Updated on: March 16, 2016

ICD-10 Training: Tailored to the Learner’s Sub-specialty and Practice Setting

Original story posted on: August 4, 2014

There are 20 pediatric sub-specialties recognized by the American Board of Pediatrics today, and that doesn’t include surgical or radiological sub-specialties recognized and accredited by other board agencies.

Specialists, who practice exclusively at one of 183 pediatric hospitals or 68 National Cancer Institute-designated cancer centers nationwide, have unique patient populations and corresponding top diagnoses and procedures. When it comes to ICD-10, training must account for each learner’s specialty, sub-specialty, and practice setting to optimize relevance and ultimately, learning.


Targeting to ensure training is relevant because it not only cuts out information that is low-yield and time-wasting, but it also boosts a learner’s attention level during the course of training. The more attention is paid during training sessions, the greater the retention of knowledge.

Consider the standard ICD-10 training regimen for an orthopedic surgeon, through which each professional is instructed to clearly document the following:

  • Episode of care
  • Laterality
  • Fracture features
    • Pathologic versus traumatic
    • Laterality
    • Open versus closed
    • If Open, the Gustilo classification
    • On subsequent encounters, whether the fracture demonstrates:
      • Routine healing
      • Delayed healing
      • Nonunion
      • Malunion

That’s pretty basic, especially for highly specialized individuals who deal with a far greater amount of detail regarding their patients on a daily basis. To further increase learning for these individuals, training should go a step further and account for the procedures and conditions frequently encountered at the sub-specialty level.

For an orthopedic spine surgeon, training should instruct the provider to always specify in his or her documentation if a lumbar fusion involved anterior, posterior, or both columns of the spine; whether a posterior, anterior, or posterior and anterior approach was used; and from a diagnosis perspective, if the lumbar disc disorder is associated with myelopathy or radiculopathy. This additional relevance based on the sub-specialization of the learner is ultimately more impactful.

Targeting of training becomes even more critical when it comes to specialized hospitals such as cancer centers and pediatric hospitals, which have unique patient populations. The standard training offered by most vendors, even at the specialty level, was designed for a standard practice. ICD-10 training for an oral surgeon or pediatrician in a standard practice might appropriately cover topics such as tooth extraction and asthma, respectively.

For a busy oral surgeon at a cancer center, however, the standard training will leave behind critical knowledge gaps associated with practice setting, and perhaps training should more appropriately instruct the learner how to correctly document malignant neoplasm of the lip:

  • Specify location
    • Upper versus lower lip
    • External lip versus inner aspect
    • Lip commissure
  • Specify histology, differentiating between squamous cell, basal cell versus malignant melanoma, or Merkel cell carcinoma of the lip
  • Specify any known history of alcohol or tobacco dependence

To some degree, all physicians have uniqueness of their practice and patient population, which largely is driven by their specialization and practice setting. This ultimately will impact what diagnoses and procedures they encounter and perform most frequently.

One of the easiest ways to understand this uniqueness in an effort to tailor an ICD-10 training curriculum to individual sub-specialties is through the review of historical billing data. All healthcare organizations can benefit from reviewing this data and ensuring that training delivered accounts for each learner’s specialty, sub-specialty, and practice setting. The end result is an increase in relevance, an increase in retained knowledge, and a decrease in time-wasted learning about conditions that might not be relevant at all.

In a future article, we will review how to accommodate this level of material within your training programs.

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.
Andres Jimenez, MD

Andres Jemenez, MD, is the founder & CEO of ImplementHIT, a physician and PhD Candidate in adult education, and his company's training software is used by hundreds of hospitals to train physicians on ICD-10 and their EHR.