November 21, 2014

Practicing ICD-10: Eight Tips Every Organization Should Consider

By Cathy Brownfield, MSHI, RHIA, CCS and Nena Scott, MSEd, RHIA, CCS, CCS-P, AHIMA ICD-10-CM/PCS Certified Trainer

 
Most of us have heard the saying “practice makes perfect.” Although 100-percent perfection is usually unattainable, the idea of applying one’s knowledge regularly to improve performance is something toward which all health information management (HIM) professionals strive. The same holds true for learning how to code using ICD-10.

By now, most coders have undergone some type of formal ICD-10 training. This training is critical. However, perhaps even more important is the ability to apply what coders learn in the classroom or online to real, hands-on coding of records. The more practice coders have with ICD-10, the better off they will be, particularly in light of the delay.

If coders don’t use what they have learned, through practical application on a regular basis, they risk losing that information. The challenge is providing coders with ICD-10 practice while also supporting day-to-day operations. This article suggests eight ways that organizations can find time for coders to maintain ICD-10 skills while continuing to protect their education investments and ensure coders’ success going forward with ICD-10.

Eight Practical Strategies 

Finding time for coders to practice ICD-10 is one of the biggest challenges faced by HIM directors and coding managers. There aren’t enough hours in the day, nor is there typically much extra money in the training budget. This is especially true in smaller facilities and at critical access hospitals.

TrustHCS has worked with a variety of organizations that are addressing this challenge head-on. Following is a summary of some of the strategies gleaned from hospitals nationwide.

1. Think strategically. Coders’ time is limited. Thus, organizations must ensure that time spent practicing ICD-10 is used wisely. Rather than practicing coding random records, some of which may include obscure diagnoses or procedures, ensure that coders practice using records that include the types of surgeries performed most frequently.

Also, ask coders to identify their own weaknesses and then allow them to practice coding those diagnoses/surgeries. Create an environment in which coders can discuss difficult cases and even develop internal coding guidelines. Also, compile a list of any unanswered questions that arise during practice sessions so coders can follow up with Coding Clinic accordingly.

2. Use a goal-oriented approach. Dual-coding records in ICD-9 and ICD-10 is an efficient approach for any organization that wants to provide coders with practice time using the new system. Dual coding is also helpful in terms of performing financial analyses and documentation audits. However, if the goal is to understand the productivity impact of ICD-10, ensure that coders code records in ICD-10 first.

The idea is to ensure accuracy during the time spent coding. If organizations don’t do this, it may appear as though coders are more efficient coding with ICD-10 when in fact this is only true because they have already reviewed the information to assign the ICD-9 code. 

3. Focus on surgical coding. Experts agree that ICD-10-PCS is more challenging than ICD-10-CM. To build a PCS code, coders must have access to the operative report that includes critical details about the type of procedure, approach, etc. They must build each code character by character using in-depth knowledge of anatomy and physiology. As coders code surgical cases, they will also gain experience with diagnosis coding. Focusing practice time on surgical cases will be an important part of ensuring coders’ success.

4. Use real medical records. Although fabricated scenarios are helpful for novice coders who are just beginning to learn ICD-10, organizations should advance beyond those scenarios to include actual medical records. Many organizations are already doing this as part of their dual-coding programs. Real medical records include the often ambiguous and challenging scenarios that coders will encounter on a daily basis.

5.   Create an internal library of cases. This is particularly helpful as new coders are hired and staff members want to refresh their knowledge. To build this library, identify internal records that provide a good cross-section of common diagnoses and procedures. Code these records in ICD-10, and then audit to ensure accuracy.

6.   Look outside the organization. Directors and managers should encourage coders to attend local hospital association and state American Health Information Management Association (AHIMA) chapter meetings, where they can network with others and bring best-practice strategies back to their own facilities. Some coders may learn more during these face-to-face events than they ever would during a formal training session or self-directed practice time. Hands-on training is often provided, and these events are a great way to put one’s knowledge to use as well as learn from others.

7.   Partner with your vendors. Coding vendors can assist in a variety of ways, freeing up time for internal coding teams to practice ICD-10. Consider the following three tasks that outside coding vendors could perform:

    • Coder staffing assessments — How many extra FTEs may be necessary to allow coders sufficient time to practice using ICD-10
    • Backup coding for day-to-day production while internal coders practice ICD-10.
    • Auditing of cases that internal coders code in ICD-10 to create an immediate feedback loop and to fine-tune education and hands-on practice on a coder-by-coder basis.

Vendors will need to know your organizations’ specific goals. For example, what percentage of cases do you want to dual code and when? Will coders work for a specific duration each day or week? What do you hope to achieve from your dual-coding efforts? Keep in mind that multiple outside coding vendors may be needed to meet all of your goals. 

8.   Don’t forget to audit. Practice time with ICD-10 is essential, but auditing is perhaps even more important. Coders need to be able to learn from their mistakes. Coding vendors can assist with auditing or organizations can perform their own peer-to-peer audits. However, working with a vendor may be more beneficial, as it is often difficult for peers to provide objective feedback to each other.

Coders’ ability to practice coding records in ICD-10 is one of the most important determinants in whether an organization will experience a smooth transition to the new coding system. Ensuring practice time not only increases coder confidence, but also helps identify documentation gaps in advance of the transition. 

About the Authors

Cathy Brownfield is co-owner and vice president of operations for TrustHCS, a health information management (HIM) services and revenue cycle consultancy firm providing coding, coding compliance, auditing, and educational services. Cathy is an active leader in auditing and coding compliance serving on various industry workgroups and development teams.

Nena Scott has served as an educator in the healthcare industry across numerous organizations over the past two decades. Her experience includes the creation and successful implementation of a registered health information technology program at a community college in Northern Mississippi where she served as the program director and lead instructor for over a decade.

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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.