October 16, 2012

ICD-10 Transition – Focus on Facility-Wide Education Planning

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The clock is ticking leading up to October 2014, and there are now only 24 months left before the transition to ICD-10-CM/PCS. This seems like plenty of time, but if organizations haven’t started their preparations yet, they must do so now.

Although the main thrust of any ICD-10 conversation revolves around coding and training coders to use the new coding classification systems, the major impact of the transition will be felt long before the medical record ever reaches the coder – during the documentation of the medical record. Therefore, clinical documentation improvement (CDI) strategies and organization-wide training and education, matters extending beyond mere coding, will play a critical role in an organization’s ability to transition to ICD-10 successfully.

While coders definitely will need to learn the new coding classification, a process that will require significant hours of training, it is important to include in training plans all staff members impacted by ICD-10. Regardless of how well-prepared coders are, their ability to code accurately will be hampered without the detailed documentation required to support ICD-10-CM/PCS coding. Documentation needs to be provided to coders by physicians, clinicians and other ancillary departments that participate in telling the patient’s story within the medical record. If those professionals are not properly trained and educated about the documentation improvements necessary under ICD-10, organizations will run the risk of increases in queries, causing a negative impact on the revenue cycle.

Currently, there is a lack of governance in many facilities when it comes to ICD-10 education. If there is planning in place, it often is limited to affecting the coding staff, leaving more than 50 other impacted areas without a training plan. Facilities must identify who will be responsible for creating a comprehensive, facility-wide education plan that takes into account the type of education necessary for each group, the amount of education needed and a timeline that guides the effort. This responsibility could be assigned to the ICD-10 project manager, education director, learning management system (LMS) administrator or an education planning committee. Regardless of who is responsible, training plans must be developed, disseminated and monitored.

Now that the new deadline has been set for Oct. 1, 2014, officials at many facilities are expressing concern they are behind and won’t be prepared because planning was stalled when the delay was announced. Providers are revitalizing their efforts to finalize facility-wide education plans and to make decisions about rolling out ICD-10 education to all impacted departments so they can adhere to the new implementation timeline.

Health information management (HIM) departments should conduct baseline measurements of coders’ aptitude in order to identify strengths and weaknesses in preparation for learning the new code sets. In addition, decisions should be made about training for coders, with such decisions based on plans for dual-coding programs that could begin anywhere from six to 12 months prior to implementation.

Facilities that have not taken steps to evaluate documentation gaps should conduct audits to identify lapses, and use that data to educate physicians about the need for documentation improvements achieved through their CDI programs. Now is also the time to implement a communication campaign about the benefits of ICD-10 training. Communication about the availability and importance of education is just as crucial as the education itself. To ensure participation, it is important for organizations to use as many communication vehicles as possible to spread the word among impacted departments.

As we work with facilities to develop ICD-10 education plans, we are seeing some best practices and recommended steps emerge:

  • Form alpha groups or “tiger teams” to review ICD-10 education before enlisting the aid of quick learners who can validate training plans and serve as training leaders.
  • Ease into ICD-10 education by using innovative approaches such as arcade games, coding and documentation simulators, and/or animations.
  • Supplement e-learning with webinars or face-to-face workshops, using interactive discussions to reinforce learning and to share knowledge.
  • Provide education available on demand through smart-phone apps specific to the learners’ educational needs.
  • Offer a variety of learning methods so that education is available to meet the diverse learning styles in your organization, thus avoiding the trap of one-size-fits-all ICD-10 education.
  • Obtain a baseline measurement of coders’ and CDI specialists’ knowledge to identify strengths and weaknesses in preparation for ICD-10-CM/PCS training.
  • Conduct ICD-10 documentation impact audits to identify documentation gaps so that improvements can be made to support ICD-10 coding.
  • Use communication tools such as posters to increase general ICD-10 awareness, and begin educating physicians about the documentation improvements that will be necessary.

The ability of an organization to transition to ICD-10 successfully will be dictated not only by the specificity and adequacy of the documentation, but also by whether that documentation is detailed enough to support accurate coding in ICD-10. This will require facility-wide training and education, again, not just for coders and clinical staff, but for every department that is part of the healthcare organization’s revenue cycle. By doing this, it not only will help avoid potential financial consequences, but it also actually may create a competitive advantage.

About the Author

Anita Majerowicz, MS, RHIA, is director of ICD-10 and Educational Services for Precyse.

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