November 11, 2013

ICD-10: Nearing the Finish Line

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For many, the ICD-10 journey can be compared to running a marathon – and with less than one year until implementation in the United States, all providers should be well into their preparation plans and nearing the finish line.

In other words, providers should be in their final stages of implementation preparation by now and getting ready for “go-live preparation” in the spring of 2014. But what if providers aren’t at this point? 

The marathon is almost over, as the implementation deadline is drawing nearer, but there is still time to get on track. Providers should use all the resources that are available to them. The American Medical Association (AMA) has a preparation checklist for physician practices, and the American Healthcare Information Management Association (AHIMA) has a general planning and preparation checklist that can be used by all providers. If preparation is not underway now, facilities should waste no time and get started immediately.

 

All providers in all settings should have their lead coders and/or subject matter experts trained so they can help other staff on their educational journey. These coding leaders should be helping ensure that training is taking place on schedule. They also should be developing or purchasing training that is appropriate for the level of coding skill required by different types of staff members. Actual training of staff should now be underway, or at least set to start in the near future.

Assessment of coder skill levels also should have taken place by this time. If this hasn’t been done, an assessment should be performed now in order to determine the amount of previous coding training that was offered and coders’ knowledge levels of anatomy and physiology.

Many staff members who assign codes on an occasional basis, or who only use (but don’t’ assign) codes in their daily work, may have never received formal training in code assignment for ICD-9-CM diagnosis codes. Without a solid background in diagnosis code assignment, it will be more difficult to learn ICD-10-CM diagnosis coding quickly. Some “back-to-basics” coding training may be necessary to instruct staffers on how to apply the coding conventions and how to use the features of the coding system. It’s never too late to learn, but time is of the essence.

For hospital inpatient coders, the biggest challenge seems to be ICD-10-PCS. Many such coders have excellent diagnosis coding skills and are finding the transition to ICD-10-CM diagnosis coding to be demanding but achievable with training. But it’s ICD-10-PCS that is posing some surprising difficulties for those who are already on the pathway to PCS.

Two factors are influencing the level of difficulty in mastering the new procedure coding system for inpatient surgeries.

The first factor is the variety and scope of the procedures performed at many facilities. For example, critical access and smaller hospitals have fewer procedures to master as it pertains to coding, and they may not be experiencing as daunting of a challenge.

The second factor is the knowledge level of coders regarding how these procedures are actually performed. An experienced ICD-9-CM procedure coder may be very familiar with the coding structure in the current code set. The challenging part of the new code set is that coders need knowledge of anatomy as well as knowledge of how each procedure is performed in order to make an appropriate code assignment. The system is designed around the concept of root operations, which describe the intent of every procedure. The correct selection of the root operation requires more knowledge about how the procedure is performed.

In the ICD-9-CM procedure system, codes can be assigned by using a common procedure name (such as “metatarsectomy”) or an eponym (such as a Baldy-Webster or Spinelli procedure). In the new system, the coder now must determine how much of the metatarsal was removed, or whether the uterus was suspended (Baldy-Webster procedure), or if a uterine inversion was corrected (Spinelli procedure). The new system contains no eponyms and requires complete documentation for accurate code assignment. 

Again, there’s still time for targeted education to help coders rise to the challenge. Hospitals should use any and every available training aid to help coders, such as some of these creative tools:

  • Pre-surgical patient education videos or materials that explain procedures in basic language, often with non-threatening or animated graphics
  • Device manufacturer videos that explain what the devices are and how they are used
  • Education tools available to medical staff on an intranet site that describe both disease processes and procedures available as treatments

These, and many others, represent tools already available in many hospitals, many of which could help ease the transition for coders as they learn the new system and the details required for coding.

Most have us have been with you throughout this marathon, and we will continue to be there until the finish line.

© 2013 CCH, Incorporated

About the Author

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.

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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.