December 18, 2012

The ICD-10 Training Plan: Not Such a Simple Task

By Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CEMC, CPMA, COBGC, CPCD, CCS-P, CDIP

Creating an ICD-10 training plan might seem like a simple task to include as part of your ICD-10 project planning, but is it? Unless you work at a small medical practice, I would say it is a very important yet daunting task. There is still confusion about who needs training, what type of training is needed, how much training is needed and when the best time is to start. It is important to take things step by step when identifying the training needs within your organization. Keep in mind that facilities, medical practices, etc. are not all alike. They are all unique, and a unique training plan needs to be developed specifically for your organization. Still, here is some general guidance:

ICD-10 education and training planning efforts can be accomplished by establishing the following:

  • An education committee
  • An education strategy
  • An education plan

The education committee should be comprised of key department staff, including health information management (HIM) directors and/or supervisors, department managers, a physician “champion” and coders. You might also invite any others who could be key drivers of education. We all know that in healthcare, the first item cut from any budget often is education. However, it is imperative that it becomes a priority when it comes to ICD-10.

An ICD-10-CM education committee should serve to establish strategies for its organization’s ICD-10-CM education plan. This committee should establish all program guidelines, and each member should be responsible for carrying out the essential functions of the plan. The committee serves to perform a number of essential tasks and maintains the core responsibility of ensuring that useful ICD-10 education and training is provided.

The education plan should be a written document with the following elements addressed:

  • Objective: What will be accomplished?
  • Goal(s): The methods in which those objectives can be accomplished.
  • Audience: To whom will the education be addressed?
  • Tools: What methods of education will be used?
  • Timetable: When will the education be delivered?
  • Evaluation: How will results be measured?

An ICD-10-CM education strategy recognized and supported by an organization should identify all staffers who will require training as it pertains to the new code sets. An effective education strategy will offer a foundation and understanding of the coding changes, representing a process that will continue throughout ICD-10-CM implementation.

Education should center around four strategic objectives:

  • Increase diagnosis and procedure coding awareness across the organization.
  • Maximize educational opportunities.
  • Engage the staff and sustain their interest in ICD-10-CM/PCS coding (and its significance in the implementation effort).
  • Collaborate with others, internally and externally, to continue to enhance knowledge of ICD-10 code change implications.

 


 

The education strategy team also will face the challenge of addressing the budgetary considerations for this effort. Education and training to learn special skills generally are included in hospitals’ and medical practices’ annual budgets, especially for areas that require technical knowledge to get the job done. To achieve a successful implementation, formal education needs to be budgeted for as needed and programs must be developed and provided across the organization.

A clear education strategy that identifies all key elements of ICD-10-CM education is a prerequisite to empowering staff to participate in this key endeavor. An effective education strategy will build confidence in your staff’s  ability to make informed decisions and recommendations during the rollout of this new code set and to be ready in time for the compliance date.

The aforementioned education objectives also outline how the education effort will address the mastering of ICD-10-CM/PCS codes and ensure that messages to targeted audiences are consistent, effective and clear.

Determining whether to use external or internal training is a first step toward your educational goals. Discussions about those goals and budgets can help determine what is best for your organization. It is possible that it may take several months to a year to develop a practical education and training plan for your organization.

The four key elements of a good training plan should include:

  1. Communication;
  2. Planning;
  3. Assessment; and
  4. Education.

Introducing the new coding system to key stakeholders and staff is another key first step.  Communication across the organization is essential when it comes to creating a successful training program and promoting buy-in from key stakeholders.  Relaying the requirements of ICD-10 and the role each group has in implementation is a key component of education and training.

Communicating with physicians and non-physician providers about the changes in documentation that must occur for a successful transition is also important. Physicians have been documenting the same way for decades, but considering the increased specificity in the ICD-10 codes, documentation must change to adjust to it. Including physician champions in the education process can put your organization at a tremendous advantage in terms of fostering change management across the organization and promoting the acceptance of change. In addition, it will create an understanding of the value of training, which will be disruptive to many schedules. Acquiring the endorsement of the chief medical officer (CMO) or physician leadership is also critical, as is gaining buy-in from department directors and influencers.

Building the training plan also involves allocating sufficient time for implementation of the plan. Training timelines will hinge on the current skill level of your coders and other staff.

The ICD-10 final rule estimates that inpatient coders will need approximately 50 hours of ICD-10 training. Experts from other countries have indicated that 60-plus hours is a good start. These estimates presume that coding professionals have a strong background in ICD-9-CM and that they also have detailed knowledge of anatomy, physiology, pathophysiology, pharmacology and medical terminology. Global guidelines indicate the following:

1. For physicians, the focus of training should be documentation, emphasizing specificity for the most common codes they use in their specialty areas.

2. For inpatient coding staff, training should include approximately 30 hours for ICD-10-PCS and 20 hours on ICD-10-CM (again, based on current skill levels and the number of specialties involved). This does not include time that must be spent enhancing knowledge of anatomy and physiology, etc.

Outpatient coders with a working knowledge of ICD-9-CM, who will need only ICD-10-CM training, should receive 20 or more hours of such training, along with education about fundamentals of anatomy and physiology, etc.

Note: It is critical that coders have a fundamental knowledge of anatomy, physiology and medical terminology to assign ICD-10 codes properly.

3. For ancillary staff, an overview and general ICD-10 training should take approximately 8-10 hours.

4. For IT staff, personnel should have an understanding of ICD-10 in relation to GEMs and code mapping. One of the areas of training must include instructions on how the codes are mapped and an overview of ICD-10 specificity.

5. For directors and managers, 6-8 hours of education should be provided relative to the structure and function of ICD-10 and how each department will be affected.

6. For key stakeholders, there should be provided awareness training and information about how ICD-10 affects each department. Training also should cover implementation planning steps along with how reimbursement will be affected.

7. For administrative staff, 4-6 hours of education should be provided relative to the structure and function of ICD-10 and how each department is affected.

Different ways in which training can be provided must be considered. Options for evening and weekend training may be required. Consider training for different skill levels (beginning versus experienced coders, for example). Consideration also must be given to coverage while training is ongoing. This will be particularly critical for coders and all clinicians. Documentation education for practitioners should begin immediately. Training of coders and other staff should begin early in the year of implementation and should continue until the go-live date. In addition, remediation and refresher training may be necessary beyond implementation.

It is estimated that practitioners will spend 3-4 percent more time documenting under ICD-10, though those figures will decrease the more reinforcement and training they receive. his will, of course, impact productivity, however. Consider the fact that if practitioners are not trained properly, it will result in many more queries and questionable diagnoses being reported on claims. Coder productivity potentially will be affected for the first year, post-implementation, but with proper training, the impact should be manageable.

The ICD-10 project manager should prepare a training needs assessment to identify:

  • Affected staff members, including physicians, nurse practitioners, physician assistants, clinical technicians, administrative staff and coders;
  • Staff competence and skills gaps, and how to tailor training to individuals or business user groups;
  • Optimal timing of training; and
  • Best-approach training methods for your organization, including webinars, courses, community college sessions, online courses, etc.

During recent months ICD-10 training and education for professionals has been infused with a sense of urgency, and this coupled with the current economic climate lends itself to getting creative with approaches. Here are a few examples:

  1. Web-based training: This often is offered in the form of e-learning, with purely Web-based instruction. Under this method factual material is presented in a direct, frank manner, making it useful in educating large groups. Scheduling is left up to the person seeking instruction. Research suggests annual savings of 40 to 60 percent among companies that use anytime, anywhere online training in lieu of the traditional classroom setting.
  2. Interactive distance learning: This often comes in the form of bidirectional learning with instructor proctoring. By instituting an interactive approach with Web-based distance learning, those receiving instruction can ask questions, seek clarification and challenge the material. Instructors will have to be well-prepared in content preparation and possess good oral communication skills. Due to the interactivity, instructors also need to anticipate questions and offer appropriate answers in order to avoid shifting gears too abruptly. With minimal investment, distance learning enables an organization to provide critical training for employees across multiple sites. Distance learning also can address content retention concerns. Research on education shows that 70 percent of the information learned in training courses is lost by the time the trained person is required to use it.
  3. Classroom-based, hands-on instruction: This face-to-face training should include useful tools such as code books, guidelines and implementation curricula. This is most effective when learners require a high degree of hands-on practice or detailed explanations of the new codes and implementation steps. An instructor must be highly knowledgeable about the content and have good oral communication skills. The advantage of this method of learning is that there are very specific targets and goals that are easily measured by utilizing testing materials.

There is no right or wrong method for training focused on any particular portion of the ICD-10 universe, but there are some criteria pertaining to every method that can help providers make the right decisions on instructional design and delivery.

Physician training should include both an overview of ICD-10’s impact on practitioners as well as detailed education sorted by specialty. Training physicians should begin as soon as possible in order to improve documentation. Mock-ICD-10 coding can begin after training is completed to assess documentation improvement and to offer individual feedback. ICD-10 documentation readiness audits also can be beneficial when it comes to assessing training success. Keep in mind that behavior changes slowly, so begin this training now. Physicians will need more documentation training than coding training if they have coders or other staff performing coding.

Remember, it will be important to develop your training budget once you determine the method(s) of learning that will be required for ICD-10 preparedness. Make sure you budget for training managers, clinical staff, non-physician providers, managers, ancillary staff, stakeholders, IT staff and physicians, to name a few groups. Keep in mind that everyone will need training on some level.

Timing for ICD-10 training depends on the type of training and the audience. Here is some general guidance, though:

1. Overview and understanding of ICD-10

Begin now and update with new information routinely, at a minimum each quarter.

2. Anatomy and psychology for coding and staff

Begin no later than the first quarter of 2013.

3. ICD-10 documentation education for practitioners

Begin no later than the first quarter of 2013 and maintain continuously until after Oct. 1, 2014.

4. ICD-10-CM/PCS coding training

The timeline depends on the audience: For persons working on the ICD-10 implementation project, or for large groups that have many staffers to train (and/or for facilities that will be performing the dual-coding function within six months), start in the first half of 2013.

For coding staff, it depends on the size of the organization, but typically you should begin in early 2014 and have all training completed by the beginning of the third quarter of that year.

Keep in mind, however, that innumerable people in the healthcare industry will need some type of training – and training resources such as expert trainers, projects, etc. could become overutilized very quickly. So begin selecting the training, method, venue, company that will offer training, etc. early in 2014. Also keep in mind that it is always a good idea to hire a company or a person who uses AHIMA-approved ICD-10 trainers, who have undergone extensive training and testing to provide education to the industry.

About the Author

Ms. Grider, an AHIMA-approved ICD-10 trainer and an American Medical Association coding author, is a senior manager with her firm, possessing more than 30 years of experience in coding, reimbursement, practice management, billing compliance, accounts receivable, revenue cycle management and compliance across many specialties. Her specific areas of expertise include medical documentation reviews, accounts receivable analysis and coding and billing education.

Contact the Author

To comment on this article please go to

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.