CWTC [Episode 179] Amending a Medical Record, Plus Jobs for Coders and IGC Selection - Make Your Revenue Smarter
Welcome to Coffee with the Coder®, our conversation with Paula Digby and her team to address issues, observations and questions for Health Information Management professionals, physicians, auditors, payors and students. Listen in for twenty minutes or so every other Monday and send in your favorite questions or comments for Coffee with the Coder® To receive text notifications send an email to with your request. We will text you in the hour prior to the start of the next episode, which will be Monday, November 6th! For the “Insiders” and for the live audience, Paula Digby gave a rather extensive list of opportunities for jobs that utilize coding skills and knowledge. The contest will end before our next episode, so be sure to enter again and again and tell your colleagues to enter as well. Here’s how to enter (each point is another entry):
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Our dear friends (Anonymous) provide the questions for Episode 179. (Can you believe we’re almost 7 years old!) First, Anonymous IRF asks about IGC selection for a patient who did not have surgery, but did have a greater trochanter fracture. Finally, Anonymous Physician Office wondered whether the physician can amend the medical record later, as in after the patient has already left the practice or facility. The reference Ms Digby spoke about is: Congratulations Melissa for winning the “mugging” today!” Coffee with the Coder® LOVES your questions!! To watch episode 179, click on the smiling mugshot of an Donna. (Just so you know, the captions are not yet validated.) Connect for Episode 176 on September 11th beginning at 10 am Eastern. You’ll find us on Free Conference Call HD,  Linked In, YouTube, and on Facebook. #coffeewiththecoder For all of you Detail Junkies (like us) here’s the initial transcript for Episode 179: Good morning. Good morning. We’re so excited to welcome you. Hey, Susan. You’re dialing in or clicking in. Maybe that’s the better word, or the insider portion of Coffee with the Coder. Episode 1 79. Woo. Yes. I just amazed, you know, we’ve been in triple digits for a long time now, and, and what are we, six years old? Yes. We’re pushing almost to our seventh birthday. Oh my goodness. Wow. We’re growing up. Isn’t that amazing? Having a wonderful day today at Coffee with the Coder, and so excited to have you joining us. We do have anonymous questions, so tell your friends, get with us on a pre-conference call and get with us on social media, because I’ll be writing down the names of everyone I can tell. That’s there. You’ll be in the running for today’s mugging, and I’m gonna step out and let Paula tell you the wonderful stuff that’s going on on the insider topic. So, good morning and good morning. And hey, Susan, you’re not the only one here, but you were the first one. You’re the first name I saw this morning. I, maybe I should just start, we should start giving away prizes to the first who gets there. I mean, I think you, you were in way even before 10 o’clock, so good morning. Thank you for joining us, and thank you for everybody on Facebook, LinkedIn, YouTube. I am so excited because this is the time I get to see my people, right, my colleagues, my comrades. I get to enjoy time with some of you, and it’s just, it’s just a fun time. So welcome back, as Pam said for another episode of Coffee with a Coder. Let me look at that. She said episode 1 79. I was looking at the number. So we are growing up to almost seven years old. We’re six years old now, so almost pushing it a little bit further. So anyway, I’m so excited to have you here and so excited that you continue to join us and share us. And don’t forget the contest, guys, because the more you share about Coffee with the Coder, the more you get entries. But you do need to hashtag Coffee with the Coder so that we know to get to capture that for your entry. Now, this weekend I had a great time, really fun time. I spoke at the Macon chapter of a, a PC’s fall back in Love with coding event. Now, it was a lot of fun getting to meet new people and network with my new friends. My topic was the updates to ICD 10, right? And we all have to have to have that information. I think I’ve given that presentation now three different times. It, I always like to make my presentations fun. So that seems to be a little bit more dry that that conversation when you’re, when you’re doing the updates, but it’s relevant information that we have to know. So we’re usually, usually on the edge of our seats learning all the new stuff so that we know how to change our headsets, right? But during the break at when we were, when I was speaking, we had a little break, and during that break, the president of the chapter, who we’re gonna call Christina, well that’s because her name is Christina. Anyway, she and I were talking about some of the struggles that some of the members, some of her members specifically were having really in the field getting jobs or looking for other opportunities that they can use their skills before, before, you know, getting, maybe they’re new into the field, I guess I should say. Maybe they’re cpca or maybe they have not been in the field very long and they don’t have a lot of experience. Or maybe there were some folks who were credentialed and might have had several credentials and they were really looking for something new and didn’t understand really all the paths and all the different career choices you could make as a coder. So, and actually on the way out, I talked to several people who asked, you know, Hey, you know what other jobs are available with my coding knowledge? They didn’t really know where to look. So first of all, I wanna ask the audience, do we have any coding mentors on the call? Type in the chat if you are a coding mentor, because I have been a, a mentor with AHIMA for a number of years. I’m certified three, a PC and AHIMA, but I have been an AHIMA mentor for years, and I get comments and questions all the time about, Hey, you know, is coding a great field? Is co you know, can I get a job in coding? Can I do this? Can I do that? And so I love to have those conversations. And so I took the opportunity when we, when the president and I started talking about this, this particular discussion point, and I, before I started back into my presentation, I just said, Hey guys, don’t give up because this is a great field. I love coding. Hey, hey, type in the chat guys. If you love coding, I love coding and coders, and I know many of you on the line know if you do something in your day-to-day job other than coding with your coding knowledge, type that in the chat too, because that gives other people who are coming into the field or who are in the field and want to know more encouragement about what else they can do. So I wanted to answer this question in a little bit more detail for, for our audience. So like I said, if you’re new in the field or if you’ve been in the field, there’s really two different types of job searches and, and they’re really not the same. Number one is for the person who has experience in the field. And number two is the person who does not have any experience, but they have, have gained the knowledge through some type of coding, course coding certification through college level course courses. And so they’re just really looking for a break, right? So there’s two different ones. First, before you consider looking in any direction, my best advice to you is to learn how to network, okay? Get on social media, get on LinkedIn. If you’re not on LinkedIn, get on Facebook. Join the groups on LinkedIn and on Facebook, and if there’s any other social media platforms that, that you can connect on, join those groups of coders of clinical documentation improvement professionals of billers. Just join those groups. Sometimes you’ll get in a group and you’ll go, oh wow, this one is really all about advertising. Or, oh wow, this one is really, you know, it’s just really not where I wanna be. Get out of it. Get in another group to continue to network with the people in those groups. In addition to join your local chapters, AHIMA, A A P C H, D I, let’s see, there’s others, a CDI s Join those groups because you want to put yourself out there and you wanna continue to apply for those jobs. If whether you’re in a position or you’re not in a position, you wanna continue to apply, even if you’re not getting a response or even if you’re getting responses as no, oftentimes, oftentimes what I will tell you, it’s the relationships that get you the position. So like at go to events, make those relationships, join industry organizations, A A P C and ah, AHIMA of course, but also M G M A A H D I, like I said, a CDI s local chapters, even organizations like Rotary and Lions Club, which are service organizations will get you connected with others in your community. And I can’t tell you the number of times that I’ve made connections and, and gotten business out of, you know, somewhere outside of my h i m coding world or CDI world. Also, remember, if you’re new to the industry, you might just wanna take a position that’s going to get your foot in the door that will, you can expound on. And then when a coding position comes available or a position that you like comes available, you can apply for that position because oftentimes organizations promote from within. So now that I’ve given you that spiel, I want to kind of go over some of the, just brainstorming. I just took a few minutes and I brainstorm jobs that I see coders have, okay? And, and it’s quite a lift, actually. It’s probably not everything, but number one of course is coding. Whether you’re coding in a hospital, an ambulatory surgery center, a skilled nursing facility, a long-term care facility, a home health organization, an inpatient rehab facility, a physician office of anesthesia, chiropractic or integrated practices clinics, state clinics, ambulance services, behavioral health services, self-insured companies. I know years ago when I first became a coder, and this was quite a while, and I honestly, I didn’t go out there to see if they still hired coders, but you know, the, the railroad, Norfolk Southern, they were, they did a mass hire in metro Atlanta at the time for coders. And so coders and billers actually. So I think I was in a room with about 5,000 people to start with, and at the end, which I didn’t end up going forward, but I did end up in the last pick of 10 candidates, but then I didn’t get selected at that time. But it was a great experience. Also, working claims, not just for health insurance companies, but auto insurance, home insurance, any accidental type insurance companies, those are other places you could go with your coding knowledge. Now, these are some others that you might not think about. Medical device manufacturers or service companies that create, I guess they create tools for healthcare providers because they might need to have some consideration of coding, healthcare software companies, research and development with elect with electronic medical records or going, you know, applying for electronic medical record conversion teams. And Pam is coming back. So that must mean it’s, it’s time to start. So I’ve got some more for you, but I, I don’t wanna, I don’t wanna let this go because I was very encouraged, just my list. But anyway, go ahead, Pam. We can get started. Thank you. Thank you. We’re gonna get this started and I’ll come back and let you finish. Okay. Dancing at my desk to the music. Yeah, Me, me too, me too. Oh, and I’m reading all the comments, which is fabulous, that I love coding. Yes. And, and Gigi says, Hey, you gotta learn terminology. Yes. Especially if you’re new, that’s very, very important. Yes. And as a medical record technician, you have probably seen a lot about that. Yes. Yay. Susan said she was working in a billing and coding company. Now she’s part of a facility team that works, edits for claims that were kicked out before the claims drop. And when rejections come back from the payers, that’s very, very important. And also od So go ahead and tell us what else might need a quota. I, That was gonna be one of my recommendations. So I’m so excited that you said it, Susan, because, you know, sometimes it’s just like digging and investigating those claims. What happens in a, in a hospital particularly, and it’s not just acute care hospitals, it can be multiple different types of hospitals, is there’s this list of claims that got stuck and can’t get out the door for whatever reason. Coders don’t have time to typically to deal with it. So they oftentimes per put a person into that role or people into that role to work that list. And they have to go, they have to be, become very familiar with the claim edits and what, what diagnoses are covered for each procedure and that type of stuff. And the billing rules. And it is a great place to grab some knowledge. I know that you’ll agree with that, Susan. So it’s a great place. So medical billing, AR specialist denials, appeals management, collections educator auditor surgery scheduler in hospitals or physician offices and other positions that you might not think about that they’re really kind of more in an organization that is a facility like an acute hospital unit clerks and hospitals of all types. Charge entry payment posting, working with charge capture or the charge master medical records, technicians, release of information scanning, chart assembly. Of course, we don’t have as much chart assembly now because we’re, most of us are all electronic. However, even with the electronic, there is a need for validation of chart completion. So that’s another thing that your knowledge can get you. And what that does, this is my, my passion, my I love coding. My passion is auditing in order to learn where the processes are broken so we can help correct the processes. And that’s huge. So understanding not only where the codes come from, but understanding the whole revenue cycle in those processes is a huge deal. Reimbursement specialists, patient access, admissions, like I said, revenue cycle compliance, clinical documentation improvement, working those stuck, stuck claims, credentialing and contract management. Because then you understand when you’re work dealing with contract management, how things pay and then you understand the coding piece and, and so you can, it’s just a great place to marry that knowledge. Working credit balances or old claims. We started a business, when we started my company years ago, we were actually doing contractual non-compliance. So we were working with hospitals who had contracts with insurance companies. And the insurance companies typically, you know, they pay the claim. The person who is posting the money in the facility post that balance or post that payment. And then sometimes things get written off or things get left out there forever. Well, going back and looking at that contract of how the payer should have paid and then working that non-compliance when they don’t pay appropriately, that is huge. That gives you so much knowledge to do that. Of course, being a consultant, going after healthcare law firms or c p a firms that do have healthcare clients, governments. And that is not only the federal government, but your local government, your city government, your county, your state, they all have, you know, healthcare needs. And so there is a place that h i m or coding professionals or even clinical documentation and billing professionals can potentially find work. So don’t give up and go, oh, I’m not in a, a coder in a physician office or in a hospital, so there must be something wrong. I’m not getting a job. Open up, think out of the box. ’cause there’s so many different opportunities now, like I said, I’ve not mentioned them all. That was probably just a quick brainstorming, but also stay on top of the changes that are coming up. You know, think about AI in using, in as in the coding realm. And I don’t believe that it will replace our jobs. I believe that it will enhance our jobs, it will allow us to do our jobs more effectively. So look at what’s coming and see what those opportunities are and look for places that your skills can fill the gap and then apply. And once you also register, let’s see, register or subscribe to c m s, their email service and also the O I G and other industry related things and read, read everything. Because that’s gonna be good information to have when you’re having those conversations in an interview. You’ve stayed up with what is current and what is going on. And that makes you and your conversation more relevant. So I hope this has been encouraging and I, I love every one of you and I appreciate your interaction here because I know that we have some folks out there who are in the field who are discouraged, they can’t get in another position or they can’t get a position. And I believe that there is a lot of good places that we could, we could mentor you, we could help you. And that, that you could find a job doing what we do because it’s a great field. It really is. If you are, if you’d like to solve puzzles, it’s, it just excites you because you’re, you’re having, you’re really solving puzzles as you’re, as you’re coding, you’re, you’re reading through those records and you’re digging and you’re finding things. And when something is missing, you’re querying. So again, lots of opportunities there. So thank you guys. Yay. You can tell that Apollo’s pretty excited about coding. Yeah, yeah. I’m a geek. I’m a geek. I can’t help it. Oh, well, lemme throw you a couple of questions this morning. The first one I have is, well, they’re both from our dear friends who are called anonymous and we love questions whether they’re anonymous or not. And anyway, this first one is from the inpatient rehab. And our friend wants to know if the patient has a greater tro cantor fracture without surgery, what IGC does that go to? Okay, good question. ’cause we always think about that surgical event following the fracture, getting us into the hip fracture category, which is zero 8.11, when it’s a unilateral. So it’s actually kind of the same thought process here. And I went out and did some digging just to make sure, ’cause I, I felt like I was right, but I always wanna check myself and, and make sure I’m right, just really looking at what the definition is of a hip fracture and what parts of the tr canter would be included in the hip fracture or the, the femur, I should say the femur, not the, the whole trant in the femur. So that said, the greater trocanter fracture does fall also under zero 8.11. That’s where I would put it. If you’re in IRF and and you have a different idea, please let us know and, and let’s talk about that because I think through my research I kinda, I would go with a 8.110 8.11. Thank you. Thank you. Okay, so our other friend anonymous works in a physician office and says, can physicians amend the medical record after the patient has been seen and the original documentation completed or has been discharged from an inpatient setting? Oh, that’s a really good question. And I really think this, I, you know, I, I actually went out and grabbed some information on this one, but this might be a great topic for coffee with a coder to dig a little deeper. And if you would like us to dig a little deeper in this subject, comment and let us know, because I will definitely dig a little deeper for you. ’cause I thought, ooh, this is a really good question. So number one is for amending or addendums to medical records, you gotta know state law. And then you, the number, the number two thing I would do is go out and check those Medicare payer guidelines. So whoever your payer is in your state, they typically will have guidelines for how to amend a medical record and when it’s appropriate, how it’s not. So I went out and grabbed Meridian’s decision related to this, and I want to read to you how detailed it is because really, it, it makes sense, but I just want to make sure that you understand what is the underlying theme and to make sure that we’re not falsifying the record. So Noridian says, late entries, addendums and corrections to a medical record are legitimate occurrences in documentation of clinical services. A late entry or an addendum or a correction to the medical record bears the current date of that entry and is signed by the person making the addition or change. So you heard me say that, right? Even if the patient is discharged, even if the patient you know, has been out of the office a week and the provider is reviewing the records, the addendum or the addition in the record needs to be dated, timed, signed, the date the addendum occurs because c m s expects that your documentation is contemporaneous, which means at the time of service, however, we are not robots. We are not in a perfect world. And oftentimes care happens even after that encounter. And so there are going to be times where addendums or late entries are needed. So the Noridian document goes on to say a late entry supplies additional information that was omitted from the original entry. The late entry bears, the current date is added as soon as possible, is written only if the person documenting has total recall of the omitted information and signs the late entry. And then they give you an example of a late entry, which says the left foot was noted to be abated laterally, John Doe, MD 6 15 0 9. So you see it’s got the, the physician’s name and the date of the addendum. And then for an addendum, they give this description. An addendum is used to provide information that was not available at the time of the original entry. The addendum should also be timely and bear the current date and reason for the additional clarification of information being added to the medical record and be signed by the person making the addendum. And the addendums, of course, would be by people who are allowed to make addendums in the medical record. And an example here was the chest x-ray report was reviewed and showed an enlarged cardiac silhouette. And it gives the provider’s name signature John Doe, MD 6 15 0 9. And then we have corrections. It says, when making a correction to the medical record, never write over or otherwise obliterate the passage when an entry to the medical record is made an error. Of course, now we have electronic medical records and there are ways that we are doing that in our electronic systems, right? But some people are still on paper, right? Or we have paper documents that get scanned in, right? It says to draw a single line through the erroneous information, keeping the original entry legible. So don’t scratch it out like you want, don’t want it to be seen sign or initial the date of the deletion stating the reason for the correction above or in the margin document the correct information on the next line or space with the current date and time making reference back to the original entry. Correction of electronic records should follow the same principle of tracking both the original entry and the correction of the current date, time, reason for the change and initials of the person making the correction. When a hard copy is generated from an electronic record, both records must show the correction. Any corrected records submitted must be clear or must make clear the specific change made and the date of the change and the identity of the person making the entry. So I think that was pretty clear, right? They go on to tell us what’s not allowed. So I wanna, I know I’m gonna, I’m going, going over a little bit long today, but I want to read you what’s what they say. And this is, this is probably what you’re gonna see in a lot of the medic c m s payers, even from the federal level as well. So not the whole United States as well as individual states. What is not allowed is providers are reminded that deliberate falsification of medical records is a felony offense and is viewed seriously when encountered. Examples of falsifying records include creation of new records when records are requested. Now, I had a provider once that we were doing an audit on where, when he saw the patient, he was a physician’s office, he saw the patient, he had a, a drawing of the patient, he was in pain management, he had a drawing of the patient. And on that drawing of the patient, he had the patient’s name the date he signed off on it. And he just made a few marks on the drawing of that patient. Well, he became under investigation and right before, when they requested the medical records, months later, he went out and created written documentation or electronic medical record documentation for each one of these. Other than the graphic, well, you know, our electronic medical records have date and timestamp on ’em for the entries made. So he was caught. And what happened is c m s threw out all of those documents that were created months after the fact and only allowed the graphic to audit him based on, because that was contemporaneous. Oh boy. So that’s a huge deal. Other things that are not okay, backdating entries, postdating entries, predating entries had another case where a provider, and this was a scheme to where one provider, two providers were in a hospital, one provider would refer to the other. So they would, this was when we had written medical records more so than electronic. One provider would go down in the record, in the progress notes and leave enough space for the other provider to write and then say that he had referred the patient so the other provider could come back and bill a consult and fill in that blank space. So there you go. I mean, there’s always ways, right? Writing over content is incorrect. Adding to existing documentation except as described and as appropriate, making late entries, addendums or corrections. And it says collections, corrections to the medical record legally amend amended prior to claim submission and or medical review will be considered in determining the validity of services billed. If these changes appear in the record following payment determination based on the medical review, only the original record will be reviewed in determining payment for services billed to Medicare. Now, I would say if the payment has already been made, and, and it is entirely possible that could happen if there is some salient point from a medical legal perfe, you know, perspective still make the appropriate addendums, it just may not impact payment. Right. And then it also goes on to say, appeal of claims denied on the basis of an incomplete record may result in the reversal of the original denial. If the information supplied includes pages or components that were part of the original medical record, but were not submitted in the initial review. So, I’m sorry I got really long-winded on that one, but I felt like it was extremely important and we could even dig deeper in it guys, because it’s, it’s a big topic. It’s a big topic. There’s lots of case files that I’ve worked on that had inappropriate amending of records and so there’s lots of stories there. But I hope you’ve enjoyed today’s topics and questions. And Pam, you wanna give away a mug? Yes, I do. But first I wanna ask you, I think I found the Meridian reference that you talked about. We did. Can I put that in the Oh, Absolutely. Holly, Holly was asking for that and also said, please, please dig deeper. Yes. Yes. Okay. Awesome. We’ll do that. Thank you Holly for that, for that comment. So I have been writing down the names of all the people who are, are dialing in that I can see. And, and here we go. Here’s one calling in on free conference call. Your phone says your name is Melissa. So I’m gonna try calling that number from Tampa in a few minutes and, and find out where to send your mug. Yay. Thank you for being here for episode 1 79, Coffee with the Coder and we look forward to hearing from you in the meantime, seeing your posts so that you’re doing the contest. ’cause we are excited it’s gonna end on Halloween before our next episode and we’re very excited about the entries that are coming in and hey, share it around. ’cause when you use the hashtag on social media, then other people can join the contest too, which is yay. Really the point. Right? Right. So Melissa, excuse me, Melissa, I’m calling you to, to see where to send your mug and find out if your name is really Melissa? Yes. Can you, Can you give the last four digits of that phone number so that if her, if their name is not Melissa, that they’ll know they’re calling from that number and they can contact us? Oh, that’s true. How about I give the last three because Okay. Okay. 4, 3, 2 is the end of your number. If your name isn’t Melissa, but you’re calling in on free conference call and your number ends in 4 3 2, then you’re welcome to call us at (877) 976-6677 and, and tell me where to send your mug. And if your name is really Melissa, I that over the time. Yeah, sometimes it’s you’re using a friend’s phone, your, your spouse’s phone or whatever, but.

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