Pulmonology Coding Alert

Check out these tips for more effective onboarding.

Coding education is an ongoing effort in healthcare, which is why Samuel “Le” Church, MD, MPH, CPC, CRC, FAAFP, core faculty family medicine residency at Northeast Georgia Health System and Crystal Tompkins, CDEO, CPMA, CPC, CRC, COBGC, auditor/coding educator at Northeast Georgia Health System went into helpful detail about the topic during their 2024 HEALTHCON session titled “Tag Team Coding Education for Family Medicine Residents.”

Whether you work closely with pulmonologists, are looking to improve your onboarding process, or simply need fresh insights into how to better educate your practice’s physicians on coding and documentation, read on to learn what our experts have to say.

Recognize the Common Challenges With Coding Education

When it comes to pulmonologists, for example, coding is hardly touched on during their schooling. This means that they’re starting at square one. Anytime there’s an exchange of expertise and information, there are certain barriers or blocks that should be addressed.

For example, doctors, like anyone else, have different learning styles. What’s easy for one doctor to understand with one explanation might be difficult for another doctor to understand without the use of a case study. Establishing a trusting relationship is essential in any learning environment. It’s easy for coders and teaching doctors to come at this from an overly aggressive standpoint. “You never want to approach anyone as an educator to put them in their place. These are areas of opportunity to help the physician,” Tompkins said.

Here are a few other things to keep in mind when you’re trying to establish this kind of relationship:

Interest: Doctors did not go to school to document codes. They went to school to treat patients. Their interest generally lies in patient care.

Language barriers: Doctors have a specialized, clinical skillset and knowledge base which does not include coding and billing. This often makes it hard for coders and doctors to understand one another.

Focus: Doctors have several things going on, often that literally have to do with life and death, so it can be difficult to truly hold a doctor’s attention. Educators often have to say the same thing multiple times, which can cause frustration on both sides.

Interpretation: Many coding rules and guidelines are open to interpretation. Clinical documentation disputes are incredibly common as coders, physicians, and payers can all have legitimate arguments in favor of their points of view.

Consider the “Why” to Help Motivate Doctors

Like anyone else, if doctors don’t understand how proper coding and thorough documentation directly affects them or their patients’ care, you won’t have their attention. “Coding touches every patient encounter. Treat it that way,” Church said.

Whether it’s a matter of compliance, contractual obligation, revenue optimization, resources to hire more staff or expand care, there are a plethora of reasons to care about better documentation and accurate coding. Sometimes, the biggest motivation is simply better pay and more reimbursement. “Remember, pay shouldn’t be what drives the work, but lack of pay can prevent great work,” Church said.

Consider Teaching These Concepts First…

We think of doctors as really smart, and with good reason. They are. But coding is not easy, and there is plenty of nuance. Doctors need to start off with easier coding concepts, as well as stuff that is relevant to their everyday workload. Give them the opportunities to have success that they can then build on.

Evaluation and management (E/M): A good place to start might be with the office/outpatient codes. Start with a discussion of what constitutes a medically appropriate history/exam, then break down the medical decision making (MDM) chart into small pieces, one column at a time. E/M isn’t straightforward, but it does affect every encounter. Give them bite-sized concepts and sound bites they can apply right away. This might include mnemonics, white boards, notes, and the like.

Diagnosis codes: The ways doctors learn about diagnoses in medical school don’t always translate to the ICD-10-CM. A lot of what’s in the code book simply doesn’t match up with the doctor’s language. “Start with the most common codes and conditions,” Church advised.