Q&A: Organizing staff in a coding department

Q: We are revamping our coding department at our facility after acquiring new sites and wanted to know what types of positions and roles our staff should have. Do you have any advice?

A: Organizing the coding function depends on the type of coding that will be done and the volume of cases. In small organizations, one or two individuals may perform all of the coding, and one of those individuals may be the department director or manager. In larger organizations, the following positions are common:

• Coding manager: In addition to being able to step into any of the positions listed below, this position may clear state data reporting and scrubber edits relevant to the National Provider Identifier (NPI), ZIP codes, or other demographic edits. As a manager, the position selects and orients new staff, schedules their work, monitors the quality and quantity of work, and prepares performance evaluations. Skills required: ICD-10-CM, ICD-10-PCS, E/M, CPT.
• Coding specialist I: This position codes outpatient noninvasive tests, recurring laboratory and similar types of accounts, and/or diagnoses for clinic or physician practice encounters. Skills required: ICD-10-CM. This position may clear scrubber edits relevant to the cases it codes.
• Coding specialist II: This title entails coding physician practice encounters with E/M, CPT, and diagnoses and/or coding ambulatory surgery, emergency department, simple obstetrical cases, and observation. The coding specialist II also assists the coding specialist I, especially during end-of-the-month recurring coding time. This position may clear scrubber edits relevant to the cases it codes. Skills required: ICD-10-CM, ICD-10-PCS, CPT, E/M.
• Coding specialist III: This position codes complex inpatient and outpatient surgeries for the physician and the facility and all types of inpatient encounters (medical and surgical) and may assist the coding specialists I and II. This position may clear scrubber edits relevant to the cases it codes. Skills required: ICD-10-CM, ICD-10-PCS, CPT, E/M.
• Coding support technician: This position supports the coders by following up on outstanding reports, queries, and other documentation needed to complete the coding of encounters. The position is also responsible for coordinating with information technology (IT) on access permissions for new coders and external auditors. Skills required: Knowledge of the electronic health record (EHR), documents in a record, deficiency analysis, physician email system.

If the organization has a high volume of outpatient activity, an edit specialist may be part of the team to address all scrubber-related edits for the outpatient cases. The edit specialist will need to have knowledge of ICD-10-CM and CPT and understand local coverage determinations (LCD), national coverage determinations (NCD), and billing edits.

Editor’s Note: This answer is excerpted from The Contemporary Guide to Health Information Management.

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