By Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA
A reader asked “Do you need to be a coder to be a coding auditor, and if so, what is the best path to take to achieve the goal of becoming an auditor?” My earlier article focused on whether one needs to be a coder to be a coding auditor. This article will deal with the second part of the reader’s question.
What is the best path to take to achieve the goal of becoming a coding auditor?
I am a proponent of coders advancing in their career to a coding auditor role. My first recommendation is to gain coding experience, ideally in all types of records. Understanding what it takes to accurately code inpatient, swing-bed, observation, rehabilitation, and all types of outpatient records provides an individual with in-depth knowledge of the different coding rules that apply and the clinical indications and treatment regimens for common outpatient and inpatient conditions.
Seek specialty certifications for additional education on certain record types, such as the Certified Risk Adjustment Coder (CRC) for Hierarchical Condition Categories (HCCs) or Certified Interventional Radiology/Cardiology Coder (CIRCC). There also are programs and professional associations available to prepare you for your auditing role. Advanced educational programs will provide you with a deeper understanding of these specialty areas and enhance your expertise.
Once the coding experience is gained, understand the routes you took to code cases. Where did you glean the information? Was it in the H&P, consultation notes, test reports such as radiology or pathology reports, medication orders, nursing notes, etc.? What role did the coding guidelines and rules play in whether a symptom versus a diagnosis was coded or whether a single code versus multiple codes were assigned? When coding procedures, what was needed to accurately apply the most specific PCS code or CPT code and modifier?
Being an effective auditor requires people skills as well as analytical. Study how consultants provided you feedback and recognize the Golden Rule, that is, communicate errors to others the same way you’d like to receive feedback about your errors. A great way to provide an opportunity for prospective auditors to practice providing feedback is “second look” activities among peers. These might include looking at inpatient cases that do not have a CC or MCC or can simply be a selection of 1-2 cases coded by each coder. Second looks can also be used for outpatient coding to validate the CPT code, the assignment of modifiers, as well as diagnosis accuracy. The benefit for the peer reviewer is learning how to give accurate but kind instructional feedback; for the peer recipient it is the opportunity to experience supportive and helpful feedback to improve the quality of their coding.
Once becoming an auditor, the obligation to keep up with coding changes and medical science does not diminish: auditors must continuously learn. Investigating new procedures and determining how to accurately code them; understanding new treatment regimens, medications, and technologies and how these affect or are used for certain conditions; and keeping abreast of new codes, coding guidelines, and coding rules are a must for the coding auditor. Auditors need to be prepared to address these state-of-the-art situations and help educate those coders being audited. If you are seeking to become an auditor, be prepared to seek continuous education, often secured on one’s own time.
In my experience, the best coding auditors started out as coders. We need skilled auditors as well as skilled coders and I encourage you to consider this as a career option. I welcome any additional suggestions on pathways to becoming a coding auditor from the readers.
Auditing Skills for HIM Professionals
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