November 13, 2012

ICD-10 Education: How Soon is Too Soon?

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Now that the implementation date for ICD-10 is finalized, the next step many are tasked with is to figure out the training schedule for education. It is prudent to make the best use of the two-year timeline remaining; however, many continue to ask themselves….Is it too soon to start training coders? Will they forget what they’ve learned by the actual implementation date? Developing and following a training plan will help, but it is important to note that the plan needs to be phased in correctly to allow coder knowledge and confidence to build, as consistent reinforcement is necessary for successful implementation.

Additionally, the burning question continues: How many hours is the training really going to take? Centers for Medicare and Medicaid Services (CMS) and American Health Information Management Association (AHIMA) have estimated that it will take about 60 hours to train an inpatient coder in both ICD-10 CM and PCS. Although this has become an industry standard, 60 hours does not seem to be enough. For ICD-10-CM, coders with solid diagnosis coding skills may find the 26 hours in the training pathway sufficient because of the significant knowledge transfer from the old system to the new. But, with PCS it’s an entire issue in and of itself. The 24 hours listed in the PCS training pathway is likely a bare minimum requirement because the system is completely new! The PCS system requires that the coder learn the concepts of building a code, memorizing the definitions of the root operations, and the ability to recognize the root operations within procedure documentation. Now combine this with the fact that not all documentation is created equal. Considerable practice is required with PCS to recognize the root operations, specifically when the coder is faced with a wide variety of documentation styles.

So, how soon is too soon? The answer is that “it’s never too soon.” Start your training plan with basic knowledge-building about how the new systems work, including what’s changing in the new system and what’s required in the documentation. Use a phased approach that uses short statement coding in the beginning, then builds to coding short scenarios and short stay cases, ultimately working up to longer admissions with more complex diagnostic scenarios. For ICD-10-PCS, start basic education as soon as possible, including the concepts of root operations. Use the same phased approach for procedure coding that uses short statements, then shorter reports that encompass basic procedures, and then building to cases that involve multiple procedures across multiple root operations and body systems.

Phased plans should be developed around the most common cases seen in a facility. The larger the facility and the greater the variability of cases performed, the sooner you need to start into the training schedule. Training will take less time in smaller facilities such as critical access hospitals, additional time in medium-sized and community hospitals, and the greatest amount of time in teaching facilities and Level I trauma centers. PCS coding in these more complex settings may require as much as 48 hours of hands-on coding in the classroom to allow the coder to feel comfortable with the variety of procedures they’ll encounter in their daily work.

To get started, present a one-day awareness training session for the basic concepts of each system. Follow up with at least three to four days of both basic and then advanced training in your training plan. Basic training could include the high-volume MS-DRG cases, both medical and surgical. Advanced training could move on to the higher-dollar, higher-complexity cases seen in the facility.

Know that the most important part of any training plan is what happens before, during, and after the formal classroom education. It is the skill development and reinforcement activities that matter the most, and being creative helps engage your audience. Use any technique that keeps the adult learners engaged and helps move learning forward. Let’s look at some suggestions or “tips” to assist you with this process:

  • Establish an ICD-10 learning page on the facility intranet to post activities such as an ICD-10 training blog and upcoming schedules.
  • Post coding challenge exercises, using biweekly cases for everyone to code and compare their answers.
  • Share any information about MS-DRG changes found during the coding challenge exercises.
  • Use chat room technology to discuss coding questions with the team.
  • Start weekly contents with topics such as “Name that root!,” “What in the world is a (insert unique anatomy term here)?,” or “Integral or Not Integral, That is the Question.”
  • Develop a library of cases coded in both ICD-9 and ICD-10 to use in training, both now and in the future (a great resource to use when working with coding students at your facility).

Know that it is not too soon to develop and implement a solid training plan, but take your time as you plan your ICD-10 education program so that you take an approach that works best for your organization. Most importantly, start your education plan sooner rather than later to take advantage of the two-year timeline remaining.

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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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.
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.