January 18, 2010

Hidden Treasure
By Judy Sturgeon, CCS
For The Record
Vol. 22 No. 1 P. 8

It should be difficult to find an inpatient diagnosis-related group (DRG) coder who is unfamiliar with the American Hospital Association’s (AHA) Central Office on ICD-9-CM and its quarterly publication, Coding Clinic. Yet I’ve run across too many outpatient coders who have no clue as to its existence, much less its scope of service. These folks provide valuable information for the entire profession: inpatient and outpatient coders, facility and professional coders, as well as all those in ancillary businesses. The AHA Central Offices for ICD-9-CM and HCPCS have to rank among the most critical national resources, not just for the coding profession but for the entire medical industry.

Let’s start with the most popular and recognized endeavor: Coding Clinic. Those who live and die by the code are likely to eagerly await each new edition. Sometimes it clarifies an ambiguity in a sequencing or documentation rule, while other times it provides guidance on how to correctly use new codes. And while the original publication was for ICD-9, the AHA also provides advice on level I and some level II HCPCS codes in its sister publication Coding Clinic for HCPCS.

Unimpressive to the general public, perhaps. Inconsequential to surgeons and nurses, you might think. But consider for a moment the financial impact that a single code assignment clarification can have on a facility. Approving or disallowing codes in certain circumstances can impact a hospital DRG by tens of thousands of dollars. Multiply that by all of the DRGs for all of the patients in the United States and imagine the impact. Anything that can affect hospital budgets across the country must be correspondingly significant to everyone in the industry.

For many years, I assumed publishers of Coding Clinic were just that: the people who publish Coding Clinic. But the AHA Central Office dates back to 1963 when it was established as a cooperative effort between the AHA and the National Center for Health Statistics. In addition to being one of the four cooperating parties that create official ICD-9 rules and guidance, the AHA Central Office is also responsible for several other national functions, including the following:

• It serves as a national clearinghouse on ICD-9-CM issues.

• It recommends changes to the International Classification of Diseases.

• It develops and presents educational materials and programs for ICD-9-CM.

• It promotes uniformity of healthcare data.

• It participates in endeavors that use and interpret that data.

• It develops standards to ensure correct reporting of that information.

One may presume the council to be a group of coding gurus who vegetate in the Chicago offices trying to read doctors’ handwriting while balancing old rules and codes against new technology and applications. And when they need a break, they walk to another office and work on answering the jillions (that’s right, jillions) of questions faxed in from coders all over the country. While they certainly qualify as gurus and they do all of the above, they are also extraordinarily active and vital in endeavors and professional support.

When a coding question is received, it could merit a quick response with reference to a published coding rule. However, it also might be a new issue that could have significant medical or financial impact. If that is the case, extensive research must be conducted among support groups to determine whether new and modified codes or rules are necessary.

These types of decisions are made neither lightly nor in a vacuum. ICD-9-CM’s editorial advisory board includes the big four (the AHA, the AHIMA, the National Center for Health Statistics, and the Centers for Medicare & Medicaid Services [CMS]), as well as industry heavy hitters such as the American Medical Association, the American College of Physicians/the American Society of Internal Medicine, the American College of Surgeons, and the American Academy of Pediatrics. Their corresponding support group, the HCPCS Editorial Advisory Board, represents critical stakeholders in the healthcare community, including the AHIMA, the CMS, state and national hospital associations, and coding, billing, clinical, and financial experts.

Even with that impressive collection of running mates, the central office will call in any national medical organization for assistance. Such was the case recently when it was decided to move the diagnosis code for seizure disorder from the symptom chapter to a modified code description in the epilepsy category. Extensive research, deliberation, consideration, and caution were undertaken prior to making this decision. Because of the final determination, many admissions lost an increase in their DRG payments—the original diagnosis code was one that could improve reimbursement, while the new assignment is rarely of financial impact. Patients who had never previously been categorized as having epilepsy were no longer reported as simply experiencing seizures. Data reporting was skewed immediately and significantly, albeit more correctly, for this type of diagnosis. While this was not by any means a popular decision, the result was nevertheless a deliberate and medically correct one.

Nelly Leon-Chisen, RHIA, the AHA’s director of coding and classification and executive editor for both Coding Clinics, often escapes the offices along with her associates to join the lecture circuit, where they speak not only on coding topics but also on DRGs, data reporting, and quality issues. Leon-Chisen also handles the annual revision of Faye Brown’s ICD-9-CM Coding Handbook, the ICD-9 coder’s essential training source.

The central office doesn’t limit its participation to the national level. For example, the Texas Hospital Association has received an impressive degree of support from our coding heroes. During mediation efforts between members and payers that validate codes by utilization review criteria, one of the AHA’s senior coding consultants served as an expert resource to explain correct and appropriate coding guidelines. Benji Oden, RHIA, CCS, CCS-P, provided answers to questions and concerns from both sides of the table and was of extraordinary assistance in resolving several bones of contention between the two groups.

The most recent AHIMA national convention featured a bevy of AHA Central Office coding experts who explained new codes and clarified older problems for attendees. Their expertise, dedication, and value to our profession cannot be overstated (although I’m certainly willing to try).

The respect they have earned from hospital executives and health data-reporting experts has in turn helped garner greater respect for coders and the services they provide to facilities and employers. As we begin a new year, let’s remember to recognize the AHA Central Office’s continuing contribution to our profession and give them a round of applause. Please visit the Web site at www.ahacentraloffice.org to learn more about the vital, unending services provided by these unsung professionals.

— Judy Sturgeon, CCS, is the clinical coding/reimbursement compliance manager at Harris County Hospital District in Houston and a contributing editor at For The Record. While her initial education was in medical technology, she has been in hospital coding and compliance for 21 years.