April 6, 2015

Fifty Shades of Coding: Tips for Taming ICD-10 Knowledge Loss

By Joseph J. Gurrieri, RHIA, CHP

Christian and Anastasia lit up movie theaters in February during the much-awaited premiere of Fifty Shades of Grey. Fans of the three-book series waited over two years to see their favorite characters grace the big screen. Likewise, health information management (HIM) professionals and medical record coders have been waiting for the premiere of something big: ICD-10.

Two delays and two years of uncertainty have left most clinical coders woefully behind in ICD-10 knowledge and hands-on experience. With each delay, coders are pulled away from ICD-10 training and pushed back into ICD-9 production.

This article describes the impact of ICD-10 delays on coder training, knowledge, and accuracy. It also provides practical tips and techniques to get coder knowledge back on track in 2015.

PCS Accuracy Declines after Delay

Like most coding companies and hospitals, H.I.M. ON CALL invested significant time and money into training our coders for ICD-10. Over 150 coders were trained and tested in late 2013 and early 2014. After the most recent delay, these coders were shifted back to ICD-9.

While coding accuracy rates for ICD-9-CM were consistent with pre-training efforts, surgical coding results revealed three important insights for everyone involved:

  • Fundamental differences between PCS coding structure in ICD-9 versus ICD-10 tables and root operations are extremely difficult for coders to navigate.
  • Individual coder accuracy results vary, but the general trend is for knowledge loss to occur within PCS coding.

Five areas within the procedure category have presented the most challenges and lowest accuracy levels to date, according to H.I.M. ON CALL coder assessment data. These five include procedures involving upper veins, procedures of the lymphatic and hemic systems, lower vein procedures, cardiovascular procedures, and procedures of the urinary system.
To counter knowledge loss and accuracy issues, the following three steps should be taken today:

  • Reduce the amount of workload shift.
  • Ramp up learning and focus for ICD-10 PCS.
  • Continually assess coders in preparation for Oct. 1, 2015, and identify specific strengths and weaknesses.

Minimize Coder Confusion: Stop the Shift

Taking ICD-10-trained staff off the bench and placing them back onto  ICD-9 cases may negatively impact accuracy and productivity, especially for surgical coding, since the code structure and, more importantly, terminology is not in synch across the two systems. Coders strong in ICD-10-PCS are not necessarily strong in ICD-9 surgical coding, and vice versa. This is due to the extreme structural differences between code sets. In fact, CPT coders may be more adept at coding procedures in ICD-10 than their ICD-9 coding peers due to the language’s logical use of root operation tables.

If at all possible, coders strong in ICD-10-PCS coding should remain focused on ICD-10 to avoid confusion and knowledge loss. Organizations should continually build skills and hands-on experience for these staff, relying on them to become ICD-10 experts, mentors, trainers, facilitators, and code auditors.

Ramp up Learning

The degree of knowledge loss caused by the 2014 delay is remarkable, especially for ICD-10-PCS. Coding surgical cases in ICD-10 is a significant shift for ICD-9 coders.

Prepare accordingly by retraining coders and emphasizing hands-on practice with real cases. Apply ICD-10 theory to the real world through dual coding, and use dual-coded cases for testing, measuring productivity, and gauging accuracy.

The American Health Information Management Association’s (AHIMA’s) refresher coursework is a good place to start, combined with other tools such as mobile applications, flash cards, and more. Ask coders to continually practice and review. It is recommended that ICD-10-PCS mentoring programs begin now and continue for the next 12 months. 

Assess Specific Coder Strengths and Weaknesses

Not every coder is cut out to be savvy in ICD-10 or an expert in all fields. We predict that specialization of coders will become more common in the year ahead, with deeper lines of division in coding expertise associated with ICD-9, ICD-10, and CPT.

Continually assess coder accuracy and productivity to identify where individual coder skills lie, and then keep coders focused within their strongest areas for maximum productivity and accuracy. A constant back-and-forth is not effective. It confuses coders and hampers outcomes. 

Resist the temptation to move strong ICD-10 coders back to ICD-9, if possible. This strategy may sound risky, but it will be beneficial for everyone in the long run. Organizations will develop a solid team of ICD-10 experts, coders will become less confused, and once implemented, ICD-10 coding accuracy will be stronger, resulting in fewer denials and better cash flow in the year ahead.

About the Author:

Joseph J. Gurrieri, RHIA, CHP, has more than 20 years of experience in health information management. He is a registered health information administrator (RHIA) and certified in healthcare privacy (CHP) from the American Health Information Management Association (AHIMA) and holds a bachelor’s degree in health information management from SUNY Health Science Center in Brooklyn. Joseph is currently the vice president at H.I.M. ON CALL. He came to H.I.M. ON CALL in April 2006 from the New Jersey Hospital Association (NJHA), where he was the assistant vice president of information services. Joseph has held various positions in hospitals in New York and New Jersey.

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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.

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