March 5, 2013

Dual Coding versus Double Coding: An ICD-10 Implementation Plan

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Consider the practice known as dual coding – or is it double coding? That is a very good question to ask yourself as you work toward ICD-10 implementation. The difference between the two can be difficult to discern at first, but know this: dual coding can be your avenue to a successful transition to the new code set for your organization.

Dual coding means coding the same record in both ICD-9-CM and ICD-10-CM/PCS, using each code set and all of the associated coding conventions and guidelines throughout (some also call this “native coding”). It does not mean using mapping or crosswalks to assign codes in another code set following the initial code assignment.

Dual coding also does not mean coding every record in both code sets; that would be “double coding,” a practice that would prove extremely labor-intensive. However, is dual coding every code a reasonably desirable strategy? At this juncture, with approximately 18 months left to go before the implementation date arrives, healthcare facilities cannot afford to perform such reviews, even for a short period of time. What works is a well-designed, practical dual-coding program – a system through which only selected cases are dual coded can have as much, or more, benefit than total re-coding of all records can offer.

Elements of a well-designed program include:

  • A strong teaching method: There is no better way to learn what you don’t know than to perform a trial run in a safe environment. Offering education in dual-coding mode can supplement other training methods and may even reduce your overall training costs.
  • Coding confidence builders: Coders gain speed and accuracy in the new system when they get to work in a controlled environment. Confidence is built with every successful code assignment and every aspect of learning.
  • Documentation assessment: By tracking missing documentation, the dual-coding method provides immediate feedback in the arena of the clinical documentation improvement process. Paying for a documentation assessment by outside vendors is not always necessary. By keeping this element internal, your coders can strengthen their skills and locate missing documentation within the records with which they are most familiar.
  • Database testing: Dual coding provides the robust database necessary to participate in end-to-end collaborative testing with payors.
  • Financial analysis: While the Centers for Medicare & Medicaid Services (CMS) says that ICD-10-CM/PCS implementation will be budget-neutral, it meant their budget and not yours. There will be winning and losing service lines within your case mix, rendering a potential loss or gain in revenue.  Dual coding can offer financial analysts the data they need to move forward with ICD-10.

While you may have heard this before, there are a few things you need to consider before starting a dual-coding program.

  1. ICD-10-CM/PCS training: This should be complete before the program can be implemented. While coders will not know everything when they begin the dual-coding process, they should have practiced using both ICD-10-CM and ICD-10-PCS systems and the new terminology.
  2. Level of IT readiness: Vendors need to be able to create separate databases for ICD-9 and ICD-10, and to allow “native” coding in both systems. Crosswalks will not work. With training and IT infrastructure in place, the only rational solution is a manageable dual-coding strategy.

The best strategy is one that is tailored to meet your needs. Here are some sample steps and matters to keep in mind to get your planning moving in the right direction:

  • Divide and conquer: Assign DRGs to the coders with the best technical skills on various subjects in ICD-9-CM, helping develop them into “super coders” for certain diagnostic conditions and/or surgical types in ICD-10-CM/PCS. Remember that not all coders need to code the same DRGs.
  • Quantity matters: Watch your budget, and don’t attempt more than you can afford. Try for a goal of no more than 3 to 5 percent of your discharges, in time. Do the math to determine how many records should be coded in both systems during an average workday. Schedule carefully in order to minimize backlogs and loss of productivity.
  • Just the right stuff: Consider limiting the cases to your top 20 DRGs by volume and any other top revenue-producing DRGs. This is an efficient strategy that can help you learn about your organization.
  • Sequential coding is best: Have coders read the records and code in ICD-9-CM as they normally would. For the cases chosen for dual coding, have the coders assign the ICD-10-CM/PCS codes immediately thereafter. This way, the clinical story is still fresh in their minds. This way they also can see the differences in the code sets more clearly, and recognize the new documentation required for ICD-10.
  • Create a “most wanted list:” Track missing documentation and share this information with the provider staff to help foster comprehension of what you need to do before the implementation date.
  • Brainpower required: Learning takes a fresh brain. Consider having coders work on their dual-coding cases early in the day to maximize education efficiency and to avoid frustration at the end of the day.
  • Time is of the essence: Start as soon as your training schedule and IT infrastructure will allow. With approximately 18 months left to go, now is the perfect time.
  • The power of sharing: Provide time for coders to discuss their difficult cases and to share what they’ve learned about the new systems. Provide supplemental training on areas that present the most daunting coding challenges.

Be strategic as you work toward the implementation date. Use dual coding to your advantage within your overall implementation strategy and you will achieve success.

About the Author

Maria T. Bounos, RN, MPM, CPC-H, is the Business Development Manager for Regulatory and Reimbursement software solutions for Wolters Kluwer.  Maria began her career at Wolters Kluwer as a product manager, responsible for product development, maintenance, enhancements and business development and now solely focuses on business development.  She has more than twenty years of experience in healthcare including nursing, coding, healthcare consulting, and software solutions.

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Maria Bounos, RN, MPH, CPC-H

Maria T. Bounos, RN, MPM, CPC-H, is the practice lead for coding and reimbursement software solutions for Wolters Kluwer.  Maria began her career at Wolters Kluwer as a product manager, responsible for product development, maintenance, enhancements and business development and now solely focuses on business development.  She has more than twenty years of experience in healthcare including nursing, coding, healthcare consulting, and software solutions.