Q&A: Creating an internal coding audit program

Q: I am the coding manager for our inpatient coding department. I am wondering if I should create an audit plan to monitor new coders or difficult diagnosis. If so, is there anything specific I should consider when trying to implement a plan?

A: Yes. An internal coding audit program is the monitoring effort that ties together all coding management functions. Managers must select topics that will allow them to develop an exemplary coding program. They should consider all available topics but select only those that are applicable to their setting and that will improve the team’s performance.

You should consider whether any of your coders are new to the profession or team. You could monitor their performance to determine whether it is at an appropriate level. Coding quality is gauged in the 95%–96% range.

You must also determine whether your newer coders are meeting this level of proficiency. Conducting an audit of their current work can answer that question and lend insight regarding necessary corrective measures. Remember that corrective measures are not intended to mean punitive actions but rather corrective actions, which may include focused education, additional reference materials, or closer monitoring.

External or internal audits that have identified weaknesses and claim denials attributable to coding may signal other areas to monitor. Capturing denial reasons attributable to coding serves to identify ideal topics for in-services. Managers can use the findings to implement education programs that can help reduce denials. Reducing coding denials is something tangible to demonstrate the value of your team members to upper management.

You also may consider auditing confusing conditions such as sepsis and septicemia or documentation-driven services such as infusions, for which the combination of inadequate documentation of start and stop times and improper coding yields incorrect results.

Editor’s Note: This Q&A is adapted from the Practical Guide to Coding Management by Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA. Dunn is the chief operating officer of First Class Solutions, Inc., a health information management consulting firm based in St. Louis.

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