Updated on: January 29, 2014

Early Adopter: Cedars-Sinai Prepares for ICD-10

By Thea Campbell, MBA, RHIA
Original story posted on: November 4, 2013

In January 2011, Cedars-Sinai Health System engaged a consulting firm to help build an initial project management plan for its global ICD-10 implementation. The plan started as a risk assessment and recommended governance structure. As we started developing a more detailed plan and moved into execution, the need for multidisciplinary committees to tackle the tasks of risk migration, inventory collection, and work process change became abundantly clear.

We chartered an executive steering committee with senior leadership from our medical center and medical group structures, including Finance (broadly Revenue Cycle Management), Contracting, Technology, Medical Staff, and Compliance. The Clinical Operations leadership was an identified need; however it wasn’t actively engaged until 2nd quarter 2013.

We developed a discipline-specific work team structure that was governed by a Project Steering Group. Our working teams included:  

  • Scheduling/Registration
  • Professional Billing Services/Coding
  • Patient Financial Services
  • Hospital Coding/Charging
  • Reporting
  • Contracting
  • Clinical Operations

The work teams contained representation from the medical center and medical group practice operations contingents. Additionally, Cedars-Sinai’s Enterprise Information Systems (EIS) or IT Department provides a support role to each of these committees whenever a technology matter is identified as needing to be addressed. Since the initial project inception and first activities, a project team dedicated to the technological components of ICD-10 implementation has been staffed and active since late 2012.

The progress made at the work team and project management levels are reported monthly to the Executive Steering Committee, which provides input, approval, and resource allocation as needed. While the working teams focus primarily on operational and technical needs, there are two additional strategies that are governed at the executive level—the education strategy and dual coding strategy.

Education Program

The educational strategy began with the organization’s coding professionals. The Health System partnered with Precyse to license the online education product Precyse University in late 2011. Beginning with the anatomy and physiology modules in January 2012, more than 75 coding and coding audit professionals completed these online teachings. The A&Ps modules gave way to ICD-10-CM and ICD-10-PCS, with program completion in November 2012. Once the “knowledge” portion of the training was complete, our strategy turned to the actual “skill” development phase with test cases, virtual labs, and live training. We are now in the third phase of training for this group—the “practice” phase within the dual coding initiative.

The formal education program includes physician and provider training as well as organization multitier training, depending on role and level of interaction with ICD-10 (Tier 1-4). For the purposes of this article, the full detail of this program is not presented.

Dual Coding Program

For several years now, Cedars-Sinai’s Executive Leadership has been keen on pursuing opportunities to analyze our existing ICD-9 data to gain perspective on what life in ICD-10 will look like. The seedlings of this initiative led to a very progressive Dual Coding Program, which included securing training and resources to assign both code sets to the complete patient population, in some instances for a complete year.

Cedars-Sinai kicked off its inpatient dual coding initiative last month after extensive preparatory work. We plan to fold in additional patient types throughout the first and second quarters of 2014. The dual coding program is intended to be the actualization of the “practice” portion of the education program for our professional coding teams.

Our Dual Coding Program has several essential goals:

  1. Identify problem areas in Finance and Technology/Systems
  2. Have an uneventful October 1, 2014 with regard to operations and AR management
  3. Produce a highly trained and skilled professional coding workforce
  4. Provide significant volumes of dually coded data for use in various testing products
  5. Capitalize early on integrating education to physicians/providers with regard to documentation specificity

The scope of our program calls for every single visit and discharge to be coded in both ICD-9 and ICD-10. All patient types except for outpatient diagnostics will be coded by two separate coders. The reason for two separation work streams is two-fold – first, to allow our revenue cycle to progress in a normal and consistent manner in ICD-9 and secondly, it allows our trainees to focus on the needs of ICD-10 from a documentation specificity and guideline perspective. To achieve our goals, we needed to partner with a services group who could be committed to our success and realize the benefit to their organization. Precyse has worked with us for more than 9 months to train a mirrored workforce of coding professionals to be integrated into the dual coding teams.

Meeting Milestones

Certainly as our Dual Coding Program progresses, future milestones will include ICD-10 education-related activities with our providers. We plan on funneling information gleaned from the records we are coding in ICD-10 into our education program to help physicians with their documentation. Additionally, end-to-end testing with a few of our contracted payers will be other major milestones for us to achieve. We are also planning to share our dual coded data with other reporting organizations to verify conversion assumptions.

Lessons Learned

With so many different players at the ICD-10 implementation table, different perspectives will be prevalent. Being mindful of assumptions is very important throughout this collaboration. What you understand as X could certainly mean Y to someone else. Using active listening as a tool ensures you will clearly understand what is being communicated to you, as well as ensuring your collaborators understand what you are conveying to them.

We have also come to realize that training on the code set is only one piece of the transition. More significant at times is the “simple” art of managing change. We have now started four contingents of coding professionals on coding actual cases in ICD-10. Without exception, each group had an initial shock-like reaction to the reality of live cases, which with guidance and reassurance was overcome.

Generally, the participants in the industry will rise to this challenge. Through proactive communication and extensive practice/testing, we can be prepared for the real transition that looms less than a year away.

About the Author

Thea Campbell, MBA, RHIA, is the Director of Health Information at Cedars-Sinai Medical Center and a leading sponsor for the implementation of ICD-10 in the health system.

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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.