Updated on: March 16, 2016

Diffuse the Intimidation” Surrounding Number of ICD-10 Codes, says Physician Trainer

Original story posted on: March 5, 2013

The way to get physicians interested in better documentation is to address the quality of patient care. That’s one bit of the advice that Donald Rappe, MD, medical director, documentation and coding, Group Health Cooperative, gave to listeners on the March 5 broadcast of Talk-Ten Tuesday.

Rappe and the two other guests on the show were speaking live from the HIMSS convention in New Orleans. They included Rhonda Buckholtz, CPC, CPMA, CPC-I, vice president of ICD-10 education and training, AAPC, and Mike Hodgson, vice president of healthcare and corporate partnerships, Career Step.


Establishing Communication

Buckholtz and Rappe teamed up at the HIMSS conference for a presentation entitled “From Coding to Communication: ICD-10 Readiness for You and Your Clinical Team.” “Among other items, they discussed strategies for ICD-10 readiness, such as the alliances that need to form between coding professionals and physicians.

“The business of I-10 creates the necessity of team support,” said Rappe. “Physicians and coders bring two different skill sets, and, as long as they are talking together, the transition will go more smoothly.” This is also true when it comes to physicians, whose language is “clinical speak,” and payers, whose language is “code speak. “Documentation allows translation between the two,” he said.

As Rappe explained, physicians “have a duty to document what they are doing” in the medical record. If the chart isn’t well-documented, the physician’s partners, who include coding professionals as well as payers, “don’t know what’s going on,” he says, and this will “lead to problems” in ICD-10.

Physicians also need to realize that their “documentation needs to be precise,” Rappe said. Tools such as the electronic health record and computer-assisted coding may make things easier, but physicians need to be careful because “it makes people get sloppy.”

Although there are many other things that physicians need to know about ICD-10, confusion surrounds the large increase in number of codes available in ICD-10. As Rappe explained, there are “lots of codes but few clinical concepts to master,” and it’s important to “diffuse the intimidation” related to the number of codes.

“What is important in I-10 is laterality—which side or both sides? Acute or chronic? These are simple concepts that physicians should grasp even though there are so many different codes.” However, a few specialties—orthopedics, cardiology, obstetrics—have more codes than most, and they should know that fact before they start their code-training.

In their HIMSS presentation, Buckholz and Rappe also reviewed clinical documentation issues related to I-10. As Buckholz said, they discussed “how those issues could translate to hurtles,” such as how to prepare physician practices and get provider buy-in.

In addition to ICD-10, there are other big changes and initiatives ahead too, such as meaningful use, and, as Buckholtz says, these two worlds will collide.

“Those doing meaningful use now should realize that the measures will change, and we don’t know how but we’ll need to react quickly,” she says. “It will be an eye-opener for physicians starting to get their feet wet with EMR implementation.” They might want to do that before I-10 comes along, she says.

“For CDI, we stress that making changes for I-10 will make all other initiatives and regulations fall into place. Effective documentation promotes good patient care. Reimbursement will be timely and denials will go down.”

Assessing Retention


Mike Hodgson, Career Step, an online education company, provided highlights of a study the company conducted related to pre-and post-training assessments.

Between March 2010 and October 2012, Career Step assessed more than 800 coders to get a baseline of their knowledge of biomedical sciences, especially medical terminology, anatomy, pathophysiology, and pharmacology. The goal, said Hodgson, was to measure their retention “right off the top of their heads” and then their retention following I-10 training.

Participants came from a wide range of patient-care settings and brought with them various credentials and job titles, including that of clinical documentation improvement (CDI) specialist.

Somewhat surprisingly, the results for were similar for individuals with credentials, including CDI specialists, and those with no credentials. But not surprisingly the study proved that the participants’ knowledge increased after biomedical science training.

According to Hogson, study participants prefer training that allows them to gauge their knowledge as they go along the educational path. Specifically, doing exercises before the end of the module or exam, so they knew they were retaining knowledge.

Hodgson offers this advice to those learning, or who will learn, ICD-10: “Know your strengths and weakness and study those areas where you need more help. The project plan should include very little gap between code-set training and the biomedical sciences’ training.”




From Coding to Communication: ICD-10 Readiness for You and Your Clinical Team.

March 5, 2013 Talk Ten Tuesday Broadcast

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.