It’s all in the numbers: medical coding change important to this job

A job that is usually done quietly by about 30 Upstate University Hospital staffers will be attracting the attention of thousands of their fellow employees over the next few months.

That job is coding, or assigning a numerical code to the diagnoses and procedures of every hospital inpatient, as well as to one-day surgery and emergency-room patients. The coded medical charts play a key role in the hospital’s financial health, since they are used for billing and insurance claims.

The code set that is used for those records will undergo a massive change Oct. 1, as the United States abandons a system that dates to the 1970s and adopts “ICD-10”—the International Classification of Diseases, 10th version. The U.S. has delayed the adoption of ICD-10 for several years.

The change will be far-reaching enough to affect just about anyone who deals with a patient’s chart, from billing and admitting staffers to physicians, said MaryAnne Petranchuk, the hospital’s assistant director of medical records. “I figure it’s pretty much going to affect everyone across the board, except maybe the cafeteria.”

“It’s a very complicated code set,” she explained, noting that it’s more detailed and allows for future expansion, unlike its outdated predecessor, ICD-9, which has run out of room for new codes. “It’ll be great for research, and it gives people a better picture of what actually is wrong with the patient,” Petranchuk said.

As the coding manager of clinical data services, she oversees the 20 coders and four lead coders at the downtown campus, all of whom have been training extensively for the code switchover.

Undergoing the same training are their counterparts at Upstate’s Community Campus — five coders and a lead coder, overseen by Coding Manager Mary Lupole.

Upstate’s coders have been working with a training encoder—“a whole set of computer modules that you can go in and work at your own pace, and it’s working out really well. They’re almost all the way through all the training,” Petranchuk said. They are also “dual coding,” or coding some charts in both systems for practice. Results are good so far on practice tests.

Another tool they are using is computer-assisted coding, designed to speed up the process, and the lead coders, who normally supervise and audit, will perform coding this fall to help keep things moving.

“Documentation is going to be so important; we are all going to have to be more specific,” said Peggy Presbyla, operations manager for Health Information Management at the Community Campus.

Although health information professionals are predicting coding slowdowns of 50 percent or more nationally and insurers may experience their own problems with ICD-10, Petranchuk is optimistic that any coding difficulties will not last long. “I do think our staff is very skilled and knowledgeable,” she said, noting all of them have either an associate’s or a bachelor’s degree in health information technology or health information administration, take a certifying exam and do continuing education.

“We are going to do everything in our power to get the coding done as quickly as possible, so the hospital can be paid in a somewhat timely manner.”

“They’re right on track,” Petranchuk said of the coders. “I think they’re doing really well.”

“We’re good to go,” agreed Presbyla.

Visit ICD-10 for more information.

Caption: Coding Manager MaryAnne Petranchuk shows some of the training manuals and code books used to prepare for the Oct. 1 switch to the ICD-10 medical coding system. Petranchuk, who needs a rolling backpack to carry the hefty volumes, says the books’ final versions won’t be available until just before the system goes live. One set of ICD-10 codes (CM) refers to diagnoses, and another (PCS) refers to inpatient procedures.

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