpatient Coding Services at Maimonides Medical Center in Brooklyn, New York
Rebecca Harmon, MPM, RHIA, CCA, HIM Director and Educator in Pennsylvania
Wendy Pelletier, RHIA, CCS, CPC, Director of Coding at Maine Medical Center in Portland, Maine
Christopher Rushbrooke, MHA, RHIT, CCS, Associate Director of Coding and CDI at Mass General Brigham in Boston, Massachusetts
Cheryl Takei, MHA, RHIA, CDIP, CCS, HIM professional in southern California
Lisa A. Eramo, MA, moderator and freelance writer
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