July 25, 2011

Preparing your CDI Team for ICD-10: Have You Completed Phase I?


At this point in time, preparation efforts for ICD-10 should be well underway, with most providers having completed at least Phase 1 (“Impact Assessment”) and some having covered Phase 2 (“Overall Implementation”) from AHIMA’s June 2007 ICD-10 Preparation Checklist.

As suggested by AHIMA, preparation and implementation planning for ICD-10 should be accomplished in a phased approach. As such, Phase 1, which also covers implementation plan development, was recommended to be completed sometime between the first quarter of 2009 and the second quarter of 2011, while work on Phase 2 should have begun during the first quarter of 2011.

The tasks associated with Phases 1 and 2 from AHIMA’s abbreviated checklist are included here for your review, along with our suggestions for adequately preparing your physicians, clinical documentation specialists and coding professionals.

Phase 1

Organization-wide Implementation Strategy

  • Establish a cross-functional team to prepare for 5010 transaction standard and ICD-10-CM/PCS code sets;
  • Create a communication plan to provide awareness training and status updates;
  • Assess organization readiness for data standard changes and data conversion options;
  • Ensure that the health information management team is aware of the benefits and value of ICD-10, and assess education needs;
  • Develop budgets for 5010 and ICD-10 implementation;
  • Evaluate data, workflows and operational processes for improvement opportunities; and
  • Determine the extent of changes required for systems, processes, policies and procedures.

Information Systems

  • Orient IS staff on specifications of the code set and HIPAA changes;
  • Perform a comprehensive systems audit for ICD-10 compatibility;
  • Determine vendor readiness and timelines for upgrading software;
  • Build flexibility into systems to ensure ICD-10 compatibility; and
  • Perform (with IT vendors) a comprehensive system audit for necessary HIPAA transaction changes.

Education of Coding Professionals

  • Assess staff knowledge and skills necessary to translate clinical data into codes for secondary use.

Documentation Improvement

  • Conduct medical record documentation assessments to Identify documentation improvement opportunities;
  • Identify a physician champion to assist in communicating and resolving documentation deficiencies;
  • Implement a documentation improvement program to target deficiencies; and
  • Report documentation assessment and improvements to senior management.



Note that ICD-10-CM does not require improvements in documentation, as many nonspecific code options have been retained, but high-quality documentation still will increase the benefits of a new coding system and increasingly is being demanded by other initiatives such as value-based purchasing. Procedure code assignment using ICD-10-PCS may require improved documentation in order to assign procedure codes, as there are very limited code options for nonspecific procedures.

Phase 2

Organization-wide Implementation Strategy

  • Contact payers, business associates, other HIPAA trading partners and vendors for ongoing updates, preparations, and testing for HIPAA transaction standards and ICD-10 changes;
  • Develop strategies to minimize problems during transition;
  • Revise processes, policies and procedures as appropriate;
  • Determine the impact of the coding system change on longitudinal data analysis;
  • Provide updates to senior management and affected staff; and
  • Develop a schedule leading up to “going live,” establishing key stakeholders’ roles and responsibilities.

Information Systems

  • Follow up with system developers or suppliers regarding their readiness;
  • Modify reports and redesign forms identified in Phase 1;
  • Implement and test system changes, including in-house and proprietary changes; and
  • Maintain testing schedules with vendors and all HIPAA and ICD-10 trading partners.

Education of Coding Professionals

  • Coding staff should increase familiarity with new coding systems and associated coding guidelines.

Documentation Improvement

  • Continue to assess and improve medical record documentation practices, engaging clinical staff in the process.

Awareness Training

Phase 1 of the ICD-10 preparation includes the provision of awareness training. While this training is necessary for the organization as a whole, physicians, clinical documentation specialists and coders should be the primary recipients. ICD-10 awareness training provides:

  • An introduction to ICD-10-CM/PCS;
  • Tips for preparing for the transition;
  • Understanding of the impact; and
  • The dispelling of myths.

Awareness training should have begun in 2009, continuing through 2011. This training is important in that it provides a foundation for the next two phases of training for your CDI team: developmental and role-specific training.



Developmental Training

Developmental training involves assessing and acquiring, core skills commonly referred to as biomedical skills. Biomedical training would cover medical terminology, anatomy and physiology, pathophysiology, and pharmacology. Skills in these areas are critical to learning and working successfully with ICD-10-CM/PCS. While it is argued that both the CDS and coder already have advanced knowledge of biomedical subjects, there are many reasons why an assessment of this knowledge, coupled with additional training, is of great value in preparing for ICD-10-CM/PCS.

First of all, most of us in CDS and coding roles received our biomedical training decades ago. This is concerning because research indicates that when we are exposed to a complex idea in a short amount of time, at the end of 30 days most of us will have retained less than 10 percent of the material. Much of the education acquired in biomedical courses taken during those early college years was not utilized while working with ICD-9-CM due to its lack of specificity. The same cannot be said for either ICD-10-CM or ICD-10-PCS. In fact, ICD-10-CM/PCS has tens of thousands more terms than ICD-9-CM.

To use ICD-10-CM/PCS effectively, coders and CDS staff must know:

  • Greek and Latin prefixes, suffixes, roots and combining forms, which are used as the basis of most medical terms;
  • Commonly accepted and approved medical abbreviations;
  • Eponyms and names of syndromes;
  • Alternative names and descriptions for diseases;
  • Adjectives used to describe and define diseases and disorders (purulent, necrotic, etc.);
  • Verbs and terms used to describe surgical approaches and techniques (resect, dissect, incise, excise, aspirate, -scopic, -otomy, -ectomy, etc.); and
  • Technology-driven and manufacturer-given names for tests, devices and procedures.


JATA suggests that developmental training begin either in 2012 or early 2013, prior to the start of the next phase of training, which is referred to as “role-specific training.”

Role-Specific Training

The scope and depth of role-specific training is dependent on the role of the individual, such as a physician, CDS or coder. At minimum, the following role-specific training would be required:


Study of clinical documentation requirements of ICD-10-CM/PCS, by specialty

(Note: J.A. Thomas and Associates advises utilizing a physician ICD-10-CM/PCS expert to provide both physician awareness and role-specific training).


Study of:

Clinical documentation requirements unique to ICD-10-CM/PCS;

Official coding guideline changes;

CDI software training; and

Possibly ICD-10 coding training, depending on the sophistication of software used to develop clarifications/queries.




Study of:

Clinical documentation requirements unique to ICD-10-CM/PCS;

Official coding guideline changes;

Coding training (basic, intermediate and advanced); and

Encoder software enhancements.

In the end, there are no shortcuts to preparing your CDI team for ICD-10. To stay on track with your preparedness efforts, we advise making 2011 the “year of awareness,” 2012 the ”year of development” and 2013 the “year of role-specific training.”

About the Author

Angela Carmichael, MBA, RHIA, CCS, CCS-P, joined J.A. Thomas & Associates in 2008. She is a HIM Product Development Specialist specializing in clinical documentation improvement, coding education & reimbursement methodologies. Angela earned a Bachelor of Science degree, in Health Services Administration from Barry University and a MBA from Nova Southeastern University. She is a Registered Health Information Administrator and also has achieved the designations of Certified Coding Specialist, and Certified Coding Specialist-Physician and AHIMA Approved ICD-10-CM/PCS Instructor.

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