Encoder Versus ICD-10-CM Codebook

Encoder Versus ICD-10-CM Codebook

Rely on coding technology for efficiency, but know your way around a codebook for accuracy.

As our lives become more intertwined with technology, so do our jobs.
Many of us started with an ICD-9-CM tome, wondering how we’d ever digest its contents. We did it, though, as well as ICD-10 — and some of us really enjoyed it.
While taking an introductory coding course, I found it fun to use the alphabetic index in the book to pinpoint a code in the tabular list. It’s what initially drew me into medical coding. In my first coding job as the gastroenterology coder for the Department of Internal Medicine, I highlighted the codes I used in the index, and I would look back at the end of each year to see the pages became more and more yellow. At that time in my career, I printed consultations, progress, and operative notes off the computer, hand-coded them using the ICD-9-CM and CPT® codebooks, and then entered the diagnoses and procedure codes into our billing system.
What a difference five years make.

Fast Forward to Today’s Coding Technology

For facility coders and auditors, health data management system software (such as an encoder) is an essential part of day-to-day work. It’s crucial for computing diagnosis-related groups and sequencing codes for proper reimbursement. It also helps in evaluating Patient Safety Indicators and “hold bill” edits.

What Is an Encoder?

An encoder is a software program — a type of electronic “codebook” that assists in choosing codes by using a “tree” of terminology. This tree starts at a main level and then branches off, with selections for you to choose on each subsequent screen, until you find the most specific set of diagnosis and procedure codes available.
Some encoders include a computer-assisted coding (CAC) element that suggests possible codes associated with diagnoses that may have been overlooked in the documentation.
Without a doubt, encoder software is important for more efficient work, and the use of an encoder helps speed up the coding process.

Does an Encoder Replace the ICD-10-CM Codebook? 

The answer is no.
An encoder is a tool, and a tool is only effective when you understand how to properly use it. The paths in encoding systems are developed by people who may not have a medical coding background, but who understand nosology (i.e., the systematic classification of diseases). Relying on the software program alone, without using your book skills, could prove costly.
For example, the encoder may send you to the wrong location in the tree. This was especially true when transitioning from ICD-9 to ICD-10 — even with the mapping equivalents in place. There are a lot of additional codes in ICD-10, and the encoder had to learn along with us.
My facility was an encoder/CAC beta site, and we were dual-coding in ICD-9 and ICD-10 during August and September 2015. Our input helped the encoder software company fine-tune the coding paths to make the code mapping process more accurate for encoder users. Even after practicing dual-coding for two months, I spent many hours/days after the transition double-checking unfamiliar codes in my ICD-10-CM codebook. It was time well spent.

Encoder Miscues Rely on ICD-10 Clarification

Unfortunately, no amount of fine-tuning can make a system 100 percent reliable. You must know how to use the index in your codebooks to assess the accuracy of your encoder. Some issues are minor. For example, the encoder we use does not tree out to capture the external cause code for “perpetrator” when coding an assault (which is a coding guideline). I create my own path to arrive at that code. It also does not offer the option for hyperglycemia as a complication under diabetes (E11.65 Type 2 diabetes mellitus with hyperglycemia). I need to know to spell the complication under that option, rather than choose “other,” which results in a less specific code (E11.69 Type 2 diabetes mellitus with other specified complication).
Other encoder miscues can lead to greater issues. For example, if you code a case where a patient has an intestinal anastomosis, and you choose:
Other (with the only other choice being “complicated”)
You arrive at K63.89 Other specified diseases of intestine; however, the proper code is Z98.0 Intestinal bypass and anastomosis status, which is very different from having a specified disease of the intestine. Only by using the index in your codebook will you initially determine how to get to the code that the encoder did not find.
As another example, if you code vomiting in pregnancy and take this route:
Excessive in pregnancy (the only choice that is relevant)
Gestation week
You arrive at O21.0 Mild hyperemesis gravidarum (a more severe form of morning sickness), when the better code is O21.9 Vomiting of pregnancy, unspecified. To get to the correct code in an encoder, you must start with:
Complicated by
Spell “vomiting”
Gestation week

Accuracy Always Comes First

Although technology is important to making you more efficient, it does not always lead to greater accuracy. Learning how to use the time-tested ICD-10-CM codebook should be your first step in becoming a proficient coder, and it should always be a readily available resource you rely on throughout your career.

Kelly Mitchell, MHA, MSHI, CPC, CGCS, CPMA, CCS, is the audit and quality monitoring coordinator for University of Missouri Healthcare’s Health Information Services Department. Her career path started seven years ago in physician coding, gastroenterology, and has progressed to facility coding and to auditing. Mitchell served as secretary of the Columbia, Mo., local chapter in 2014–2015.

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