Providing expert coding advice in helpline

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

Република СрбијаМИНИСТАРСТВО ЗДРАВЉА

Linda Best

14.00 - 14.45 Thursday, 8th December 2011

Providing expert coding advice in helpline

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

Република СрбијаМИНИСТАРСТВО ЗДРАВЉА

Coding query mechanism

• Two-way process

– Avenue to resolve coding problems

– Provide feedback on problem areas

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

Република СрбијаМИНИСТАРСТВО ЗДРАВЉА

What is a coding query?

• Answer to problem areas in coding:– New condition – no code– New procedure – no code– Limited medical science knowledge– Incomplete understanding of classification

system– ‘Alone’ coder

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

Република СрбијаМИНИСТАРСТВО ЗДРАВЉА

Coding advice

• Crucial to the coding process

• Helps maintain accurate and consistent data

• Reduces variations in decisions

• Provides support to coders

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

Република СрбијаМИНИСТАРСТВО ЗДРАВЉА

Who provides the answers?

• Sound knowledge of:– Medical science– Medical terminology– Coding and classification system– Coding conventions– Coding standards/guidelines

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

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Query process

• Written NOT verbal

– Allows for consistent responses– Storage of responses– No misunderstanding– No misinterpretations– Does not allow for dissemination

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

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Query process (cont)

• Set guidelines

• Document the process– Submission of query– Response to query

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

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Steps in query process

1. Coder responsibility

– Review the classification– Reference texts, web– Seek advice locally– Send off for advice

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

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Steps in query process (cont)

2. Submission of the query– Email– Fax– Web submission

3.Query form– Detailed information

• Enquirer• Query

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

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Example

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

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Example - Electronic

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

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Steps in query process (cont)

4. Reviewing the query

– Review the classification– Check the query database– Check other classifications– Reference texts, websites– Seek clinician advice

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

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Steps in query process (cont)

4. Reviewing the query (cont)

– Seek international advice– Circulate & discuss– Prepare a response– Publish the query– Submit feedback to the authors

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

Република СрбијаМИНИСТАРСТВО ЗДРАВЉА

Query database

• Storage

• Easy reference

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

Република СрбијаМИНИСТАРСТВО ЗДРАВЉА

Example

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

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Publishing Q&As

• Up-dates coder workforce

• Consistent solutions to problems

• Coder education

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

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Publishing Q&As

• Methods

– Coding magazines

– Websites

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

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Example - Ireland

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

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Example - Australia

The 10-AM Commandments

Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011

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Example - Australia