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Concurrent Coding – Exploring the Concept

In today’s healthcare industry, the standard, simple coding process is a thing of the past. Coding patient records has become quite complex; it is imperative that coding professionals not only work to capture the correct DRG (diagnosis-related group) assignment, but also accurate illness severity and mortality risk, as these factors directly impact organizations’ quality-based initiatives. Further, trends in patient diagnostic data directly inform clinical pathway development.

Due to the multifaceted nature of the coding process, organizations around the country are moving toward – or at least entertaining the use of – concurrent coding. The movement to concurrent coding is an effort to capture the severity of the patient condition as well as to streamline the final coding process, ensuring timely claims payment and reimbursement.

Concurrent coding is the process of real time patient data record review. The process often involves collaboration between the clinical documentation specialist (CDS) and the coding professional to assist in data capture while the patient is in-house. The process of concurrent coding will vary depending on whether the organization operates an Electronic Medical Record (EMR), a paper-based record, or a hybrid record.

Each organization will need to consider the most efficient approach to their individual workflow. The partnership between the CDS and the coding professional is the main link in optimal data capture. The coding professional’s knowledge regarding Official Coding Guidelines and Coding Clinic, paired with the clinical knowledge of the CDS, enables the concurrent coding process to achieve its maximum potential.

There can be many benefits realized from a successful concurrent coding process. The listing below indicates some of the key improvement areas:

  • Quicker turnaround of final coded records: Usually the concurrent coding process assigns a coder to follow a patient from admission to discharge. The record is reviewed and coded over a determined period of time (e.g., every 2 or 3 days), adding information into the coding system and analyzing documentation for gaps along the way. When the patient is discharged, a great deal of the coding process has already been completed and the coding professional is familiar with the record, decreasing the amount of time for final coding. Additionally, if a query is necessary, the coding professional can work directly with the CDS to institute clarification while the patient is being treated, thus lessening wait time for a retrospective query to be answered.
  • Enhanced case management: Concurrent coding provides data for the hospital EMR that allows case management to proactively follow up on treatment plans, gaps and social deficiencies that patients may experience, rather than waiting to address challenges upon discharge.
  • Length of stay concerns related to DRG: Concurrent review of a patient record will allow evaluation of extended length of stay concerns for patients in certain DRG categories. This can greatly benefit patient care and effective facility resources management. Such an approach will also emphasize focus on outliers in the data related to patient conditions, as these may have a negative impact on reimbursement.
  • Disease management: With concurrent data entry, facilities will be able to trend infections or diseases of concern in real time rather than retrospectively identifying issues. This will allow proactive clinical management and, in turn, should improve facility quality scores.
  • Medical necessity management: Reduction in medical necessity denials will be evident as the concurrent process allows for real time analysis of patient treatment. The CDS and coding professional can ensure appropriate documentation is present for justification in the patient record.

As with any change in a program, the move to concurrent coding highlights challenges for organizations. The CDI staff and coding staff must build a productive relationship as their collaboration is paramount to building a successful program. Likewise, physician buy-in is also a strong factor in success. Often, programs have to revise their original plans until they find a process that works well for them. Concurrent coding is not a “one size fits all” process. Rather, it is customized to the individual facility, its staff and their needs.

At UASI, we have seen success in the area of concurrent coding. The seasoned coding staff we have onboard acclimate well to concurrent record review. Also, their interaction with CDI staff is enhanced by their clinical knowledge base. This assists in query writing and identifying gaps in documentation. Our team’s experience also lends itself to educating medical professionals treating the patient and helping them understand the necessity of clear, concise and complete documentation in the patient record.

Concurrent coding has been shown to benefit data capture and identify trends and gaps in documentation that need to be addressed. Additionally, a strong program can facilitate improvement in turnaround time related to final discharge coding, resulting in faster claims payment and improved cash flow. When the decision is made, commitment is required to move into the concurrent coding arena. But with proper planning and forethought, the benefits can be worth the effort.

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