April 30, 2013

Dual Coding: It’s Time to Practice for ICD-10

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As the Oct. 1, 2014 ICD-10 compliance deadline looms, many providers are readying their coders for the magnitude and breadth of the new coding system. Beyond the obvious challenges of training your coders, avoiding reimbursement losses and actually meeting the compliance date, there is the additional challenge of uncertainty. How will you know that you will be ready to flip the switch on Oct. 1, 2014 without any practice?

It’s time to join the dual-coding movement. In a recent Talk-10-Tuesday poll, 18 percent of respondents indicated that they already are involved in a dual-coding effort or plan to begin one by year’s end. Dual coding refers to coding in both ICD-9-CM and ICD-10-CM/PCS in the same patient health record. Although doing so may make it seem like you are losing productivity at first, the long-term benefits of a dual-coding movement will far outweigh any initial loss. Making dual coding part of your strategy makes sense because it provides you with the information you need to reduce the impact of the switch to ICD-10. It should be of paramount importance to any provider organization.

You can start by performing an ICD-10 documentation and systems assessment, then analyzing the outcomes. A well-thought-out dual-coding strategy can eliminate problems in critical reporting areas. Next, identify how coders, clinicians and other impacted staffers with your organization are being educated on ICD-10. Dual coding should be a critical part of your training plan, because it involves patient charts being formed in real time, but comprehensive ICD-10 education is essential to ensure that your staff is well-versed in all areas impacted by the new coding set. Third, assess what mitigation plans and testing systems are in place to ensure that reimbursement will not be impacted. With dual coding, your finance team can develop strategies tailored to your organization to allow for revenue reimbursement impact analysis meaning you can align your budget with your most critical service lines and most common patient stay types.

In 2012, a large West Coast facility was concerned about the potential impacts of ICD-10. It was looking for a creative approach to mitigate the risks associated with the transition to the new coding set; specifically, facility leaders were  concerned about accounts receivable/DNFB, documentation and recognition of patient acuity, quality data and scorecards, and coder productivity. The Precyse team rose to the occasion with a dual-coding plan that helped them “know what they didn’t know” sooner so they could adjust accordingly and mitigate potential issues.

One thing the Precyse team noticed during this project is an increased anxiety level even among the most seasoned coders. Most of it has been self-imposed, but stress levels are much higher than we anticipated because our coders already are seeing a decrease in their productivity. We feel this really hammers home the notion that the sooner you start preparing and training your coders, the better off you’ll be. If you launch your dual-coding program now, your coders will be much more comfortable when implementation time comes.

By implementing a dual-coding program, facilities will improve education and training for their coders as well as take the necessary steps to optimize financial reimbursement. They say that practice makes perfect – and striving for perfection when it comes to ICD-10 will increase coder productivity and improve quality throughout your organization.

About the Author

Cindy Doyon, RHIA, is vice president of coding and client audit services with Precyse, a leader in health information management (HIM) technology and services.

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