By Lisa A. Eramo
Assess. Educate/train. Practice. Experts say these three primary steps will be essential to ensure that coders can correctly report ICD-10-CM/PCS codes once the new coding system goes into effect.
CMS’ decision to delay implementation until October 1, 2014, gives coders even more time to prepare, says Gloryanne Bryant, RHIA, CCS, CDIP, CCDS, an AHIMA-approved ICD-10-CM/PCS trainer in California with more than 30 years of HIM experience. “We can—and are—using the time to complete more of our readiness activities and tasks. Having a well-organized implementation and readiness plan is key,” she says.
Step #1: Assess
Individual coder assessments determine what, if any, anatomy and physiology or other courses coders must take, says Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CPMA, CEMC, CPCD, COBGC, CCS-P CDIP, an AHIMA-approved ICD-10-CM/PCS trainer and senior manager at Blue & Company in Indianapolis, Ind. Coders may also fill in any knowledge gaps by:
- Attending ICD-10-CM/PCS boot camps
- Taking online courses,
- Purchasing books
- Participating in a wide variety of other educational activities
Unlike physician coders who tend to possess an in-depth knowledge of anatomy related to the particular specialty in which they work, inpatient coders need a broader knowledge base to be successful in ICD-10-CM/PCS, says Grider. “Inpatient coders work with a broad range of different conditions and diseases. Coders will struggle especially with ICD-10-PCS unless they have that anatomy expertise under their belt.”
Designing ICD-10-CM/PCS coder training programs without performing individual coder assessments is possible, but not necessarily cost effective “I don’t think it hurts anyone to go through an anatomy and physiology refresher every couple of years,” says Grider. “The problem is that it costs money.” If an organization employs 30 coders, but only half of them needed the anatomy and physiology training, the organization may save money by performing the initial coder assessment.
Many vendors offer secure, online testing to gauge coders’ proficiency with ICD-9-CM as well as anatomy, physiology, and pharmacology, says Grider. Assessments should already be well underway or at least in the plan for early 2013, she adds.
Ssome hospitals that plan to eventually employ utilization review (UR) nurses as clinical documentation improvement (CDI) specialists are testing these specialists’ knowledge of ICD-9-CM as well as anatomy and physiology using the same tests that coders take. “Hospitals are finding that their range of skill set related to anatomy and physiology is in the high 70th percentile. So even some of the nursing staff needs to be updated,” Grider says.
In general, CDI specialists who haven’t received formal coding training may benefit from in-depth ICD-10-CM/PCS training as well, says Grider. “Our UR nurses are responsible for getting patients admitted as inpatients. The only way they can do this is if the diagnosis meets medical necessity for an inpatient stay. Well, it makes sense for them to have the coding training,” she says.
Step #2: Educate/train
Once coders complete the assessments, hospitals can begin to develop education and training programs tailored to staff needs.
Grider and Bryant agree that coders shouldn’t receive in-depth ICD-10-CM/PCS training until early 2014.
“Nobody should wait until the third quarter of 2014 to conduct their [actual ICD-10-CM/PCS] training,” says Bryant. This training should take place prior to any education on the core medical sciences of medical terminology, anatomy, physiology, disease process, and pharmacology, she adds.
Although training schedules and timelines will be hospital-specific, they should generally follow this outline, says Grider:
2013
- Anatomy, physiology, and pharmacology training for coders who need it based on assessments. This training should take place in early 2013 to allow for more in-depth instruction throughout the year.
- Basic ICD-10-CM/PCS training (and a review of anatomy of physiology) for most common diagnoses and procedures. This training should take place monthly during staff meetings after more formal training has occurred.
2014
- In-depth ICD-10-CM/PCS coder training. This should take place in early 2014 to allow coders to perform dual coding six months prior to implementation. “If hospitals plan to start the ICD-10 dual coding functions sooner, then coders are going to need the in-depth training sooner than 2014,” says Grider. “But it’s doubtful that most hospitals will be ready to go until 2014.”
Grider says HIM directors and coding managers must answer these important training-related questions:
- Which coders need training, and what type of training do they require?
- Where or how will coders receive that training?
- Will everyone receive training at the same time, or will it be staggered?
- Will the hospital purchase training or build its own training program internally? Alternatively, will hospitals use the train-the-trainer model?
- Will the training require overtime pay? If so, how much?
Step #3: Practice
Dual coding is extremely important, as is simply allowing coders time to practice coding current charts using ICD-10-CM/PCS alone, says Bryant. Planning ahead allows hospitals to build this practice time into their overall education and training plan. However, it will be nearly impossible to allow for practice time if coders don’t receive in-depth training until close to October 1, 2014, she adds.
In addition, providing coders time to practice coding with ICD-10-CM/PCS prior to the implement date also enables organizations to conduct accurate productivity or impact studies. These studies can help organizations gauge how the new coding system may affect productivity and whether additional resources will be necessary to maintain productivity standards, says Bryant.
Thinking ahead
ICD-10-CM/PCS will likely spark a synergy between coders and CDI professionals on which organizations can capitalize, says Grider. “I think this is a good thing because I think it will reduce the number of denials on the back end, and I think it’s going to make hospitals more efficient,” she says.
HIM directors may want to consider holding joint staff meetings with CDI staff and coders now to prepare for this anticipated integration, says Grider. “What the UR nurses do today with patient admissions actually affects the coding on the back end. If everybody understands their role in the facility and how it ties together, that’s helpful,” she adds.
Hospitals also need to consider retention. Organizations must develop a strategy for retaining coders, says Grider. For example, will it offer incentives for coders to remain working at the hospital after being trained? Hospitals frequently invest in training only to find employees leave to join another company and make more money. “How will you stop this when there’s already a coding shortage?” Grider says.
Also think about coder compensation going forward, says Grider. “The buzz now is that coders will demand between 10%-20% more after ICD-10 is implemented because of the complexity of the coding,” she adds.
Finally, consider technology solutions, such as computer-assisted coding, to offset any productivity losses as well as gain efficiency, say Bryant.
Editor’s note: Eramo is a freelance writer and editor in Cranston, RI, who specializes in healthcare regulatory topics, health information management, and medical coding. You may reach her at leramo@hotmail.com.