DRG Coding Advisor: New coding system saves small facility time, money
Rural hospitals gain by technology, too
Odessa (WA) Memorial Healthcare Center is a small 55-bed facility. Despite its size, the facility uses high technology to help it provide the best care in an efficient manner. That even goes for the coders who work in billing, says Judy Iverson, medical records associate for the hospital.
"In the past, I needed to spend an average of 20 to 30 minutes looking through two different books to find the right DRG codes," she says. "Now I simply type in the general category of the diagnosis, such as fracture, and the program provides me with the short list of all the possible DRGs."
Iverson picks out the primary diagnosis, uses the same approach for any secondary diagnosis, and even has the option of choosing complications and comorbidities from the program. Finally, the program prints out an attestation ready for signature by the doctor. "The entire process takes only minutes, saving me several hours every day that I can spend on other important tasks."
The hospital long had known the benefits of good computer systems. It had been using Hospital Information Systems software from Sterling Systems in Downey, ID, for billing, accounts receivable, accounts payable, and general ledger. Iverson says the menu-driven software package is easy even for the beginning user, or can be command-driven by more experienced users. All functions are completely integrated. On the other hand, coding until very recently had been a tedious manual process.
"It’s not an easy task finding the right code in an ICD-9 reference manual, even for an experienced coder," Iverson explains. "The first problem is deciding the best keyword to go to the index with. Very often, the index directs you to the wrong page or merely to another index entry.
"The less common diagnoses, especially, can really take quite a bit of time to track down. While I have enough experience that I can nearly always find the code, this presents a major problem whenever someone new is assigned to the task. For the first months, this job can be an exercise in frustration, and productivity is inevitably at very low levels."
Management knew there was a problem and had considered purchasing a computerized program in the past but always ran into the same two problems. The first was the cost of the software, which could easily run to several thousand dollars per month. The second was that some of the software packages that the hospital evaluated were so complicated that they almost made using the reference books look easy, according to Iverson.
Among the companies the hospital had looked at in the past were CodeMaster, AMA CodeManager, and Cascade Health Information Software. "They just weren’t cost-effective for small hospitals," she says.
When Iverson heard from a friend in another rural hospital about Clinical Coding Expert, a program from IRP Systems in Billerica, MA, she decided to check it out. "The software only costs less than $500 per month, putting it more within our price range," she says. The company sent the facility a demonstration to try out, and Iverson found it very easy to use.
At the same time, the other software company the hospital uses, Sterling Systems, decided to select Clinical Coding Expert to develop an interface to make it possible to move the codes selected with the system into their billing software.
"It wasn’t a very hard sell to management then to purchase the system," Iverson says.
Streamlining the coding process
Iverson says she has saved 50% of her time through the new coding system. She opens the IRP software and types in the basic patient information, such as name, age, sex, discharge status, and admission and discharge dates. The program automatically fills in fields such as the Centers for Medicare and Medicaid Services hospital identification and provider number.
The F2 button opens up the diagnostic area of the program. "I type in the general category of the patient’s diagnosis, such as pneumonia," she explains. "As you start typing, the program moves to the first selection that matches the letters you have entered so far. Often you can get to the right category by typing just a few letters."
The program instantly selects all of the codes that have anything to do with the phrase entered and presents them in a list. Almost every time, Iverson says, the proper diagnosis is on the list, and all she has to do is highlight it. She notes that it is rare that she has to enter category a second time, usually due to an obscure term entered the first time.
If the coder needs a fourth or fifth digit, the program provides various options. For instance, if Iverson types in the word "fracture," the program will list all diagnoses that involve fractures. A secondary term usually shoots her to the right spot. But if not, she merely has to choose from a list rather than try to figure out how to spell words such as acetabulam.
"Once I have selected the primary diagnosis, I enter another category for the secondary diagnosis. This process works exactly the same as selecting the primary diagnosis," Iverson explains. The secondary diagnosis for the fracture might be osteoporosis. "I only have to put in three or four letters before the program gets me to the right choice. This is much, much easier than trying to figure out under which term the diagnosis is indexed in the reference manual. Once I’m satisfied that I have all the right codes, I just hit F2 again and the program inserts them all into the form."
The most common complications and comorbidities for a particular primary and secondary diagnosis are provided on the screen — something Iverson says is much simpler than trying to identify them from scratch in a reference manual. The list usually contains around 30 items, arranged in order of frequency. "It’s usually just a matter of picking the right ones," she says.
Another stroke of the F2 key, and Iverson is back to the summary screen. The program calculates the estimated reimbursement based on the weight of the DRGs and the patient length of stay. The information is entered into the records, and Iverson can print out an attestation form for the physician. No more typing of forms or making copies for the charts. "It also provides an audit trail of exactly how the codes were determined in case anyone asks."
Iverson can spend more time working on transcription, credentialing, utilization reviews, and billing. She also says coding is more accurate now. "The choices provided by the program — particularly the complications — make it much harder to overlook something," she says.
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