Coding Quality Points to Ponder

C. Matheson, RHIA, CCS Medical Coding Leave a Comment

Nothing is more dangerous than an incorrect code. Whether in ICD-9, ICD-10 or CPT, your organization’s coding practices must be ethical, complete, accurate and compliant. So how are you measuring coding quality today? Which of the following best practices do you use?

Lynn Salois, RHIT, CCS, CDIPDirector of Coding Lynn Salois, RHIT, CCS, CDIP Director of Coding

  • Perform periodic internal coding quality audits.
  • Review all new hire records until coding accuracy standard is achieved.
  • Include focused and random audit samples.
  • Validate items through the auditing process.
  • Classify variances.
  • Identify root causes for coding errors.
  • Conduct education to address coding errors.
  • Capture, analyze and report results.

Keep in Mind

Coding compliance plans should be designed to reduce the potential for fraud and abuse and ensure the integrity of coded data.  The above best practices should be addressed within the framework of your overall coding compliance plan.

Best practice standard includes performing an internal coding quality audits on a quarterly basis and reviewing all new hire records until they achieve 95% coding accuracy standard.  In addition, an annual external coding quality audit is advised to ensure audit objectivity.

There is a degree of subjectivity in coding. Develop a standardized method of classifying errors and scoring the variances across your coding team.  Some coding errors are considered more serious than others and may weigh differently in the accuracy score.  For example, a critical variance would be inaccurate sequencing of the principal diagnosis, whereas a non-critical variance may be omission of a past medical history code.

Finally, develop a quarterly coding performance scorecard to outline the coding teams’ overall performance. Be sure to allow for identification of problem spots and improvement opportunities.

Maintaining a coding audit program reduces your risk for fraud and abuse while ensuring the highest integrity of coded data. It’s your greatest asset in improving your coding program.

What are your thoughts?

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