ICD-10: Just Do It

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Original story posted on: January 29, 2014

As adults, we learn theories in many different ways; however, until we apply those theories or glean “What’s in it for me?” it’s difficult to truly learn much.

The opportunity to take knowledge and apply it in practice is a great one, especially when we are talking about ICD-10. I have been knee-deep in ICD-10 during the past year. I have received vast amounts of information about ICD-10 that I heard and thought I learned; however, until I underwent the experience of coding records in ICD-10, it was all simply theory. I think hands-on experience is the most valuable lesson we can learn this year as the implementation of ICD-10 looms before us.

Many of us within the clinical documentation improvement (CDI) and coding arena have been proactive and deeply engaged in ICD-10 education during the past year. We have received and delivered awareness training as well as read articles and attended workshops or seminars. Others are just beginning to attend ICD-10 boot camps this year. These are great transitions into the next phase of ICD-10 education efforts, which should focus on application and practice. It is here where the rubber meets the road and people learn the most.

What I learned from practicing ICD-10 coding:

  • Productivity will fluctuate – I learned firsthand that productivity will definitely be affected by the learning curve. I have spent countless hours attempting to determine exactly what root operations I should apply to certain procedures. While it seems like a simple task, it can be very difficult to select the correct root operation – which determines the third character of the PCS code – and when I finally did decide on one, inevitably a co-worker would be equally certain that he or she had identified it correctly earlier, using a different root operation for the same procedure.
  • Research and discussion are a team sport – Until your team can agree on what is correct, you should allow time to dig into the reasoning. This is very time-consuming, and productivity will decrease during the process. However, I have learned that it is very helpful to be able to discuss various scenarios with my clinical colleagues.
  • Identify common surgical cases – I would encourage you to identify these for the clinical documentation specialists and coding professionals, and have them collaborate on root operation selection before Oct. 1, 2014. Use dedicated training time this year to figure out which root operations and surgical approaches are common within your facility. This will mitigate productivity loss after the go-live date and provide consistency in code selection among staff, which in turn will help to preserve your case-mix index.
  • Remember the body part key and device key found in PCS – These tables are extremely helpful! Don’t forget to reference this information in order to save valuable time and productivity. I learned this the hard way, after spending way too much time trying to find information that was already at my fingertips.
  • Read the “code first” notes and “use additional code” notes in code selection – I have found that ICD-10 code application is not always as intuitive to me as I would like it to be. It really does require that you read these notes first. It’s not necessarily what we are accustomed to doing in ICD-9; therefore, it sometimes feels a little uncomfortable. I find this to be especially true when coding the various types of chronic obstructive pulmonary diseases (COPD). 
    I would recommend that each coder focus on coding COPD cases individually, without discussion, and then compare code selection as a group. I can almost guarantee there will be differences of opinion. The takeaway here is that now is the time to hash out these differences and determine the most appropriate code selection for each case. Until you actually try and apply these codes, you don’t realize the layers of “use additional” and “includes” notes that are located in this section, which make a difference in the final code selection.
  • The more I code in ICD-10, the more confident I feel – Yes, there is a learning curve. Yes, things aren’t always the way I think they should be. Yes, the root operations can sometimes trip me up. However, those cases are becoming fewer and farther between as I code more records. Better yet, sometimes I even remember the first three digits of my PCS codes for the more common procedures.

The best advice I can give to all of you was made famous as a trademark of one of the most successful brands in the sporting goods business: Nike. “Just Do It!” Start coding real records in ICD-10, start asking physicians for documentation exhibiting ICD-10-ready specificity, and start looking at DRG assignment using the ICD-10 codes. You might just end up surprising yourself by actually looking forward to Oct. 1, 2014.

About the Author

Lisa Roat, RHIT, CCS, CCDS is manager of HIM Services for Nuance Healthcare. She has more than 23 years of experience and expertise within the healthcare industry specializing in clinical documentation improvement, coding education, reimbursement methodologies and healthcare quality for hospitals. She is an American Health Information Management (AHIMA)- Approved ICD-10 CM/PCS Trainer and Ambassador. Lisa has worked extensively with the development of ICD-10 education and services for Nuance 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.
Lisa Roat, RHIT, CCS, CCDS

Lisa Roat, RHIT, CCS, CCDS is manager of HIM Services for Nuance Healthcare. She has more than 23 years of experience and expertise within the healthcare industry specializing in clinical documentation improvement, coding education, reimbursement methodologies and healthcare quality for hospitals. She is an American Health Information Management (AHIMA)- Approved ICD-10 CM/PCS Trainer and Ambassador. Lisa has worked extensively with the development of ICD-10 education and services for Nuance Healthcare.