COVID-19: The HIM Professional’s Role in Ensuring Data Quality

by Gail I. Smith, MA, RHIA, CCS-P

As our country faces the COVID-19 pandemic, coding professionals have an important role to play capturing critical health data.

Guidelines from the National Center for Health Statistics and CMS provide strict instruction to ensure consistent data collection. Coders take this responsibility seriously and both internal and external auditors review the coding to ensure it accurately reflects the patient’s record and that the coding is compliant with guidelines. This accuracy and completeness of data collection is essential to public health efforts to combat illness.

From the perspective of data collection for an illness we are just starting to understand, we have been here before.

In July 1985 I was working at a Cincinnati Hospital when a 25-year-old male was admitted with a ten-day history of fever and a temperature that peaked at 105°. In addition, the patient suffered from cough, sore throat, headache and blurred vision. Treatment included rehydration and antibiotics. Four days later the patient was discharged with the final diagnosis of fever of undetermined origin. The principal diagnosis was a symptom code for fever. It was later discovered that the 25-year old male had AIDS. Subsequent readmissions allowed us to properly capture the AIDS diagnosis with an ICD-9-CM code.

In a sense AIDS and COVID-19 are similar: they both emerged suddenly into our national consciousness and both demonstrate the vital importance of consistent, reliable health data to make public health decisions.

While the AIDS epidemic had its share of political implications, I recall no controversy about data collection methods or application of principal diagnosis. Back in the 1980s and today, coding professionals’ contribution to healthcare included following guidelines for proper reporting.

As HIM professionals, this is our life work. It is important work, vital to our nation’s efforts to combat illness and promote public health. I want coding professionals to know we applaud their efforts.

 

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About the Author

Gail Smith, MA, RHIA, CCS-P
Gail Smith, president of Gail I. Smith Consulting, is a nationally recognized coding educator. For most of her career Gail was an associate professor and director of the health information management (HIM) program at the University of Cincinnati and HIM program director at Cincinnati State Technical and Community College. Gail is a currently a consultant with a software company specializing in medical terminologies. Gail has authored several textbooks, including Basic Procedural Terminology and HCPCS Coding published by the American Health Information Management Association (AHIMA).   An advocate for advanced coder training, Gail is the author of several titles for Libman Education including CPT: Introduction to Procedural Coding and two courses on the unique challenge of CPT coding in the pediatric setting: CPT for Pediatrics and CPT for Pediatrics: Advanced Orthopedic Coding. According to Gail: “One cannot possibly teach every coding scenario a coder will experience in their career. That is why coding education needs to focus instead on how to arrive at an accurate and defensible code assignment. It is the difference between learning to fish, and being given a fish. If you learn to code instead of being given answers to memorize, you will be able to arrive at the complete codes more quickly and with greater confidence.”

6 thoughts on “COVID-19: The HIM Professional’s Role in Ensuring Data Quality

  1. Mary Dolan RN - May 6, 2020 at 3:22 pm

    I think there is little doubt that CMS will be focusing a new string of claim audits for any Medicare claim with a COVID-19 diagnosis and especially those claims coded with Sepsis as the principal diagnosis with COVID-19 as the secondary diagnosis. Accountability for the additional 20% payment on claims for COVID-19 will be strict as it should be. I predict large sums of money will be collected by 3rd party reviewers. Commercial payers will quickly follow suit

  2. Lisa Lorenzi - May 6, 2020 at 3:25 pm

    Hi Gail,
    Did you eve work at Cleveland Clinic during the 90’s

    • Gail Smith - May 7, 2020 at 5:53 pm

      Lisa, I lived my entire life in Cincinnati…but I think you may be thinking of Gale McNeal, she worked at Cleveland Clinic in the 90’s.

  3. Bracha Malka CCS - May 6, 2020 at 4:28 pm

    Hello Gail,

    I understand that from a hospital standpoint there may be overreporting of covid-19 because there is a financial incentive
    how do coders deal with this wrinkle?

  4. mildred g bethea - May 6, 2020 at 4:55 pm

    Hello, I have many years of experience within the healthcare environment primarily in a clerical administrative role. I have my AAs in Health Info Tech as well as my RHIT cert. I am a HCC coder for a company and believe I’m looking to do something a little different that my background can help me step into. I really can’t say that at nearly 60 I want to go back to school per se, but would consider another certification. But now with Covid 19 are there other ares opening that I may be unaware of but could be an asset within?

    • Gail Smith - May 7, 2020 at 5:55 pm

      Mildred,

      These are uncertain times, I would check the local/national job postings to see the trends. Many outpatient coders have transitioned to inpatient to fill the gap during the surge of inpatient admissions.