July 11, 2017 | | Comments 0
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Symposium Speaker Highlight: McCall demystifies outpatient coding

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Shannon McCall, RHIA, CCS, CCS-P, CPC-I, CCDS

Editor’s note: As we did with the 10th annual ACDIS conference in May, we’ll take some time leading up to the ACDIS Symposium: Outpatient CDI to chat with a few of the speakers. The event takes place September 18-19 at the Hilton Oak Brook Resort & Conference Center in Oak Brook, Illinois. Today, we talked with Shannon McCall, RHIA, CCS, CCS-P, CPC-I, CCDS, the director of coding and HIM at HCPro in Middleton, Massachusetts. She manages the instructors of the Certified Coder Boot Camps and has extensive experience with coding for both physician and hospital services. She will be presenting “The Ins and Outs: Inpatient and Outpatient Coding” on Day 1 of the Symposium.

Q: There are so many differences between inpatient and outpatient coding! What would you say is the most difficult one(s) for those moving from the inpatient CDI world to wrap their minds around? (e.g., that words like probable, likely, suspected don’t count toward a diagnosis, that outpatient facilities not only use ICD-10 but also CP[SM] T, the different code sets each have their own set of guidelines and rules governing use?)

A: Documentation for outpatient encounters is much briefer than documentation for an inpatient admission so the application of the guidelines of only assigning codes for relevant diagnoses is important. Providers typically lack the documentation in their notes to clearly identify chronic conditions being clinically relevant in their decision making process. Since risk adjustment is based on diagnosis coding, the differences in procedure coding has no bearing. 

Q: That said, what are some of the areas where coding rules overlap? Basic specificity?

A: The conventions and chapter specific sections of the Official Guidelines (Sections I-11) are the same for both inpatient and outpatient coding. The sequencing rules, however, are not really applicable to risk adjustment. There some fundamental differences regarding coding uncertain diagnosis in an outpatient setting addressed in Section IV as well as guidance on coding for ancillary services such as diagnostic testing utilizing laboratory, pathology, and radiology services that differ from inpatient coding guidelines.

Q: What do you think is the biggest benefit of this progression of CDI into the outpatient arena?

A: Many of the same diagnoses that CDI specialists currently query about for clarification are the same ones that can affect risk adjustment, therefore they can serve dual purposes without any additional work.

Q: When/how did you first learn about clinical documentation improvement (back 10 years ago when ACDIS first started? Before that back when you were working as a coder?)

A: CDI specialists started attending my inpatient Boot Camp 10 years ago prior to us starting the CDI Boot Camps. It was interesting to me that this role was created, but it was a natural addition because, for years the coding staff struggled at times with the clinical aspects of posing queries since most were non-clinicians. Having the liaison between the clinical and coding staff made the coding process more efficient.

Q: Aside from getting in a round of golf if possible, what are you looking forward to most about the upcoming Symposium?

A: I’m not a golfer, but I always look forward to seeing the friendly faces of the ACDIS members. Seeing them potentially twice in a year (if they attended the national convention in Vegas as well) just makes me smile!

 

 

Entry Information

Filed Under: ACDISBoot CampCDI ProfessionClinical Documentation ImprovementConferenceGrowing your programOutpatient

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Linnea Archibald About the Author: Linnea Archibald is the CDI editor for the Association of Clinical Documentation Improvement Specialists (ACDIS). In this role, she helps out with the website, blog, social media, newsletter, and the CDI Journal. If you have any questions, feel free to email her.

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