FEATURE
THE IMPORTANCE OF TELLING A STORY Coding has become the language of storytelling storytell ing in medicine BY JOSEPH HABIG II, MD, MEDICAL DIRECTOR, VALLEY PREFERRED
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rowing up, I had an Uncle Francis. medical conditions for which we are treating DON’T DROP THE DROPPED CODES. Every year He was from North Carolina, and he our patients. chronic medical conditions that persist for a could tell a story like no one I have patient need to be refreshed and the HCC codes, ever known. When our families got How we report to contracted payers the re-coded. If not, it appears to the payers that together – myself, my sisters, and many of our severity of the illness of the patients we care for, these conditions have gone away. The classic cousins – we would sit on the floor, gathered determines the expected costs incurred in caring example here is a patient who suffered a limb around him. With his southern drawl, and his for these patients. As you know, this reporting is amputation. It is important to document this way of telling a story, he kept us entranced. He done through Hierarchical Condition Categories condition every year in their record. Otherwise, could weave words and phrases that would keep (HCC) codes, encompassed in The International it will appear that that problem no longer exists us mesmerized. We would laugh and cry and Classification of Disease, Tenth Edition (ICD- when it obviously does and is a significant hang on every word. 10), created by the World Health Organization co-morbidity for the patient. (WHO), the current book of codes utilized Every patient has a story. When they seek us across the vast world of health care. CONDUCT ANNUAL WELLNESS VISTS. Doing an out as their physician, they have a story to tell. annual well visit with your patients provides the It may be an urgent problem, or an ongoing We all work very hard, as we have been trained, best opportunity not only to code accurately, but single problem or series of problems for which to provide the best care for our patients; what to capture “dropped codes,” and help close any they seek our guidance. Either way, they look follows are four key guidelines on HCCs and Care Gaps that the patient may have. If you to us to help them with improvement or cure. how to accurately and completely tell the story are a primary care physician, annual well visits of the patients we treat. are also the best way to maintain attribution of We have all been trained to listen to our your patient. This means that according to the patients’ stories and ask them proper questions. BE AS ACCURATE AND SPECIFIC AS POSSIBLE. payer, you are that patient’s physician. To paraphrase Sir William Osler, one of the four The more specific we are in our coding, the founding professors of Johns Hopkins Hospital, more accurately we represent to the payer(s) the If you are using an EMR, there may be “If you ask your patients the right questions, they true illness and condition of the patients we see. software included that can assist in selecting the will tell you what is wrong with them.” most accurate or precise code for your patient For example, a patient with a diagnosis of encounters. If you are still using paper charts, We are also trained to know the value in “Type 2 Diabetes, uncomplicated,” is fine if moving onto an integrated EMR, such as the keeping records. Long gone are the 3 x 5 index there are no complications. However, if the universally used EPIC system, would not only cards that made up our predecessors’ medical patient has co-existing nephropathy, neuropathy, assist with proper and accurate coding, but records. For example, such a record may have or another condition related to diabetes, it is enhance vital data collection that is needed in read: “sore throat,” “PCN x 10 days.” important to use the HCC code that includes the current value-based practice of medicine. that co-morbidity. Now we muddle through – and some say Physicians and other health care providers “suffer” – with elaborate electronic technology REPORT ALL DIAGNOSES THAT YOU ADDRESS. have been recording encounters with patients to record extensive information on our patients. Coding diagnoses that may be secondary or are and interpreting them through coding for Perhaps at times it seems to be too much complications related to the primary reason for decades. So, while filling out diagnostic codes information. However, in this day and age, the encounter are very important to mention may not seem like it, it is in fact an updated the insurance companies that pay our bills and and include. If you see a patient for a particular and efficient way of telling an important story. cover the cost of the patient’s care demand it. problem, even if an acute problem, but you Using HCC codes may not be amusing or also address an existing chronic problem, it is entertaining, but it is important, and allows us So, in this time of electronic medical appropriate to document it and list that existing to do a better job at taking care of the patients records and value-based health care, we are diagnosis in your note. who entrust their care to us as their physicians. required to as accurately and as specifically as we can, record the severity of illness and 22 Lehigh County Health & Medicine | SUMMER 2022
