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ICD-10-PCS is a major departure from ICD-9-CM procedure coding, and as such many Coding Specialists find ICD-10-PCS much more challenging to learn than ICD-10-CM (which still shares many similarities with ICD-9-CM).  In order to ease the transition from ICD-9-CM procedure coding to ICD-10-PCS, over the next ten months, we will provide tips for coding under this system.

Precyse University has received praise for its innovative applications and tools for ICD-10 training in a recent KLAS report titled “ICD-10 Consulting: Roadmap to a Successful Transition.” Engagements for Precyse were completed through the use of technology, so the overall performance scores are not directly compared to the other consulting firms included in the report.

Training tied for the second-highest area of ICD-10 services provided by third-party firms and is the primary area providers claim they need the most help with in preparing for ICD-10. To achieve ICD-10 readiness, providers reported both clinician training (52%) and coder/staff training (40%) were their greatest needs. In the KLAS report, Precyse tied for the top overall Staff Training score and was the “only firm in this report to receive 100% positive comments from their clients about their ICD-10 services,” wrote Erik Westerlind, the report’s author. Precyse clients praised the Precyse University training program as mature, comprehensive and flexible.

“Precyse University offers a one-vendor solution for all ICD-10 education needs within an organization,” said Chris Powell, Precyse president. “We provide each impacted population the education required to be successful in ICD-10. In addition to the comprehensiveness of our solution, we also offer myriad advanced courseware, applications and tools to make the education more practical, relevant and accessible.”

According to the KLAS report, Precyse clients selected Precyse University because of the company’s experience with ICD-10 and coding, as well as its tools and applications. In the report, a Precyse client said, “Precyse had tools that the other firm we looked at did not, and their teaching and training seemed to be ahead of the curve. Their training is visual and virtual. They have an arcade game they use for teaching people … They just had what we wanted.”

Another client reported, “We felt that Precyse's online tools, including the academy and arcade, were easy to use and navigate. The content was educational, and when we shared it with the coding staff members, they were very excited. Additionally, Precyse's pricing was very good.”

The “ICD-10 Consulting” report also noted that providers are anticipating a considerable reduction in the productivity of their coders with the conversion to ICD-10. According to the report, some providers mentioned a projected loss of 50% to 70% in coding productivity. Computer-assisted coding and outsourced coding services can potentially minimize the decrease in productivity, and Westerlind anticipates a growing demand for coding services.

“Precyse has put a lot of time and energy into looking at our coding process and our coding staff from a quality perspective,” said Sandy Wood, Director of Revenue Cycle, Naples Community Healthcare System. “With the training they are providing, we are confident that we will be prepared to meet the challenges that arise when ICD-10 goes into effect.”

Partnering with HealthStream as an exclusive ICD-10 education partner, the Precyse University ICD-10 Education Solution can be provided through an existing HealthStream Learning Center system, a current non-HealthStream learning management system or a custom ICD-10 site for delivery of the education. No matter the current systems or setup, Precyse and HealthStream can deliver ICD-10 education to all of a facility’s employees and affiliated professionals.

On-demand education is essential for a change as large and impactful as ICD-10. As an official Apple™, Google Play™ (Android Store) and Amazon® Store developer, Precyse University has launched ICD-10 smartphone apps to make content easier to deliver and update for all learning populations. Precyse University has also launched courses capable of running on mobile-ready devices, specifically optimized for the iPad®.

“We believe that healthcare professionals will need to ‘touch and feel’ ICD-10 prior to the go-live,” said Thomas Ormondroyd, BS, MBA, vice president, general manager, Precyse Learning Solutions. “From coding to documentation to general interaction, learners need the practical application of what they have learned to build a solid understanding and capability. The Precyse University ICD-10 Innovative Applications and Tools allow our learners to have this interactive and practical experience. From real-life practice with our Virtual Simulators to lighthearted fun with our Arcade, our learners will enjoy unique and innovative education.”

Career Step, an online education company offering corporate education solutions, has announced its partnership with Inquisit, a company focused on facilitating professional healthcare education. This partnership is a result of Career Step’s relationship with Amerinet, a leading national healthcare solutions organization, which has a strategic education partnership with Inquisit, according the company’s news release.

“At Career Step, we’ve built our professional coder ICD-10 training programs on over 20 years of experience helping adult learners gain the skills they need to be successful,” said Mike Hodgson, Career Step vice president of healthcare and corporate partnerships. “Our agreement with Amerinet and new partnership with Inquisit are very exciting because they allow us to share this expertise with more of the health systems, hospitals, and individuals preparing for the monumental transition to ICD-10 that’s coming in October 2014.”

Career Step’s offering ensures that healthcare professionals receive the most up-to-date ICD-10 information and provides Inquisit’s clients access to ICD-10 experts with years of knowledge and experience.

Career Step's ICD-10 training program― The ICD-10 Solution― is designed to help professional coders and other healthcare staff prepare for the transition to ICD-10 through dedicated project management, assessments and reporting, biomedical science training, ICD-10 code set training and seminars. These products are approved for continuing education units by the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC), according to the company’s news release.

“We are privileged to add Career Step as one of Inquisit’s invaluable partners,” said Dee Morgillo, MEd., MT (ASCP), vice president at Inquisit. “With a shared mission of furthering the growth and development of healthcare professionals through online training, educational workshops and seminars, we can offer the most up-to-date information n from one of the most knowledgeable sources of ICD-10 expertise in the industry.”

As we work with healthcare clients of all sizes, types and geographical areas, we are coming to understand that one size does not fit all when it comes to the bill associated with the educational strategy for your transition to ICD-10. For example, when your organization performed its original assessment and gap analysis, perhaps a Web-based approach leveraging your organization's learning management system (LMS) appeared to be the path of least resistance. After further study, however, many organizations have concluded that their educational plans are sorely lacking a focused approach, or perhaps they appear to be too deep for some audiences and too abbreviated for others. Some organizations have taken the approach of folding their plans into their annual mandatory education (AME) requirement, mandating deeper content study acquired through professional organizations. Although many providers have invested in a multi-pronged approach of Web-based education, sending their coding staff to the American Health Information Management Association’s (AHIMA's) ICD-10 Academy to prepare staff in hope they will find the time to develop custom educational programs, other organizations are sitting on the sidelines until the transitional date gets closer.

Whatever approach you have taken – perhaps based in part on a limited budget, geographic distribution of your workforce, preferences of your medical staff, or your typical educational approach – the most successful strategies involve the aggregation of roles based on depth and the need for customized content. Learner pathways with a clearly defined curriculum make the most sense, with a deliberate emphasis on coding, CDI, medical staff and those who heavily rely on secondary clinical data (quality and outcomes reporting, research, decision support, etc.).  Despite the uniqueness and complexity of your organization, try not to make this process overly convoluted. Reuse content for your baseline training, introducing minor tweaks to reduce the level of difficulty of the development effort. Also, seek advice from a stakeholder group representing key constituencies in your organization rather than a few squeaky wheels who have preferences that may not play well to the masses.

Also, consider serving up the content in a multitude of formats to take into consideration geographical challenges and providers who may have a home elsewhere (allow a reciprocity relationship with other hospitals in your service area, also). And consider partnering with your local community colleges or universities if they offer classes that your coding team can take advantage of for their foundation training and core ICD-10 content.

Regardless of the approach you employ, appoint someone to be in charge of ICD-10 education. Resource allocation will vary depending on the size of your organizational footprint. All courses offered should have associated evaluations and post-tests tied to CEUs. To ensure that your workforce is trained properly, you need to mandate the training and ensure that it is tracked via a performance-based set of metrics, either through your LMS system or a third-party system. The optimal education roadmap features a front-end assessment used to identify gaps in coder knowledge, along with a customized pathway through which staff can access information and demonstrate competency. This ensures that physicians are not sifting through detailed content that is not relevant to what they need to know in order to improve the integrity of their documentation. It also should provide the detail necessary to facilitate quality coding, and should ensure that patient access and revenue cycle staff know what changes will be relevant to their workflows and back-end processes.

However you go about this task, make it fun, relevant, useful, relatable and well-designed. Don't drag out the content to meet a preconceived set of criteria and duration, and offer choices to account for learning preferences and logistical requirements. Consider the unique challenges of your non-employed medical staff as well: don't force them into a cookie-cutter scenario that doesn't fit their busy practices. Finally, explain the "why behind the what" in order to ensure they understand why this matters and what will change post-Oct. 1, 2014.

The time is now to plot your educational roadmap, and don't get lost in your quest to ensure that your workforce has acquired the knowledge to operate successfully in an ICD-10 world.

About the Author

Cassi Birnbaum, MS, RHIA, FAHIMA, CPHQ, is vice president of health information management for Peak Health Solutions, specializing in providing remote coding, auditing, data collection and analysis, clinical documentation improvement, ICD-10 transition, and HIM resource planning services nationwide. For the last 15 years, Birnbaum was the director of health information and privacy officer at Rady Children’s Hospital in San Diego, Calif.

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News from “Inspector Documenteau,” a.k.a. the Center for Medicare & Medicaid Services (CMS), may have reached your desk around November 9 and then again on December 7, 2012, regarding progress notes, amendments, corrections, and delayed medical record documentation. At a recent meeting, I found that Inspector Documenteau is gearing up the team to validate how well medical record documentation supports medical necessity of provided services.

The CMS Transmittal 438 on November 9 documents how the reviewers are to make determinations when using the various types of forms such as Progress Notes, Limited Space Progress Note Templates, Open Ended Progress Note Templates, and other supplemental forms.

Inspector Documenteau’s team consists of organizations we all are familiar with the following:

  • MACs (Medicare Administrator Contractors)
  • CERTs (Comprehensive Error Rate Testing)
  • RACs (Recovery Audit Contractors)
  • ZPICs (Zone Program Integrity Contractors):  This group has a reputation of being the “bulldogs” in this industry, and they are scored based on the amount of overpayments recovered and the number of enforcement actions handled and referred to law enforcement.

How does this affect our daily process for communicating to the provider documenters? Are our providers documenting according to Health Information Management industry standards? Is the documentation thorough, complete, and accurate for the services provided in the medical record (MR)?

Here is a quick synopsis of the information CMS will be looking at:

  • Progress notes created with Limited Space Templates (LSPs): These will not provide sufficient documentation for face-to-face visits and medical examination. The reason for this determination is that these templates often use checkboxes with predefined answers. CMS has consistently discouraged the use of checkboxes in templates and continues to reiterate the reason in their Transmittal communications. It has been discovered that Limited Space Templates (LSPs) fail to capture sufficient detailed clinical information to demonstrate that all coverage and coding requirements are met. Additionally, CMS has noted that the selected information is normally focused on reimbursement; therefore, these documents generally do not provide sufficient evidence to adequately demonstrate medical necessity criteria.

The amount of necessary clinical information needed to demonstrate that all coverage and coding requirements are met will vary depending on the services; therefore, the entity needs to refer to the Local Coverage Determination policy for additional details.

Limited Space Templates need to be developed allowing optimization for full and complete entry of information supporting that coverage and coding criteria are met.

  • CMNs, DIFs, supplier-prepared statements, or physician attestations: One attendee asked, “Can we use CMNs (Certificates of Medical Necessity), DIFs (DME Information Forms), supplier-prepared statements, or physician attestations by themselves as medical necessity documentation?” The Inspector shouted, “No, you cannot!” None of these documents “provide sufficient documentation of medical necessity even if signed by the ordering physician.[i] And none of these types of documents will be considered by my team when making a coverage or coding determination.”
  • Financial liability for ordered services provided by another entity: Physicians and Licensed/Certified Medical Professionals (LCMPs) need to be aware that when ordering a service to be provided by another department, organization, or business, there are specific requirements to be documented. The documentation of information in the order must be adequate to support the medical necessity of the service to be provided by the entity at the time the order is documented. Failure to provide this documentation from a supplier’s request may trigger increased monitoring of the provider’s Evaluation & Management services.

  • Amendments, corrections, or delayed entry changes: The December 7 Transmittal 442 was related to amendments, corrections, and delayed entries in a medical record. Initially, the CMS representative covered principles for record keeping, noting the format was not important (e.g., paper or electronic). However, documents submitted to the reviewers containing amendments, corrections, or delayed entry changes must:
    • Clearly and permanently identify the entry,
    • Clearly indicate the date and author of the entry, and
    • Not delete but instead clearly identify all original content.

Corrections: The Inspector also described how these corrections should be made in both the paper medical record (MR) and the electronic health record (EHR):

  • Paper MR corrections should be completed by striking a thin single line through the original entry, while making sure the original content can still be read. To this, the corrected information, the author of the alternation’s signature, date of the revision, and reason for correction should be added.
  • Electronic Health Records (EHRs) must follow the same standards as paper MR corrections. In addition, systems/programs must be able to distinctly identify any corrections and provide a reliable means to clearly identify the original content and the modified content, as well as the date and authorship of the original and for each modification of the EHR.

If any member of the review team identifies medical record documentation with potentially fraudulent entries, the reviewers/auditors shall refer the cases to the ZPICs, which may refer the case to the Regional Office or State Agency.


My takeaway is this: Don’t delay. Conduct a sample review of the current process for these areas and determine the risk liability for the organization, with a strong possibility of involving the Compliance Department. Then we will be able to validate we are following industry standards as documented by our professional organization, AHIMA (American Health Information Management Association), titled: Legal Documentation Standards. This information can be located on its website:

Policies and procedures related to this information may have to be updated. In addition, the internal audit team will need to add a focused audit objective relating to these topics ASAP to determine the current level of compliance. There is always work to be done, but we need to work smart and be as effective and efficient as possible.

Let’s go to work!

About the Author

Gretchen Dixon, MBA, RN, is a consultant at Hayes Management Consulting. She is a Certified Healthcare Compliance Officer, Certified Coding Specialist and internal auditor with more than 20 years of experience in the healthcare industry with an emphasis on clinical documentation improvement, compliance, revenue cycle and coding.

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[i] Medicare Program Integrity Manual, Chapter 3 – Verifying Potential Errors and Taking Corrective Actions; Guidelines Regarding Which Documents Review Contractors Will Consider

Those of you who, like me, majored in the “dismal science” (also known as economics) will remember Adam Smith as the first modern economist. His classic work was The Wealth of Nations, in which he immortalized the concept of the invisible hand to describe the self-regulating behavior of the market:

“As every individual, therefore, endeavours as much as he can both to employ his capital in the support of domestic industry, and so to direct that industry that its produce may be of the greatest value… led by an invisible hand to promote an end which was no part of his intention… By pursuing his own interest he frequently promotes that of the society more effectually than when he really intends to promote it.”

In other words, Smith writes that by pursuing what is best for the individual (and, by extension, a payer or provider), the market (the invisible hand) creates a greater benefit for society. Another way to think of this is the concept of enlightened self-interest, and that’s where our industry’s behavior relative to ICD-10 comes into play.

In one of my prior articles, I used the phrase from the movie Jerry Maguire “Help me help you” to show how to gain better cooperation in assessing ICD-10 readiness. That is an example of enlightened self-interest. For example, forward-thinking payers want to make sure their providers are going to be ready for ICD-10. It is in their interest to do so because they know that this will make the transaction testing run better (and save money) as well as reducing resubmissions, call center volume, and so forth, post the conversion date (also saving money).

There is another school of thought. To use another movie analogy, consider the movie The Fugitive. When the Harrison Ford character says, “I didn’t kill my wife,” the marshal, played by Tommy Lee Jones, replies, “I don’t care.” Substitute “I’m not ready for ICD-10” and many organizations will reply “I don’t care.” Their logic is that it is the provider’s responsibility to be ready and they must deal with the consequences of a rejected claim, etc.

The problem is that if all large organizations take that approach, the post-cutover environment will be very costly for them. I can image lots of claims rejections resulting in significant rework for both provider and payer, with the likelihood of a massive increase in calls from the providers. There is a cost to that, and many large health plans have concluded that an ounce of prevention is better than that pound of cure.

Notice that I did not single out payers. I used the term “large organizations” because there is a similar self-interest at work for providers. Payers will not be able to do testing with their entire provider network. It is prudent for them to focus on their largest submitters and the specialties with the most complex and costly codes. Many payer outreach efforts focus on assessing the readiness of their providers and gathering the data necessary to prioritize testing resources. In turn, it is in the self-interest of a hospital to do similar outreach to its affiliated physicians. Forward-thinking hospitals realize they need their docs to get the right information into the chart, and that it is nobody’s interest to have claims miscoded or reworked. It is not in the hospital’s interest to have its affiliated physicians’ productivity plummet because they are not ready for ICD-10 and are in a cash-flow crisis because of rejected claims. That’s enlightened self-interest and the invisible hand at work.

About the Author

Hugh Kelly is the
 vice president of marketing and sales for Avior Computing. 

Mr. Kelly has more than 20 years in the software and technology business at organizations ranging from start-ups to publicly traded companies. Mr. Kelly has been involved in all aspects of marketing and sales, with considerable focus on channel development.  During his executive tenure, his organizations have raised over $200M in external capital.  He is a venture partner at Ascent Ventures.

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Precyse has been named Best in KLAS for Transcription Services in the recent KLAS report titled “2012 Best in KLAS Awards: Software & Services.” Precyse is also the No. 1 ranked vendor in the KLAS “HIM Services 2012: Helping to Weather the Storm” report for Transcription Services, according to a company news release.

Precyse achieved the top medical transcription service organization (MTSO) ranking, receiving very high marks for its turnaround times (TAT), report quality, account management and administrative tools. Precyse was the only fully rated firm to score above average in all four performance areas, and according to the report, Precyse received the highest score of any firm in report quality, demonstrating consistent service delivery among its client base.

“Providers recognize the critical nature that vendors play in improving healthcare delivery,” said Adam Gale, KLAS president. “Thus, a growing number of providers are weighing in on vendor performance. It speaks volumes that providers want to be heard and be counted. And vendors are listening.”

The clinical documentation of the patient story is critical to the success of a healthcare facility. Without accurate, concise clinical documentation it is impossible to achieve Core Measures, to transition to ICD-10 or to establish clinical data mining to produce required statistics. Precyse's combination of technology, processes and services accelerates turnaround time, reduces costs, minimizes capital outlay and transforms dictation into meaningful clinical information for ultimate patient care while achieving financial goals.

“I am so proud of our Precyse colleagues who believe in our mission and work every day to make this Best in KLAS recognition possible,” said Chris Powell, president of Precyse. “This type of recognition does not just happen. It takes commitment, hard work and a relentless focus on continually improving. I am thrilled to see Precyse honored as Best in KLAS for Transcription Services this year, not to mention the year-over-year consistency of our second place ranking for the previous three years.”

“Precyse has been an excellent company to work and partner with. Their turnaround times, reporting and customer service are all excellent,” wrote one customer on the KLAS website. “I recently had them help me develop an interface with our EMR vendor. They completed this project on time and within budget, and it is working flawlessly. Lastly, unlike other vendors that I have worked with and am currently working with, I actually have seen a cost reduction with Precyse's services for the past couple of years. Precyse is an excellent partner, and their customer service makes them my personal favorite.”

Another client wrote, “Precyse has done an excellent job for us since we contracted with them a few years ago. They have been a pleasure to work with, and their turnaround time always and easily meets our needs. … “They are a trusted partner with us, and I can't see why we would ever change to another vendor. I would highly recommend them to anyone looking for transcription services.”

Precyse received praise for its coding accuracy, great relationships, responsiveness and professionalism in the KLAS “HIM Services 2012” report.  In that report, the majority of Precyse’s coding customers claimed Precyse’s service is on par with its highly rated transcription offering. Precyse was praised for its personal touch and customer service and received high marks for quality, turnaround and accuracy.

Podcast Date: 1/22/2013

In relation to a CDIP, what is your biggest concern related to I10?

Number of Response(s) Response Ratio
A. Creating a CDIP 26 11%
B. Re-evaluating your CDIP 22 9%
C. Staffing your CDIP 14 6%
D. Educating your CDIP staff 28 12%
E. Educating your Physicians 150 63%
Total Results: 240 100%

The expectation is that ICD-10-CM/PCS will improve the data being collected, which in turn will allow data-driven outcomes to improve the delivery and quality of healthcare.

Although clinical documentation is the foundation of the health record, sometimes there are gaps within the documentation or within the translation of the documentation into current ICD-9-CM codes. Many healthcare organizations have turned to clinical documentation improvement (CDI) programs to assist with achieving quality clinical documentation, especially in anticipation of ICD-10.

How do we define quality clinical documentation in today’s healthcare environment? Back in the beginning, clinical documentation improvement was specifically about achieving the documentation needed to support the correct DRG and reflect appropriate reimbursement. Proactive CDI programs evolved to offer support with some of the core measure data collection efforts and present on admission (POA) indicators. The documentation was then “packaged up” and sent off to the Health Information Management (HIM) department to be coded with ICD-9-CM codes. Each entity working within its own silo, with specific department goals and outcomes, was considered normal and acceptable protocol.

Jumping to 2013, CDI efforts to achieve quality clinical documentation need to not only support MS-DRG assignment, but also a plethora of quality initiatives stemming from the Meaningful Use (electronic health record incentive program), Value-Based Purchasing, the Inpatient Quality Reporting Program, the Hospital Readmissions Reduction Program, and a host of other federal quality initiatives. In addition, we cannot omit the transition to ICD-10-CM/PCS that will also require more specific documentation. From an HIM coding perspective, the expectation is accurate coding. Coding accuracy includes the correct MS-DRG assignment, accurate reporting of the present on admission (POA) indicators, reporting of the correct discharge disposition, not over-reporting or under-reporting codes that reflect complications, patient safety indicators and/or hospital-acquired conditions, with the ability to withstand excessive outside audit scrutiny, including the Recovery Audit Contractors. By the way, a note to the professional coders: Hospital administration would like you to do all of the above and still drop the bill within three days. Can we afford to continue to work in silos?

In order to achieve what one could consider data-driven outcomes in today’s demanding and complex healthcare environment, all entities within the healthcare organization need to work in collaboration.

Clinical documentation is the foundation of the health record and, simply stated, requires accurate reflection of all conditions and treatment for a patient in order to appropriately reflect the severity of illness and risk of mortality that will justify level and quality of care provided. This information must then be translated appropriately with the correct codes for reporting in ICD-9-CM. This desired outcome can only successfully take place with communication and processes adopted to “check and balance” all of the moving pieces.

For example, all or select patient safety indicators (PSI) could be flagged when coded and a process put into place to hold a record, prior to billing, for review from clinical documentation, coding, and quality to verify completeness of the documentation and appropriateness of code assignment.

To demonstrate, let’s take a look at Patient Safety Indicator (PSI) #3, Pressure Ulcer Rate, which includes cases meeting the inclusion and exclusion rules for the denominator with an ICD-9-CM code of pressure ulcer in any secondary diagnosis field and ICD-9-CM code of pressure ulcer stage III or IV (or unstageable) in any secondary diagnosis field. A POA indicator of YES is an exclusion. Any diagnosis of hemiplegia, paraplegia, or quadriplegia is also an exclusion for PSI #3. The patient developed a stage III pressure ulcer after a lengthy hospital stay, which was already assigned to the highest level MS-DRG. The pressure ulcer had POA indicator of NO, but patient had other major co-morbidities (MCC). This patient had a history of a previous CVA with hemiplegia that was documented in a nursing note but not found anywhere else in the record. The Clinical Documentation Specialist did not pose this question to the physician because there were already other major co-morbidities documented. The coder did not hold up the record for additional documentation because it wouldn’t change the MS-DRG and that bill needed to be dropped. The quality department wasn’t notified of the final coded PSI until after the bill was already released.

Without education, communication, and collaboration from all entities, PSI #3 was erroneously reported for this case and will negatively affect quality reporting for this facility. With a process in place to flag any case when a PSI code is assigned, a second review could have prevented this case from being reported inappropriately. Ideally, this collaboration should take place concurrently in order to acquire appropriate documentation from provider prior to discharge.

As the complexity of documentation, coding, and quality requirements increases, so must the clinical, coding, analytical, and communication skills of those professionals working within this field. Continuing education is essential to all CDI and coding programs. With the transition to ICD-10-CM/PCS and increased emphasis on data-driven outcomes, healthcare organizations must acknowledge this common goal and work together to achieve the most accurate outcome results, driven by quality clinical documentation.

About the Author

Lisa Roat, RHIT, CCS, CCDS, is the manager of HIM product development and compliance for J.A. Thomas & Associates, a Nuance Company. She is an AHIMA-approved ICD-10 CM/PCS Trainer.

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References: Agency for Healthcare Research and Quality. AHRQ Quality Indicator, Version 4.4, March 2012 Technical Specifications.

EDITOR’S NOTE:  CHIME, the College of Healthcare Information Management Executives, is holding its annual CIO Forum in San Antonio. The conference continues today.

San Antonio, TX: Oct. 27, 2011---Even those far along the ICD-10 conversion path worry that they’re going to face difficult challenges ahead.

At a town hall meeting on ICD-10 conversions at the CHIME11 Fall CIO Forum, executives charged with implementing the new coding system in their facilities told attendees about the importance of lining up support for the transition and incorporating multi-disciplinary and executive support.

Rady Children’s Hospital has been working on the ICD-10 transition for more than two years, but executives there realize that the lion’s share of the work lies ahead of them, said Albert Oriol, chief information officer of the organization.

“We’re on the way, but we’re not seeing the finish line by any stretch of the imagination,” said Oriol at the meeting, sponsored by the College of Healthcare Information Management Executives.

Three Sponsors for ICD-10

Rady Children’s ICD-10 initiative has three executive sponsors the chief financial officer who owns the revenue cycle impact, the chief medical officer, because a key impact of the transition will involve a need for substantially improved documentation, and Oriol.

“After doing a gap analysis and needs assessment, the bottom line was documentation,” said Cassi Birnbaum, director of health information and the privacy officer at Rady Children’s. “We were able to engage our physicians, but there are other reasons to shore up our documentation.”

Many healthcare organizations see the ICD-10 transition as posing competition for resources with plans to implement electronic health records. But Rady Children’s sees synergies between the initiatives, Birnbaum said. “Some of the people who we need at the table for ICD-10 are the same individuals who are leading our EMR rollout,” she said.

Synergies at SSM

That’s also true at SSM Health Care, said Carole McEwan, project manager for ICD-10 at the hospital system that operates facilities in four states in the Midwest.  “I report to the CFO of the organization,” she said. “We used the same steering team that our electronic health record rollout was using.”

The CIO must be involved in the ICD-10 transition process, but must realize that he or she needs other key leaders to gain the necessary organization-wide support, McEwan said. “The optimal role for the CIO is he should be a key leader, a key enabler. He needs to co-own the transition, but he or she also needs the clinical and revenue cycle ownership as well.”

Both Rady Children’s and SSM Health Care realize they will need additional human resources in order to successfully make the transition.

“Health information management and HR directors are working to make sure that we have the right number of coders in place,” McEwan said.

More Coders Needed

Having more coders in place will be necessary in order to make up for the expected delays coders will experience in making the transition to the more granular ICD-10 codes. Some estimates suggest that it will take coders 30 percent to 50 percent longer at first.

Rady Children’s is considering the use of automation to assist in the transition, Birnbaum said. Tools such as computer-assisted coding can help with the process, while natural language processing applications also might be useful in the transition.



CIOs also will face concerns as they look to transition existing databases to the new coding system or determine how to translate their information.

“Because we’re an academic institution, we do a lot of research, and we have hundreds of (Microsoft) Access databases that are being used by researchers for projects,” Oriol said. “We’re going to need to tackle that. We’ll have to make a tough decision about getting the information out of those small databases and moving it to a central data warehouse.”

While the transition will be expensive, there’s no choice for healthcare organizations that otherwise will risk losing money if they’re not ready to move to ICD-10 on October 1, 2013. An expected expense is running both ICD-10 and ICD-9 coding systems, which Rady expects to do as long as necessary until its payers are prepared to operate entirely within the new coding system.

About the Author

Fred Bazzoli is CHIME’s senior director of communications. Before coming to CHIME, he was an editor at Healthcare IT News and Health Data Management magazine.

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Related Article: A Day in the Life of ICD-10