by Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA
No one wants to make mistakes. We never want to find out later that we did something wrong. This is especially challenging when a coder feels there was no resource available for finding the answer when the question came up. They did their best under the circumstances.
A recent Libman Education article, “Internal Audits: Managing to Get the Most From the Process,” discussed how it is human nature to be defensive when you are told that you did something incorrectly. While we need to give people a chance to explain their decisions, there is more we can do.
We can also view the problem from the opposite direction. We can help develop a culture that encourages coders to look for answers as they need them. Some facilities have processes for this, such as weekly huddles where cases are discussed. Medical students have been learning this way for years, using the concept of Grand Rounds for interesting cases. Why not use Coding Grand Rounds to create a culture of learning within your team?
This starts with establishing a penalty-free zone where coders are able to ask questions without fear of reproach. The penalty-free zone is essential to ensuring that the questions that need to be asked are being asked. No one benefits if staff are fearful of letting others know where they struggle; everyone benefits if there is greater sharing of knowledge.
Some organizations do the entire process internally while others bring in outside resources. I work with facilities that have lead coders serving as the first line of assistance, with a manager being an even higher source of help. When there are still differing opinions or everyone is stumped, they then route the problematic case to me for my opinion. My instructional material on these cases then forms the basis for their monthly or quarterly Coding Grand Rounds education. All “solved cases” are kept in an organized, shared library so that coders can refer to these cases in the future.
In addition, coders would have a role in nominating cases for additional discussion and education. The coder’s notes about the difficulties the case presents are vital when the coding leadership determines which cases will be included in the Coding Grand Rounds and the process of identifying cases ensures the coder is thoughtful about what others might need to learn. Case nominations for Coding Grand Rounds can be made using a folder on a shared drive where a .pdf of the coding summary is placed along with brief notes on why the case is being nominated.
What makes a good Coding Grand Rounds case? It can be anything but there are several categories that I see over and over. Tricky root operation decisions and difficult-to-find body part assignments are great nominees for discussion. Any case that took three times longer than average to code would also be a good nominee.
Coding Grand Rounds is a great tool to help you create a learning culture where your coders seek out the information they need and then share it with their peers.
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