Expertise, knowledge make health information professionals indispensable 

Tamra Zeid, Manager, Terminology Data Engineering, provides a behind-the-scenes look at the highly specialized work of health information professionals.
clinical terminology

Health information (HI) professionals can be found throughout the healthcare industry, including departments related to coding, medical records, revenue cycle, compliance, risk management, billing and charge capture in hospitals, provider practices, long-term care, and even in the payer space. We hold a variety of exciting and emerging roles, including outpatient clinical documentation improvement specialists, data analytics (including Chief Analytics Officers), clinical data managers, clinical research coordinators, and clinical data developers. In short, you can find us anywhere there is healthcare data, including healthcare technology companies like IMO.

What it takes to make it in health information

Regardless of which area of health information we end up in, there are several skills and traits that we all possess. Successful health information professionals have strong problem-solving skills and analytical abilities. We are always adjusting to the evolving healthcare environment and workflows, whether related to the regulatory environment (i.e. payment system changes and code set updates) or the constantly advancing technology. We often bring an alternate perspective through a documentation and reimbursement lens. Strong written and verbal communication skills are a must. And health information professionals are often responsible for presenting clear and concise information to clinicians, administration, finance, and others.

It used to be that, especially in coding, hospitals and other healthcare environments could cultivate their own health information professionals internally. Entry-level medical records specialists could train and learn from seasoned coding professionals to advance within the health information management department. However, given the growing volume and pace of change in recent years, attending an accredited health information program is now necessary to provide the knowledge and skills required to be successful in the field. A solid background in the disciplines of anatomy, human physiology, pathophysiology, clinical terminology, and pharmacology is required. Then, once we have established a basic understanding, the fun begins! That’s when we get into studies delving into legal requirements (i.e. privacy, risk management, conditions of participation for Medicare), research interpretation, coding, health information systems analysis and design, healthcare data management, analysis, trends, and analytics.

Know your RHIA from your RHIT?

The IMO Mapping team is staffed with health information professionals whose credentials may vary depending on where the individual focused their expertise. Credentials are earned by passing a certification test demonstrating that an individual has achieved the professional standards of excellence set by a national, state, or local organization. HI certification tests are offered through professional associations such as the American Health Information Management Association (AHIMA), the American Academy of Professional Coders (AAPC), and the Healthcare Financial Management Association (HFMA).

Some of the most common credentials, and ones that the members of the Mapping team hold are RHIA, RHIT, CCS, and CPC. The Registered Health Information Administrator (RHIA) and Registered Health Information Technician (RHIT) credentials are the broadest and cover all areas of health information. The difference between the two is that the RHIA requires a bachelor’s degree in health information management and systems (HIMS) and is geared toward management. The RHIT requires an associate degree in HIMS and is more technical in nature. Other credentials are more specific to an area within HI, such as analytics, revenue cycle, and coding. All require extensive knowledge to obtain and the submission of approved continuing education units (CEU) on a regular basis. One or more of these credentials are required for most positions within the sphere of health information. IMO requires mapping analysts to have at least one credential and we help ensure these individuals have opportunities to obtain the CEUs needed to maintain those credentials.

Coding vs mapping: Understanding the similarities and differences

Coding skills and mapping skills are very similar foundationally. In both areas, the process requires an in-depth knowledge of anatomy, disease processes, procedures, and code set guidelines. Whether you are working on diagnosis coding or problem mapping, you need to know what is integral to the disease process. What would be a sign or symptom?  Where in the body does it present? What are typical treatments? These are questions being evaluated by the health information professional to determine the appropriate code or map. For procedure coding or mapping, you need to know the details of what that procedure entails. What approach is integral to the procedure? What procedures can be coded separately with the main procedure?  Both processes require knowledge and application of administrative code set guidelines, instructions, and supplementary advice such as American Hospital Association (AHA) Coding Clinic or CPT Assistant.

Coding in the provider space requires knowledge of various reimbursement and compliance standards and regulations. Provider and facility coding is often audited since reimbursement in the US is based on the codes submitted on the claim. In mapping, the assigned maps must be appropriate for the term, consistent with other similar terms and follow internal editorial. At IMO, we use various measures to assure confidence in the accuracy of our maps. For the medical problem space, IMO has contracted with AHIMA, a recognized leader in the US for coding to review our maps at the lexical level. We do internal mapping review as a quality assurance step. And feedback from our customers also helps to inform the process.

There are, however, also many differences between coding and mapping. When you are coding, you have the context of the patient record to help inform your coding decisions. You have the progress notes, discharge notes, history and physical, lab reports, radiology reports, and operative notes with a wealth of information on the patient. As a coder, you are telling the story of the patient. We look for everything within the record or encounter that will tell that complete story while also ensuring that there is compliant documentation to support that narrative. Depending on whether you are working on facility inpatient or outpatient accounts or on the professional side, you also must consider reimbursement systems and policies such as Medicare Severity-Diagnosis Related Groups (MS-DRGs), National Correct Coding Initiative edits (NCCI), Hierarchical Condition Categories (HCCs), and modifiers.

If coding is telling the story of the patient, mapping is providing the words and phrases that make up that story. Mapping is a horse of a different color from coding in that the maps are applied without the context of the patient record. There are more grey areas, and sometimes there can be more than one “right“ answer for a map. The team works diligently to do research, apply coding guidelines, and develop editorials when necessary to assign the best code map.

To illustrate one of the important differences between mapping and coding, let’s look at an example. For documentation of “hypertension,” in a mapping scenario, the code map is I10, hypertension. This map supports the concept fully without any additional context. But in coding, if “hypertension” is documented, the coder will investigate further in the record to see if this patient also has renal or cardiac disease. If there is renal or hypertensive heart disease, different codes would be used to further focus the patient’s story.

If coding is telling the story of the patient, mapping is providing the words and phrases that make up that story.

Just a little more on mapping

Mapping also makes it easier to transmit and reuse data across different healthcare systems and for different purposes. It creates links between different code sets and enables patient data to be exchanged accurately and consistently. Our terminology mappings can be used to map to a billing code system to be used for reimbursement. They can also be used to support secondary uses of clinical data, like research. Maps are reviewed and updated as necessary when the source code set vocabulary is updated with new, retired, or revised codes or changes to the index, tabular, or guidelines. In many cases, the ongoing maintenance of our code maps is a primary value driver for IMO’s clinical terminology solutions.

IMO’s Mapping team is made up of health information experts with a variety of backgrounds. Together, we have a combined 136 years of experience in health information. We have experience in inpatient and outpatient facility coding, professional coding at multi-specialty practices, reimbursement audits for coding, teaching in HIMS programs, clinical documentation improvement review (CDIS), dental billing, and various management positions within health information and revenue cycle management. We even have an individual with hands-on medical experience from their time as an army medic and EMT.

Yet, despite the wealth of knowledge and experience on the Mapping team – and in other departments across the organization – the work of HI professionals stays largely behind the scenes…much like the work of IMO itself. Each day, we build and maintain an intricate web of over five million terms and their corresponding standardized codes. And our quiet, meticulous, and essential contributions? They form the very foundation of all that IMO has to offer.

To learn more about IMO’s deep bench of health information professionals, visit Our Experts.

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