March 19, 2021 | By Jeannie Cagle, RN, BSN, CPC, Senior Manager, The Coker Group
As is often the case, large organizations have teams of people who have particular expertise to benefit everyone. Health care is no exception. As coders and auditors, it is easy for us to be sequestered behind closed doors with our massive coding books and computer screens and lose sight of who keeps our organization going: the physician providing patient care. In working with in-house coding teams who support physicians, I often see diligent, hardworking coders who want to be correct, which is a worthy goal. Nevertheless, the team would be even stronger and more helpful with an attempt to understand the physician’s perspective.
Based on the feedback I have received over the years from physicians, here are three perspectives to consider:
- “Our number one goal is patient care; the business side of our job is often frustrating.”
As coders, we may perceive the physician’s resistance to our insistence that they include the 7th digit on an ICD-10 code as them merely being stubborn. However, consider their perspective: Their schedules are often overbooked and patients are waiting too long to be seen; lab results are coming in, other physicians are calling, their best assistant is out with the flu – you get the idea. Please take a minute to consider that their primary focus is good patient care, and you want to encourage, not discourage, that calling.
- “We want to engage with our coders, but we are busy (see #1).”
If you meet face to face with your physicians, be concise and to the point. I once observed an in-house coder pull out a 20-page flipchart to explain to her physician how to select the appropriate level of Office and Outpatient Evaluation and Management (E&M) codes. I could see the physician’s face flooded with dread. If you send an email inquiry, the same principles apply. Be quick and to the point. Create an environment where providers are happy to engage with you because you are helpful while sensitive to their time constraints.
- “Electronic Medical Records (EMR) have increased our workload.”
In my years of auditing, I have gone from trying to find notes in huge paper charts written illegibly to sorting through EMR templates full of paragraphs of “default” verbiage to determine what happened during a visit. Imagine how that documentation shift has impacted physicians. Initially, they could document the visit in one location and be flexible with how they entered it. Now they are forced to click and enter static information that is time-consuming and may not affect clinical care. Even with the lessening of technical requirements under the new 2021 guidelines for office/outpatient E/M codes, EMR templates continue to make documentation a chore. Before you insist on a specific format for documenting the treatment plan or require them to report time in a certain way, ask them about the EMR, and look for ways that make it easier for providers instead of insisting on an impractical standard. Be a resource for them to work smarter, not harder.
It is clear that physicians need coders, and, without them, we would not have jobs. Understanding the physician’s perspective will bring empathy and compassion toward them. The result is mutual respect, billing and compliance success, and movement forward.