Updated on: September 23, 2013

Early Adoption of ICD-10 Coding: Going Beyond Practice Makes Perfect

By Elaine Lips
Original story posted on: August 12, 2013

Good Samaritan Hospital is located in Los Angeles. It was founded in 1885 and is a nonprofit hospital with more than 400 beds. Annually, it has almost 16,000 inpatient discharges, 86,000 ambulatory outpatient visits, and more than 25,000 ER visits. It has 52 residents/fellows and a medical staff of approximately 625.

Good Samaritan Hospital started its ICD-10 journey beginning in April 2012 with an organization-wide assessment/gap analysis and risk assessment phase. This phase also included developing a ICD-10 budget to run through December 2014 and an implementation project plan. The CFO and CIO are the ICD-10 executive sponsors, and an ICD-10 governance committee was formed and still meets every 5-6 weeks to monitor progress and make decisions.

From the CFO’s perspective, concerns included:

  • Cash flow disruption: How do we mitigate negative impact to cash flow?
  • Coder retention: How do we retain coders in a competitive market?
  • Physician education: How do we increase focus on clinical documentation?
  • Information system costs for upgrades, replacements and implementation.
  • And is there a return on investment from the ICD-10 readiness costs?

Good Samaritan’s ICD-10 implementation phase began later. The hospital quickly developed its strategies for coding, physician education, and IT.

The hospital’s ICD-10 governance committee also made a commitment to fostering an increased focus on clinical documentation content with physician education.

In addition, an “early adoption” strategy was approved by the governance committee, wherein the conversion to ICD-10 is being accomplished in advance of the Oct. 1, 2014 compliance date.

So, how are they achieving this?

It took stringent planning to make the necessary changes with people, process and technology. Early adoption for Good Samaritan means that its coders will code exclusively in ICD-10 beginning in March 2014, though its billing system will continue to generate claims in ICD-9. There will be no dual coding once this begins.

I played a role in this process through my consulting efforts. In terms of technology, we needed to be confident the hospital’s electronic medical record (EMR) vendor could maintain both ICD-9 and ICD-10 codes following its latest upgrade. The hospital also selected a computer-assisted coding (CAC) vendor and a scanning vendor, as it currently utilizes a hybrid record. In addition, the CAC application offers a clinical documentation improvement (CDI) component.

Good Samaritan also has begun educating its physicians regarding documentation issues. They started with their OB and NICU physicians, educating them about documentation specificity to address APR-DRGs, which went into effect July 1, 2013 for California Medi-Cal. Some ICD-10 specificity was woven into the training as well (unbeknownst to the physicians). CPOE will be rolled out with the OB physicians early next year. Other physician education presentations have been scheduled throughout this year, with some to include practice management staff as well. Articles regarding ICD-10 and ICD-10 readiness also have been added to the monthly medical staff newsletters.

The hospital’s health information management (HIM) director and coding supervisor have become American Health Information Management Association (AHIMA)-approved ICD-10 certified trainers. The coders, clinical documentation specialists, and others are going to undergo classroom-style ICD-10 training next month. Once they’ve completed the four-day training session, they will practice on preselected hospital records. These records will have been coded in both ICD-9 and ICD-10. The coders will code these records in ICD-10 themselves, however, and will have time to discuss the cases with their coding supervisors. There will be backfill coders to cover the regulars’ training and practice time in order to maintain the DNFB (discharge not final billed) target level.

CAC will go live in early November. The hospital’s CAC application will have the capability of auto-suggesting codes natively in ICD-9 and in ICD-10. It is anticipated that the productivity gains from CAC will negate the need for any net new coders after the ICD-10 implementation date. In addition, a customized, three-day advanced ICD-10 training class will be offered in February.

In March, once the Good Samaritan coders start working exclusively in ICD-10, they will have backup coders who will code in ICD-9 until the regular coders catch up with the learning curve. It will be far less difficult to secure ICD-9 coders during this time than it will be to secure ICD-10 coders in October 2014. The backup coders will be relieved accordingly as the permanent coders increase their productivity under ICD-10. The hospital also will have integrity staff to assist in maintaining accuracy and continuing to train the in-house coders. Remember, claims will continue to be generated using ICD-9 codes during this time.

So, at least here, Oct. 1, 2014 is no longer a scary date, for the following reasons:

  • By then, the coders already will have become accustomed to the learning curve well in advance of the compliance date.
  • They will have ample ICD-10 subject matter experts on hand to help.
  • Physicians will be educated to provide appropriate documentation.
  • Physicians will be educated on pertinent ICD-10 codes.
  • Coding will remain at pre-ICD-10 DNFB target levels.
  • A/R will be minimally impacted.
  • There will be 6-7 months of valid ICD-10 coded accounts in the hospital’s database for use in testing, data modeling, etc.

About the Author

Elaine Lips, RHIA, is president and CEO of ELIPSe Inc., a consulting firm based in Los Angeles providing ICD-10 implementation services, training, education, and HIM consulting services throughout the nation. Elaine currently serves on the HIMSS ICD-10 Task Force and has spoken every year at the AHIMA ICD-10 Summit, and she will feature her ICD-10 early adoption strategy at AHIMA’s annual meeting in Atlanta this October. Prior to forming ELIPSe, Elaine was the HIM practice leader for Perot Systems Healthcare.

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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.