Blog Article By Vickie Bridge and Cheryl Nicholson

Coding backlogs can create havoc on accounts receivables (A/R). Just as patient visit volumes fluctuate so do the number of patient accounts that need coded. Reduce coding backlogs with a consistent, proactive approach to managing discharged not final coded (DNFC) accounts.

The root cause of coding backlogs can come from a variety of sources. As you analyze the coding workflow process, here a few areas to review as the possible root cause:

Do you have current coding process workflow maps that clearly document the process?

Observe coders and map out the current workflow for each account type. Analyze and identify redundancies, bottle necks and areas of concern. Present the information and gain input from key stakeholders such as CDI specialists, Physician champions, Clinical informatics, HIM and Coding staff to assist in developing more streamlined coding workflows.

Are your coding work lists automated, comprehensive, and customizable?

Automated and customizable coding work lists are essential to efficient coding. Develop coder work lists by account type sorted by discharge date (first in first out) and highest dollar amount. Allow Coders to participate in customizing the work lists.

Do you have a robust incomplete medical record analysis process?

The absence of complete documentation can have a negative impact on your coding workflow process. Do not present discharged accounts to the coder work list that have key documentation deficiencies. Dedicated HIM or coding support staff can prioritize and review inpatient accounts and outpatient surgery accounts within 24 hours of discharge to identify and follow up on accounts with key documentation deficiencies (i.e., missing operative report). Place these accounts on hold or in a pending status until the key deficiencies have been resolved. Once resolved, the account should then populate into a coder work list.

Who is your Physician Champion?

Complete documentation at or immediately following discharge is key to managing DNFC. Develop a strong relationship with Physicians to gain ownership on the importance of complete documentation. Identify and enlist assistance from physician champions to support complete documentation accountability. Utilize CDI specialists and physician liaisons to bridge gaps.

Are your coding staffing levels adequate?

Implement flex staffing by consistently utilizing a combination of employed coders and contract coders to better manage volumes and reduce the risk of backlogs. Assign specific coding staff to handle denial management and coding reworks. These individuals should also be responsible for educating the coder that originally coded the account to ensure future coding quality.

Are your processes maximizing technology?

Gain the maximum benefit from the coding and abstracting system by creating standardized coding workflows and hold Coders accountable to the workflows. If the EHR has the capability, set up the system to add diagnosis codes for simple visits (i.e., outpatient labs and some therapies and imaging tests) at time of registration. Leverage any system capabilities with auto charge capture and level assignments. If not using computerized assisted coding (CAC) seek out vendors and schedule demonstrations to identify potential for improvements to coding quality and productivity.

While this is not meant to be a comprehensive discussion of addressing coding backlogs or coding workflow processes – it does lay out some of the basics for a solid foundation. For additional information on establishing effective coding workflow process and/or reducing coding backlogs, please contact Vickie Bridge at