CIHI’s new learning bundle, 5003E – Different Strokes Need Different Codes, builds on their previous course on coding strokes (309 – Different Codes for Different Strokes). It focuses on limiting the use of the code I64 Stroke, not specified as haemorrhage or infarction, and instead encourages coders to choose the most accurate and specific code whenever possible.

The course includes three levels—basic, intermediate, and complex—and walks users through case studies to build skills and confidence while assigning stroke codes. Three CHIMA members took the course and were happy to share their feedback with us.

Claire Jamieson, CHIM, CCCS teaches coding for a living. She worked in acute care hospitals for 20+ years doing general coding, as well as specializing in trauma and obstetrics. She then took a position as a coding specialist, where she did data quality and answered coding questions, among other things, for over 100 coders at 30 sites in BC’s Lower Mainland. Claire currently has 120 students from across Canada and internationally.

Did you find the course description and objectives clear?

Yes, the objectives and outline were very clear. My only concern is that many students and coding staff are ESL, so using bigger words can either easily confuse or make them gloss over what they should be reading.  For example, relevant is fine, but pertinent clinical documentation isn’t a commonly used word.

Of the three courses in the bundle, which ones did you complete?

I did all three courses. My theory is why stop at basic knowledge when I can challenge myself and succeed at complex/hard levels? It was the same reason I wrote the CCCS national certification examination originally.

What did you find easiest as you went through the courses? What did you find the most difficult?

The easiest part of going through the courses was that it was guided by ‘next’ buttons or gave you the information you needed to move forward.  

The hardest parts also had to do with navigation. First, after opening the first case study and reading the discharge summary, I didn’t know how to get to the next document. Perhaps a ‘next document’ button could be useful? Second, once the course was completed I got to the ‘how did we do screen,’ which told me what I needed to do next, but not how to get there. Having the course all in that one section made we want to go looking for the exam on that same page, but all I could get to was the case studies. I finally realized I had to go back to my other internet window where I originally accessed the course itself.  

I also found it hard to remember the details from the case study summary after I clicked on ‘start coding.’  If I hadn’t been making notes as I went along, it would have relied on memory, which wouldn’t have been enough to answer the questions.

Did the courses meet your expectations?

The courses actually exceeded my expectations. I really liked that it showed you how to read the documents to pick out the relevant information. I also liked that if you clicked something not relevant, it told you why it wasn’t. As an instructor, the feedback I get from my students is that they learn a lot more because I explain why the code they chose is wrong instead of just saying ‘wrong.’ I thought the flow was good from screen to screen and case study to case study. I did find that it focused a lot on the ischemic strokes, however, so perhaps another hemorrhagic case study could be useful?

What are three of your key takeaways after completing the course?

1. I64 is only to be used under very specific circumstances. 
2. Read the supporting documentation with a fine eye for detail. 
3. Follow the guidelines/coding index to reach the most specific code by also paying attention to the includes/excludes/code also notes.

Do you feel that the course content will be useful to apply to your work?

Yes. Not only did it reinforce to me that I need to read supporting documentation, it gave me some ideas for how to get students thinking in those terms as well. I felt it built really well onto the old Different Codes for Different Strokes course previously offered.

Do you feel that this course bundle would be beneficial to CHIMA members?

Yes. Everyone needs a refresher. If you don’t see these types of charts very often, then it’s easy to forget the rules and/or get lost in the documentation terminology. If you do see these charts regularly, reinforcing the ideas and the use of supporting documentation is critical to choosing the right code. It would be easy to just assign I64 in cases when the CT or MRI are missing instead of reading the summary and consults, but that’s not good enough.

What else would you like to see in terms of future education related to classification and coding?

Speaking as an instructor, the areas I find that confuse students the most are diabetes, joint replacements, reasons for encounter vs diagnosis, and, of course, everyone’s favourite, obstetrics (so many rules, so different to all other chapters they have just learned).

Additional course reviews were conducted by Joanne Ballantyne and Corneliek Demeter.

The new 5003E-Different Strokes Need Different Codes bundled course is offered at no charge to all CIHI Core Plan subscribers. You can register today by logging in to CIHI’s Client Services and select the Learning Centre. If you don’t have an account, you can create one here.  

Completion of this course will earn CHIMA’s professional members 3 continuing professional education (CPE) credits with the Canadian College of Health Information Management.