Developing Outpatient Coding Education

Lynn Thornton, RHIA, CCS

HIM Education and Compliance Manager

education program for him coders


When developing education for HIM coders it is essential to look at the opportunity to including clinical, technical and regulatory guidance. This is an opportunity to truly have a global impact on a coder’s knowledge and competency. I also look to create expansive educational documents rather than the one off topics. The reason for this is I want to provide a broad basis of support for coders who are specializing in any one area. This is a common scenario in a large hospital setting due to the broad range of services and expansive scope of technical and clinical coding competency required.

Identifying Areas Of Education: When creating CPT/HCPCS guidance I identify the areas of education I will address. An excellent resource for identifying areas of education is to look at published audit results and also internal audit results. An area that is a frequent flyer on the internal audit log will most assuredly make it to my education list. National results that are not pertinent to the services and procedures provided in my facility will be excluded from my list. Another potential source of coding education is coder driven requests for education on any given topic.

Collecting Educational Resources: Now that I have my list developed it is time to start collecting my resources. For procedure education I expand my educational guidance far beyond the scope of the CPT Manual and CPT Assistant. I include all regulatory resources for my education guidance as applicable. This is an essential step as regulatory oversight has a significant impact on coding compliance and audit results. While it is true there are many more payers than Medicare, Medicare Advantage and Medicaid many payers follow their guidance. My ending list for procedure education is as follows:

* AMA CPT Manual

* AMA CPT Assistant

* CMS Claims Processing Manual

> Chapter 4: Part B Hospital (Including Inpatient Hospital Part B and OPPS)

> Chapter 12: Physician/Nonphysician Providers

> Chapter 13 :Radiology Services and Other Diagnostic Procedures

* CMS Medicare Physician Fee Schedule

* CMS Transmittals, Med Learn Matters and/or any other CMs Educational Document

* National Correct Coding Initiative’s (NCCI) General Correspondence Language And Section-Specific Examples (For NCCI Procedure To Procedure (PTP) Edits And Medically Unlikely Edits (MUE))

* National Coverage Determinations (NCD’s)

* NCCI Edit Tables for PTP, MUE and Add on Code Edits

* NCCI Policy Manual

Providing the instructional and coding guidance from the AMA in conjunction with regulatory guidance pertinent to selected codes assures complete coder education for procedures insofar as the technical and regulatory components.

I must also assure I touch on the clinical components surrounding the procedures and as anatomy is a source of weakness for many coders in procedure coding I rely heavily on images for this content.

Formatting Educational Products: It is essential to develop a set template for education. Consistency in format as well as structure the coders can count on will enhance the educational process. Educators have a wide leeway in their educational format and distracting clip art that is not pertinent to the topic being discussed, font that is difficult to read, line and paragraph spacing that is inconsistent distract from the final product.

Embedded Images and Hyperlinks: A wide variety of clinical and technical images can be a tremendous boost to coder understanding. The preferred images directly related to an educational topic and may include hyperlinks to selected topics.

Copyright Infringement and Educational Documents: Copyright infringements is frequently seen in posted education in the HIM Industry. Educators must be aware any document and/or image that has a copyright on the content itself may have restrictions requiring the creator be contacted and permission requested before reposting the content. And, while it is commonly thought public domain information may automatically be reproduced, this is not the case. The individual entities license must be researched to assure reproduction without restrictions is allowed. Such is the cases with the Centers for Disease Control. This is a public domain entity and there are individual contributors with case abstracts and other data that may not be reproduced due to copyright restriction.

References: No educational product may be considered complete without the provision of an official source of coding guidance provided. This should be a mandatory component of all educational feedback.

Final Thoughts: Providing education in this format allows for greater coder growth and competency in multiple areas. And, creating this type of education also keeps the educator competent in these same areas.


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