by Barry Libman, MS, RHIA, CDIP, CCS
The ICD-10-CM and ICD-10-PCS code changes for FY 2021 are now in effect and the CPT changes for 2021 are on the horizon. There are new codes and guidelines to apply and implications to be understood and explored.
Rather than a solitary activity, mastering the code updates may best be seen as a team activity. Many people, in many different roles, need to understand what is changing and how the changes affect the organization.
The individual coder who works each day with the coding systems needs to know what changed or will be changing and be able to accurately and efficiently apply the new codes and guidelines. They have the most hands-on relationship with the coding systems and require a very granular and specific understanding of the changes.
The coding team as a whole needs to have a shared understanding of the changes and a consistent approach to application. Enlisting the power of the team can ensure that everyone’s questions are answered, that concerns are raised, and that coding decisions have a cogent rational. While this may have been easier when teams could meet on site, technology to facilitate communication and sharing of information will help ensure everyone is on the same page.
The coding educators and team leads, anyone responsible for internal training, needs to focus on the specific coding challenges for their specific team, for their specific organization. What have they struggled with in the past? What are the implications of the coding changes for their particular organization? What is the best way to share information and ensure consistent application across the organization? A few hours spent now can forestall many hours spent later with audit findings and challenges.
The clinical documentation team needs to understand how this year’s changes might affect the documentation required to support the new codes. But before the CDI team can communicate the impact on documentation to the providers, they need to be brought onto the same plane of understanding as the coders. Coders with their detailed knowledge of the coding systems can work with the CDI team members to identify challenges/opportunities for improving the completeness and accuracy of documentation. Shared understanding will help to ensure that CDI efforts are both productive and efficient.
Who else within your organization works with the code set? What do they need to know? As your team approaches this year’s updates, encourage them to think broadly and anticipate how the code changes may affect other individuals and functions within the organization.
Preparing your organization for the code changes takes a team. Whether large or small, your team’s efforts will help to ensure that your organization can continue to thrive.
CPT® Code Updates for FY 2021. Now Available! Master the CPT code changes, what they mean and how to apply them. CPT® Code Updates offers detailed explanations of complex coding concepts. Ensure your coding is up-to-date, accurate, complete, and defensible. Authored by Gail I. Smith! Learn more here.