Coders Helping Coders

It may take a hospital coder a few minutes to code an appendectomy with the assistance of coding software. That coder’s job is made infinitely easier thanks to other coders, such as Jessica Knapp Ellis, RHIT, CCS, an advanced clinical development analyst at 3M, who might spend two to three weeks working with engineers to develop the simplest way to identify a single code for that appendectomy using her company’s software.

Ellis, who started her career first as a nursing student and a medical records clerk, takes great pride in putting her coding expertise to use in the vendor world, which is a career path for coding professionals that Ellis and other “nosologists” suspect a lot of coders don’t know about.

Nosology is the branch of medical science that deals with the classification of diseases. Sue Bowman, MJ, RHIA, CCS, FAHIMA, senior director, coding policy and compliance, at AHIMA, says nosology “is a broad term that covers pretty much every role involved with disease coding or classification—including traditional HIM coders, people working with terminologies, and even those who work for the National Center for Health Statistics and code death certificates.”

Yet most people who are familiar with coding products and software from 3M likely associate the term “nosology” with them, because that’s how the vendor refers to their department of individuals with coding backgrounds.

“Coders don’t typically use the terminology ‘nosology/nosologist’ for themselves or others in that specialty, they use the terminology ‘coder’ or ‘medical records coder’ for further distinction,” explains Angela C. Dixon, RHIT, a 3M clinical development specialist. “Nosology has kind of been adopted by 3M for their employees that deal with any of the coding classification aspects of their products. Some of our nosologists also do coding at facilities as a side job. In those cases, they also separate out that distinction by referring to themselves as nosologists when talking about the work they do at [the company] and then as a coder when talking about the actual coding they do on the side.”

Dixon was an inpatient coder at the University of Utah prior to work at 3M, which is common for the vendor’s nosologists.

“I agree that there are other options outside of 3M such as Optum that would have similar positions for coders and they may or may not refer to them as nosologists, but do rely on the coding background for this,” Dixon says.

Coding Pathways

To build software that helps coders identify the correct code for a given diagnosis or procedure, Ellis has to think like a coder—but in reverse. For example, to create a coding pathway in the software for a surgical gall bladder removal, Ellis says she thinks through all the key words that a coder would use to get that code.

“I’d start with ‘removal’ or I’d start with ‘cholecystectomy.’ So, I’m putting my own knowledge of coding into the system to make it user-friendly for the coders and provide them guidance along the way,” Ellis says. “If there’s a message or reminder that needs to be there, like, ‘don’t forget to code a cholangiogram if there has been one while you’re here,’ we add that,” Ellis says. “We'll send them down different trails, pathways. We'll give them alerts, ‘Don’t code that if this has happened.’”

Obviously, thinking through this process is easier for Ellis when it involves a procedure or a code she’s already familiar with or has coded before, but since there are annual updates to the CPT and ICD-10-PCS code sets, Ellis has to do a lot of research to guide a coder through a procedure.

“If I don’t understand the procedure, then how can I transfer that into software and make it easy for someone to understand it?” she explains. “So, we’re always studying and interpreting all the new guidelines, and those guidelines change monthly sometimes,” Ellis says, referring to publications such as the American Medical Association’s CPT Assistant, which is monthly, and the American Hospital Association’s Coding Clinic for ICD-10-CM/PCS and Coding Clinic for HCPCS, which are both quarterly. When those organizations adjust guidelines, Ellis has to work with her team of engineers to issue software updates.

The clinical aspects of the job came naturally to Ellis because of her coding background, but the computer programming language she’s had to learn had a much steeper learning curve.

“It can get overwhelming because of all the research [that comes along with programming] is constant,” Ellis says, noting that she is constantly researching things that come out. “Or I’ll get a call from a customer saying ‘Hey, I can't get this pathway in your Code Finder. Why are you doing this?’ And then, that takes a lot of time to review that and research it,” she says.

All that work and research pays off when a successful update is deployed to her software’s users, though.

It’s rewarding to help coders get through a pathway that would be really difficult with just a code book, Ellis says. “I'm doing everything I can and trying to think of every keyword. I try to assist them in any way possible so they have a good experience and they enjoy their job.”

Mary Butler (mary.butler@ahima.org) is associate editor at the Journal of AHIMA.