Q&A: Leveraging coders to improve HCC accuracy

Q: We're looking for ways to bring our CDI and coding teams together to improve documenation and coding for appropriate Hierarchical Condition Categories (HCC) capture. Are there any recommended models and should other departments or individuals be working alongside them?

A: Fine-tuning coding and documentation to support accurate HCCs is a team effort. The coding department will need to partner up with CDI as well as the compliance and billing departments. This interdisciplinary team will be positioned to identify and address concerns and act quickly to implement education and policy updates. It may also be helpful to include a representative from the clinical team who will be able to provide insight from their perspective and serve as an advocate among their peers.

Along with a coding manager, the coding department should be represented by a coder, says Catrena Lewis, CCS, CCS-P, CPCO, CPC, CIC, CPC-I, CRC, CHTS-PW, audit and education manager at KIWI-TEK.. A coder will have more in-depth insight into specific issues by department or provider, as opposed to a manager’s higher-level view.

It may also be helpful to include departments such as radiology, risk, or case management that provide critical links in a patient’s journey, she adds. For example, a patient is evaluated for a leg injury at a clinic. The clinic physician sends the patient to radiology to rule out a fracture of the femur and documents this in the record. The patient does have a fracture of the femur, but although this is captured in the radiology report, the patient goes to a facility outside of the health system for treatment. The clinic didn’t follow up with the patient, so the final diagnosis doesn’t make it into their records.

For more information, see "Defining coders’ role in HCC accuracy" in the March issue of HIM Briefings.