May 2, 2011

ICD-10 Education for Physicians


ED. NOTE: This is the first of a two-part series on physician education as part of the transition to ICD-10.

Preparation for ICD-10 is beginning to heat up.

Hospitals, insurers, physicians and other providers need to ensure compliance with ICD-10 diagnosis and procedural coding requirements by Oct. 1, 2013. It is important, however, for those with a professional focus on I-10 to recognize that this initiative is just one of the many challenges facing organizational leaderships these days.

J. A. Thomas & Associates recently conducted a survey of client hospitals to assess the statuses of their preparations for ICD-10. The findings of that survey are interesting and informative.  Participants included representatives of the C-suite, physicians, clinical documentation specialists and HIM professionals.

Approximately 80 percent of respondents indicated that they have begun preparing for ICD-10. Approximately 50 percent of those who have not started preparations cited competing priorities as a reason. When considering hospital challenges such as capital improvements, decreasing reimbursement, competition, the newly introduced value-based purchasing program, core measures, medication reconciliation and EMR conversion, among others, those involved in I-10 preparations must recognize that such competing priorities are not inconsequential.

Among those who have launched preparations, there also appears to be a pattern. More than 70 percent have formed I-10 committees, 46 percent have implemented or expanded their CDS programs in anticipation of challenges, 53 percent already have invested in training (primarily for HIM staff) and 15 percent have purchased new technology. One of the most revealing questions, however, was “What is your greatest challenge in the move to ICD-10?”

While 13 percent reported facing challenges in getting buy-in from executive management, 39 percent had difficulty finding space in the budget and 40 percent faced challenges in upgrading EMR/technology. A whopping 75 percent listed “getting buy-in from physicians and then training physicians” as their most daunting perceived challenge. Similarly, when asked to identify what I-10-related services would benefit their hospital most, the most common response (more than 70 percent) identified education and training as where they need the most help.

Finally, when asked what types of resources their organizations intend to use to prepare for I-10, five options were available, including:

  • In-house (34 percent),
  • External/Third Party (22 percent),
  • Professional organizations (34 percent),
  • Local colleges (12 percent), and
  • A mixture of in-house and external training programs (72 percent).

Note that the sum of these selected alternatives totals 174 percent. What is indicated clearly here is that organizations are realizing that they will need different providers of services and education to meet the needs anticipated by the I-10 committees.

The Challenge of Providing Physician Training (Let Alone Getting Buy-in)

It is fairly early in the I-10 preparation cycle, but several trends already can be identified. Most organizations have begun their formal I-10 preparation processes, typically by initially forming an I-10 committee (often driven by HIM professionals who recognize the importance of preparing).


Providing training is clearly a challenge, and more than 70 percent of survey respondents plan to combine in-house and external training programs – likely reflecting necessary approaches to different constituencies and different levels of current competency. Perhaps most importantly, more than three-quarters of respondents identified getting buy-in from physicians and providing  training as their greatest perceived challenges.

In recent interactions with a variety of facilities, from large academic centers to small community hospitals, it has become evident that there is some reticence of hospital HIM professionals to provide in-house I-10 training for staff physicians – or even to approach physicians about I-10 at all. This is due in part to timing in that HIM departments themselves are getting an early start in the I-10 educational process.

But concerns about approaching the medical staff probably are based more on HIM wisdom than lack of knowledge. As discussed in a previous article, it is extremely unlikely that there is going to be broad, immediate physician buy-in to I-10.

Surgeons particularly are likely to react negatively when approached about ICD-10-PCS. They are likely to perceive no benefit from I-10 procedural coding (since they will continue to bill professionally using CPT procedural codes), and will be prone to viewing the requirement to provide necessary documentation to support the required seven-digit alphanumeric coding necessary for ICD-10-PCS as an additional administrative burden foisted upon them by an unsympathetic hospital administration.

ED. NOTE: Part II on physician education continues in the next edition of ICD10monitor.enews May 17, 2011.

About the Author

Paul Weygandt is a Certified Physician Executive (CPE) with more than 20 combined years of experience in medical management, legal counsel and orthopedic surgery. He has served as a hospital VPMA, improving documentation across all DRG payers. Dr. Weygandt is vice president of physician services for J.A. Thomas & Associates and is a partner in the firm.

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Read 105 times Updated on September 23, 2013