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Odessa Memorial Healthcare Center in Odessa, WA, is a small, 55-bed facility. But despite its size, it thinks that technology can 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 co-morbidities from the program. Finally, it 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 knew the benefits of good computer programs. It had used 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, Iverson says. "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 we looked at were so complicated that they almost made using the reference books look easy."
Among the companies the hospital had looked at in the past are AMA CodeManager, CodeMaster, 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 Billeriea, MA, she decided to check it out. "The software only cost less than $500 per month, putting it more within our price range," she says. The company sent us 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 for raising the potential of moving the codes selected with the system into our billing software.
"It wasn’t a very hard sell to management then, to purchase the system."
Iverson says she has saved 50% of her time through the new coding system. She opens the IRP software, types in the basic patient information, such as name, age, sex, discharge statues, and admission and discharge dates. The program automatically fills in fields such as the Centers for Medicare and Medicaid Services (CMS) hospital identification and provider number.
Iverson hits the F2 button that opens up the diagnostic area of the program. "I type in the general category of the patient’s diagnosis, such as failure or 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 whatsoever to do with the phrase that I entered and presents them to me in a list. Almost every time, the proper diagnosis is there on the list and I just have to highlight it." She notes that it is rare that she has to enter category a second time, "and that was usually because I picked a pretty obscure term the first time around."
If the coder needs a fourth or fifth digit, the program provides various options. For instance, if Iverson types in 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 like "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." 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 co-morbidities 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 is usually around 30, arranged in order of frequency. "It’s usually just a matter of picking the right ones." She adds that the list is a valuable check "because there are times when the examining physician forgets to include a complication or co-morbidity, even though it is clearly present based on reading the chart. In that case, I go back to the physician and ask whether they might have missed something. This helps to select a more precise diagnosis as substantiated by the medical record."
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 input 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, doing utilization reviews and billing. She also thinks that the coding is more accurate now. "The choices provided by the program — particularly the complications — make it much harder to overlook something."
[For more information, contact:
• Judy Iverson, Medical Records Associate, Odessa Memorial Healthcare Center, P.O. Box 368, 502 E. Amende Drive, Odessa, WA 99159-0368. Telephone: (509) 982-2611.]