Got a Coding Question? Call a Nosologist for Answers
Got a Coding Question? Call a Nosologist for Answers
Special to ADVANCE
Two heads—or make that noses—are better than one, said Susan Rydman. As a longtime nosologist, a sense of humor in explaining her profession is helpful. After all, not many people have heard of nosology.
Rydman is manager of the Nosology Coding Services Group at 3M Health Information Systems, based in Murray, UT. Like other coding software vendors, the company provides its customers with access to professionals who answer coding, grouping and reimbursement questions. At 3M, these experts are part of the team—along with software engineers and product analysts—that builds, maintains and updates coding, grouping and reimbursement software.
“We’ve Always been called nosologists,” said Rydman. “Nosology means the classification of diseases, and that is the heart of coding. Besides being an accurate—if somewhat unusual—description of what we do, the name nosology catches people’s attention. Everybody asks what it is.”
“I had never heard the term,” said Faye Mobley, registered nurse and diagnosis-related group (DRG) review specialist at New Hanover Regional Medical Center, Wilmington, NC. Now Mobley said she knows that nosologists “give basic, sound advice on coding questions.
“Sometimes I call a nosologist three times in one day, and other times I’ll just have one question in a week,” she said. “There isn’t another place I can call to get this kind of input.
“Coding isn’t a simple job. There are a lot of rules and guidelines I have to adhere to, but it’s not always clear cut,” Mobley continued. “There’s a lot of decision making to do, too. The nosologists help me make the best decision.”
The 3M Coding and Reimbursement System uses what software developers call “expert system technology.” This technology helps a hospital’s health information management (HIM) staff evaluate and apply coding and grouping rules to individual patient records for accurate and complete classification decisions.
But behind the computer’s expert technology are the nosologists. “We have helped develop the software,” said Rydman, “and we continually work to make it better and more accurate. Our knowledge of how coders work and how coding must be done to meet regulations and guidelines, is written into the program.”
When Mobley or any other customer calls, they are tapping into a knowledge base of 19 people with more than 399 combined years of coding.
The coding nosologists all previously worked as coders in hospitals or physician offices. Most are accredited record technicians (ARTs) and some are certified coding specialists (CCSs). The grouping and reimbursement nosologists have varied backgrounds including computer science, reimbursement, claims processing and nursing.
Calls concern sequencing questions, new medical procedures and grouping. Oftentimes a customer is looking for an outside opinion—when an auditor may disagree with a particular code assignment, for example.
The nosologists work through the questions with the caller, looking at the same software the customer is using. Coding reference software, also online, includes all issues of the American Hospital Association’s (AHA) Coding Clinic and the American Medical Association’s (AMA) CPT Assistant, plus other medical, drug and anatomy references. Rydman and her colleagues have additional medical references they can consult if the answer is elusive. Other resources include the UHDDS Guidelines for Sequencing, current ICD-9-CM and CPT code books and a medical library.
“The Nosologists are supportive and knowledgeable,” said Minta Ozolins, ART, DRG coordinator for Northern Inyo Hospital, Bishop, CA. “I like being able to talk through a coding question with someone, working together to find the answer.”
Ozolins, who describes her scenic mountain valley community as “in the middle of nowhere,” doesn’t have any other professional opportunities to discuss coding issues with her peers. Other sizable health care facilities are about 300 miles away. “Sometimes, I get bogged down mentally and need someone to talk to who understands coding,” she said.
Nosologists are always available to help. At 3M, they are on duty 8 a.m. to 5 p.m., mountain time, every weekday. They work on the premise that the information must be provided quickly and accurately. Coders who may be processing many patient records a day can’t take extraordinary time to research one question.
“We’re proud of the fact that we answer calls and questions quickly,” said Rydman. Sixty percent of the customer calls are answered immediately. Another 5 percent are answered within one minute. Other callers leave a message, and calls are returned promptly. Only 2 percent go beyond 90 minutes.
“On average, we spend about eight minutes on the phone with a customer,” said Rydman. “If we can’t resolve the question within 10 minutes or so, we let them get back to their jobs, do additional research and call them back, usually the same day.”
The nosology team talks to about 50 customers a day. Customers report that it’s a valuable service to have experts on call. As everyone knows, coding is under more and more scrutiny because of reimbursement concerns.
In addition to getting their questions answered, callers are helping to shape future product improvements.
“People tell us about a new procedure they’re trying to code,” said Rydman. “They might suggest new acronyms we should add as key words to the software, suggest a new procedure frame to go with a certain diagnosis or a new drug that should be added to the dictionary.”
Those suggestions often show up in the next version of the software. For example, 3M nosologists were getting an increasing number of calls about the Burch procedure, a new urinary procedure. “We couldn’t find the answer either. We wrote to the AHA for clarification,” said Rydman. “Now, that procedure is included in the recent Coding Clinic.”
Product development is also an important part of a nosologist’s job. For example, nosologists were critical to the development of the 3M Coding Reference Software introduced last year. Now, customers can have easy access to: AHA Coding Clinic, AMA CPT Assistant, Clinical Pharmacology Drug Reference, Stedman’s Electronic Medical Dictionary and BodyWorks 5.0.
More than ever, coders have answers at their fingertips. But with so much information on the software and upgrades twice a year, nosologists know that coders need more than online references. They need to talk to a person.
“We help train customers on unfamiliar software features. And above all else, nosologists know there are no dumb questions; there is just too much to know,” said Rydman.
Mobley quickly agrees. “I would never say I know all the answers,” said Mobley. “There’s a new record everyday. Rules change. New codes are assigned. There’s always something new.”
* About the author: Ronda Willsher is a free-lance writer from Minneapolis who specializes in health care topics.